Robotic Proctectomy and Ileoanal Pouch Creation
Restoration of intestinal continuity following total proctocolectomy is performed by constructing an ileal pouch-anal anastomosis (IPAA). Since the advent of this technique in 1978, the operation has evolved from hand-sewn to stapled anastomoses, a two-stage to three-stage approach in the setting of immunosuppression, and from an open technique to a minimally invasive approach. While laparoscopy has become widely used for IPAA construction, a robotic approach may offer several advantages and may become more widely used in the future years. The bony confines of a narrow pelvis make the angles of laparoscopy challenging, and the robot provides improved three-dimensional and high-definition visualization of the pelvis. Once the pelvic floor has been exposed, the better visualization and multiple degrees of freedom help to improve deployment of intracorporeal stapling devices. We will herein discuss our approach to a robotic IPAA and highlight steps that may require intraoperative troubleshooting.
KeywordsIleal pouch-anal anastomosis Minimally invasive surgery Inflammatory bowel disease
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