IPEG 2020 TOP ABSTRACT: Robotic Colostomy Takedown in a Pediatric Patient
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What the experts said
Patient is a 14-year-old female who underwent laparotomy for complicated appendicitis with iatrogenic rectal injury requiring Hartmann's procedure.
Patient had an end colostomy for 3 years prior to this procedure.
Robotic colostomy takedown was performed to avoid a subsequent laparotomy.
48 millimeter robotic ports were used for the procedure.
Initial pelvic inspection revealed extensive adhesions to the uterus, cecum, and left lateral pelvic side wall.
A long Hartmann's stump had been brought up to the anterior abdominal wall.
A nest of twisted colon tethered together with many inner loop adhesions was found.
It was difficult to identify the exact location of the original iatrogenic injury because of multiple interloop adhesions.
Flexible endoscope passed relatively easily transanally despite some extra luminal compression by adhesions.
The mucosa of the distal diverted bowel was mostly healthy and pink.
An area was identified that showed either diversion colitis or was the site of prior bowel injury.
Segmental resection of the sigmoid colon was performed to ensure two viable and unobstructed limbs of bowel for anastomosis.
A vessel sealing device was used to seal and transect the mesentery up to the bowel wall.
The sigmoid pedicle was sealed and transected.
A single firing with a green load stapler was used to transect the remnant sigmoid colon.
An isoperistaltic anastomosis was created between the sigmoid and the rectum.
Three separate interrupted 3-0 Vicryl sutures were used to tack the two bowel limbs side by side.
Wristed robotic instruments allow more facile suturing, especially for anastomoses located in the upper pelvis.
Full thickness enterotomies were created with hot shears in the sigmoid and rectum to prepare for stapling.
Indocyanine green with firefly mode on the robot was used to assess vascular supply of the anastomosis, showing normal uptake.
The common channel was closed with 2-0 barbed monofilament suture in a running fashion, creating a double layer closure.
The specimen was removed through the former colostomy aperture.
Patient had an uneventful postoperative course with flatus passed on postoperative day 2 and discharge on postoperative day 3.
Full bowel function returned by postoperative day 4.