The patient operated by laparoscopic approach is a 76 year old female with no allergies and no relevant medical or surgical record
Due to anemia, she underwent a colonoscopy that revealed a 6 cm lesion 18 cm from the anal verge, approximately the rectosigmoid junction, which occupies ¼ of the circumference. The biopsy showed a moderately differentiated adenocarcinoma. Staging by CT scan excluded distant disease.
She is a patient with a BMI of 22, correct nutritional status, low anesthetic risk and CEA of 7.
The patient operated by robotic approach is a 83-year-old male with no allergies, high blood pressure and a hiatal hernia. His surgical record includes a previous transurethral prostatic resection and a right inguinal hernia repair.
Due to constipation and weight loss he underwent a colonoscopy that revealed a lesion 30 cm from the anal verge that occupied the entire circumference and did not allow the passage of the endoscope. The endoscopist marked it with a tattoo. The biopsy showed that it is a moderately differentiated adenocarcinoma The colono CT Scan excluded a synchronic lesion or distant disease.
This patient has a BMI of 27, a good nutritional status and a low anesthetic risk.
In the case carried out by robotic approach we can see the tattoo at the level of the tumor. The first step in both cases is to proceed to dissection and ligation of mesenteric vessels.
In the case performed by laparoscopic approach clips were used, while in the case performed by robotic approach we used the Ligasure. Then we proceed to the mesocolon dissection from medial to lateral, always keeping careful with retroperitoneal structures.
Once the tattoo area is exceeded and the rectum is properly dissected, we prepare the sectioning area. An EndoGIA TriStaple™ is used to divide the rectum in the two cases. We can finally see the rectals stumps sectioned, ready to create the anastomosis. After this, the specimens is exteriorized through a Pfannenstiel incision in the hypogastrium.
We make an end to end colorectal anastomosis using an EEA stapler, in both cases. After performing the anastomosis, it was checked again with ICG from transanal approach, checking the correct vascularization of colorectal mucosa. The anastomosis is reinforced with 3 stitches completing the surgery.
None of these patients presented with anastomosis-derived complications in their postoperative evolution. ICG provides an option to evaluate the perfect site to perform an anastomosis in colorectal surgery, which is especially useful in patients with potential vascularization-related problems.