Abstract
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, from 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 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 improved visualization and multiple degrees of freedom help to improve deployment of intracorporeal stapling devices. Herein, we discuss our approach to a robotic IPAA and highlight steps that may require intraoperative troubleshooting.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85–8.
Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–7.
Larson DW, Cima RR, Dozois EJ, et al. Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg. 2006;243:667–70; discussion 670–662.
White I, Jenkins JT, Coomber R, et al. Outcomes of laparoscopic and open restorative proctocolectomy. Br J Surg. 2014;101:1160–5.
Ahmed Ali U, Keus F, Heikens JT, et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. 2009;1:CD006267.
Bartels SA, D’Hoore A, Cuesta MA, et al. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg. 2012;256:1045–8.
Beyer-Berjot L, Maggiori L, Birnbaum D, et al. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg. 2013;258:275–82.
Yang Y, Wang F, Zhang P, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:3727–36.
Juo YY, Hyder O, Haider AH, et al. Is minimally invasive colon resection better than traditional approaches?: first comprehensive national examination with propensity score matching. JAMA Surg. 2014;149:177–84.
Trinh BB, Jackson NR, Hauch AT, et al. Robotic versus laparoscopic colorectal surgery. J Soc Laparoendosc Surg. 2014;18:816–30.
Tyler JA, Fox JP, Desai MM, et al. Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum. 2013;56:458–66.
Rawlings AL, Woodland JH, Vegunta RK, et al. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21:1701–8.
Bertani E, Chiappa A, Biffi R, et al. Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Color Dis. 2011;26:1317–27.
Khasawneh MA, McKenna NP, Abdelsattar ZM, et al. Impact of BMI on ability to successfully create an IPAA. Dis Colon Rectum. 2016;59:1034–8.
Burnstein MJ, Schoetz DJ Jr, Coller JA, et al. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum. 1987;30:863–6.
Araki T, Parc Y, Lefevre J, et al. The effect on morbidity of mesentery lengthening techniques and the use of a covering stoma after ileoanal pouch surgery. Dis Colon Rectum. 2006;49:621–8.
Martel P, Majery N, Savigny B, et al. Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: is high division of the superior mesenteric pedicle a safe procedure? Dis Colon Rectum. 1998;41:862–6; discussion 866–867.
Thirlby RC. Optimizing results and techniques of mesenteric lengthening in ileal pouch-anal anastomosis. Am J Surg. 1995;169:499–502.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Electronic Supplementary Material
Video highlighting the stages of the completion proctectomy and ileal pouch proctectomy performed with a robotic platform (MP4 626490 kb)
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lightner, A.L., Larson, D.W. (2020). Robotic Pouch Creation. In: Kim, J., Garcia-Aguilar, J. (eds) Minimally Invasive Surgical Techniques for Cancers of the Gastrointestinal Tract. Springer, Cham. https://doi.org/10.1007/978-3-030-18740-8_26
Download citation
DOI: https://doi.org/10.1007/978-3-030-18740-8_26
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-18739-2
Online ISBN: 978-3-030-18740-8
eBook Packages: MedicineMedicine (R0)