Background: Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical approach chosen for ulcerative colitis (UC) refractory to medical management and is recommended as a prophylactic procedure in patients diagnosed with familial adenomatous polyposis (FAP). Even if laparoscopy has become very popular for colorectal surgery, laparoscopic total proctocolectomy with IPAA has not had the same dissemination mainly due to the intrinsic technical limitations of the laparoscopic approach in the deep pelvis and the steep learning curve. The enhanced surgical dexterity offered by robotic assistance is expected to overcome some of the limitations of conventional laparoscopy, thus improving the acceptance of minimally invasive techniques in colorectal surgery. We present our surgical technique of hand-assisted hybrid laparoscopic–robotic total proctocolectomy with restorative IPAA for patients diagnosed with FAP. Materials and methods: An 18-years old man with a finding at colonscopy of hundreds of sessile polyps (low-grade dysplasia) was referred to our center. The patient underwent to a proctocolectomy with ileal pouch-anal anastomosis with a personal minimally-invasive hybrid technique. The procedure can be divided into three phases. The colectomy was carried out laparoscopically with hand assistance through a suprapubic incision; the same incision was used to create the ileal pouch. In the second phase the proctectomy was performed with the da Vinci Si. The third step is the execution of the hand-sewn IPAA through a transanal approach fashioned at the dentate line using interrupted absorbable sutures. Results: The procedure was successfully completed in 370 min. There were no surgical complications or a need for conversion to laparotomy. The postoperative course was uneventful and the patient was discharged from hospital after 6 days. Conclusions: In our experience, the hand assisted laparoscopic–robotic hybrid total proctocolectomy with IPAA resulted to be an appealing alternative to laparoscopy and open surgery, in selected patients with FAP or UC. This hybrid personal technique could combine the benefits of the three approaches to overcome the inherent limitations of each technique.

A PERSONAL TECHNIQUE OF HAND-ASSISTED LAPAROSCOPIC-ROBOTIC HYBRID TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS

Morelli Luca
Primo
;
Palmeri Matteo
Secondo
;
Furbetta Niccolò;Di Franco Gregorio;Bianchini Matteo;Gianardi Desirée;Guadagni Simone
Penultimo
;
Di Candio Giulio
Ultimo
2018

Abstract

Background: Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical approach chosen for ulcerative colitis (UC) refractory to medical management and is recommended as a prophylactic procedure in patients diagnosed with familial adenomatous polyposis (FAP). Even if laparoscopy has become very popular for colorectal surgery, laparoscopic total proctocolectomy with IPAA has not had the same dissemination mainly due to the intrinsic technical limitations of the laparoscopic approach in the deep pelvis and the steep learning curve. The enhanced surgical dexterity offered by robotic assistance is expected to overcome some of the limitations of conventional laparoscopy, thus improving the acceptance of minimally invasive techniques in colorectal surgery. We present our surgical technique of hand-assisted hybrid laparoscopic–robotic total proctocolectomy with restorative IPAA for patients diagnosed with FAP. Materials and methods: An 18-years old man with a finding at colonscopy of hundreds of sessile polyps (low-grade dysplasia) was referred to our center. The patient underwent to a proctocolectomy with ileal pouch-anal anastomosis with a personal minimally-invasive hybrid technique. The procedure can be divided into three phases. The colectomy was carried out laparoscopically with hand assistance through a suprapubic incision; the same incision was used to create the ileal pouch. In the second phase the proctectomy was performed with the da Vinci Si. The third step is the execution of the hand-sewn IPAA through a transanal approach fashioned at the dentate line using interrupted absorbable sutures. Results: The procedure was successfully completed in 370 min. There were no surgical complications or a need for conversion to laparotomy. The postoperative course was uneventful and the patient was discharged from hospital after 6 days. Conclusions: In our experience, the hand assisted laparoscopic–robotic hybrid total proctocolectomy with IPAA resulted to be an appealing alternative to laparoscopy and open surgery, in selected patients with FAP or UC. This hybrid personal technique could combine the benefits of the three approaches to overcome the inherent limitations of each technique.
https://journals.lww.com/dcrjournal/Citation/2018/05000/The_American_Society_of_Colon_and_Rectal_Surgeon_s.23.aspx
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/934425
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