Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation
Epublication WebSurg.com, Sep 2016;16(09). URL: http://websurg.com/doi/vd01en4765
A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney. Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC. Starting with a standard robotic LC would make multiple dockings and patient position changes necessary. To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first. Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position. The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures. Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.