台北醫學大學附設醫院 外科部 陳威智 大腸直腸外科 陳嘉哲 郭立人 外科醫學會 A Case report: robotic assisted subtotal colectomy with colon-rectal anastomosis under twice dockings I0718632 台北醫學大學附設醫院 外科部 陳威智 大腸直腸外科 陳嘉哲 郭立人

Basic Profile Name :吳OO, Gender : Female, Age: 36 y/o Height : 163 cm Weight : 50kg Medical history: Nil Surgical history: Nil Allergy history: Nil Family history: Nil Travel history: Nil

Chief complaint Bloody stool passage for months

Present illness Bloody stool passage for months with blood loss anemia UGI endoscopy and colonoscopy were obtained and showed familial adenomatous polyposis and ulcerative tumors over upper rectum and rectosigmoid colon which adenocarcinoma was disclosed Chest to abdomen CT and pelvis MRI were done for tumor staging and stage IIIC ( cT3N2bM0) rectal cancer was impressed

Present illness Post CCRT Main tumor reveled shrinkage compared to previous study of colonoscopy

Significant PE & Lab Data GCS : E4V5M6 Vital signs BP 125/78mmHg Pulse rate 86 Resp. rate 13 BT 36.6 Lab : Hb 8.8 g/dl WBC 4640/uL Plt 249000/uL GPT 12 U/L PT/INR 13.3/1.02 APTT 37.8 CEA 2.22ng/ml

Impression Familial adenomatous polyposis with malignant transformation, rectum and rectosigmoid, stage IIIC ( cT3N2bM0) undergoing concurrent chemoradiotherapy Ulcerative lesion noted over 8 cm from anal verge

Operation Robotic (Xi) assisted subtotal colectomy with colon-rectal anastomosis and diverting ileostomy Appendectomy  OP time: 480 mins Blood loss: <50ml

B C E A D F

Operative Findings： 2 ulcerative tumor noted over rectum and 1 in D-colon Enlarged LNs (+) Liver surface: a mass was noted

Intestine, large, colon, status post CCRT, Robotic assistant subtotal colectomy, 1) adenocarcinoma, five 2) tubular adenoma, multiple (consistent with familial adenomatous polyposis) Lymph node, regional, lymphadenectomy, carcinoma, metastatic (12/94) stage IIIC ( pT3N2bM0)

Discussion

2018 Dec

This procedure was completed using a da Vinci Si system with 2 dockings En bloc abdominal wall resection and high ligation of the right colic and middle colic pedicles The anastomosis was performed via an extracorporeal technique through a Pfannenstiel incision

1 2 3

Operation time : 640 min Blood loss: 420 ml

Si vs. Xi