Erman Aytac

Robotic transanal minimally invasive surgery (R-TAMIS) with the da Vinci Xi System – a video vignette

dicectomy alone has been demonstrated to have equivalent outcomes in terms of survival, even with peritoneal disease [3]. In this case a right hemicolectomy was mandated because of the inability to safely reduce the intussusception without risk of rupture of what was potentially an ischaemic caecal pole. The diagnosis of an intussusception secondary to an appendiceal neoplasm may not be made until the patient is in the operating theatre or indeed until the histology results are available. Video S1 provides a rare opportunity to visualize the pathological process in vivo.

Vascular high ligation and embryological plane dissection in laparoscopic restorative proctocolectomy for ulcerative colitis - a video vignette.

abscesses and autonomic nerve damage. This can be done by an intersphincteric transperineal approach, avoiding an abdominal procedure [3]. If a uniquely perineal approach is not possible (e.g. in the case of a preexisting ileorectal anastomosis), an abdominal single port can be added. In 2012 a 40-year-old woman with an American Society of Anesthesiologists score of 2 and body mass index of 20 kg/m underwent a laparoscopic subtotal colectomy with ileorectal anastomosis and loop ileostomy for complicated Crohn’s colitis with perianal disease. Later, despite maximal therapy and diversion, rectal fistulating disease worsened and a completion proctectomy and definitive ileostomy was agreed upon. A combined abdominal and transanal procedure was planned. The perineal phase consisted of dissection in the intersphincteric plane to the pelvic floor with detachment of an anovaginal fistula, induction of a pneumorectum through a single-port device (GelPOINT Path, Applied Medical, Rancho Santa Margarita, California, USA) and close-rectal dissection carried distally to the peritoneal reflection. Synchronously, the loop ileostomy was closed and a single-port (GelPOINT) pneumoperitoneum was established. After dividing the adhesions, resection of the ileorectal anastomosis was performed and a terminal ileostomy was created. The patient was discharged 5 days after the procedure following an uneventful recovery.

Simultaneous laparoscopic totally extraperitoneal and transabdominal preperitoneal repair for bilateral inguinal hernia in a patient with a history of robotic prostatectomy - a video vignette

Patients undergoing radical prostatectomy are under the risk of developing inguinal hernia in the long term, most likely due to the damage to rectus muscle and anterior and posterior rectus sheaths, which loosens the transversalis aponeurosis, which, in turn weakens the internal inguinal ring [1-3]. Repair of these hernias using a laparoscopic approach can be challenging due to intense fibrosis and preperitoneal adhesions [4]. While several studies have shown the safety and feasibility of both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair of inguinal hernia in patients with a history of prostatic surgery [5-7], there are limited reports explaining the technical tips and tricks of this complex operation. This article is protected by copyright. All rights reserved.

Role of robotic approach for management of complicated jejunoileal diverticulosis - a video vignette

Jejunoileal diverticulosis (JID) is a rare condition with a reported incidence lower than 0.1% (1-3). Surgery is the definitive treatment for JID and can be considered to improve the patients quality of life and to prevent further occurrence of severe symptoms (3, 4, 5). Minimally invasive approach facilitates postoperative recovery, lowers risks and improves outcomes in JID treatment (6). This article is protected by copyright. All rights reserved.

Laparoscopic management of bowel obstruction due to multiple congenital adhesion bands in pregnancy - a video vignette

Intestinal obstruction is a rare yet serious complication of pregnancy [1,2]. Congenital bands rarely cause bowel obstruction in patients without a prior history of surgery or trauma [3]. Excluding obstruction related to Ladd bands, the most common location of obstruction due to congenital bands is the terminal ileum, [4]. This article is protected by copyright. All rights reserved.

Combined laparoscopic-robotic approach in complex re-operative colorectal surgery - a video vignette

poses special challenges in the mid and low rectum as the mesorectum is thin. Also, this part of TME is particularly difficult due to limited access created by pelvic angles and the prostate anteriorly in men. In a cadaveric study, Denonvilliers’ fascia was found to be adherent and continuous with mesorectal fascia as can also be seen in histological slides in this video. It was suggested that TME should be carried out in front of the fascia to ensure radical resection particularly in anterior rectal tumours [6]. To avoid dissection anteriorly into the TME plane, Denonvilliers’ fascia is often included with the specimen. Equally, it is important to preserve important structures close to the mesorectal plane, particularly autonomic nerves. Injury to such structures can result in poor functional outcomes. Denonvilliers’ fascia excision may not be necessary for rectal tumours that are not anteriorly located. This video demonstrates the combination of abdominal and transanal TME approaches for safe mesorectal excision in anteriorly placed rectal tumours.

Robotic Ventral Mesh Rectopexy Technique for Rectal Intussusception with Rectocele – a video vignette

Dear Editor, Various surgical techniques have been described for the treatment of rectocele [1]. Ventral mesh rectopexy is one of the surgical techniques for the treatment of pelvic floor diseases. This approach could be performed laparoscopically or robotically [1,2]. A robotic (da Vinci Surgical System, Intuitive Surgical, Sunnyvale, California, USA) platform has several benefits compared to the laparoscopic approach such as stable retraction and enhanced dexterity [3,4]. Herein, we present our case of a robotic ventral mesh rectopexy technique for rectal intussusception with rectocele. A 40-year-old female patient was admitted to our clinic with complaints of constipation and pelvic pain. The physical examination and defaecography revealed rectal intussusception with rectocele. In addition, in the colonoscopy there was a solitary rectal ulcer. After entering the rectovaginal plane, the dissection continued on the anterior side of the mesorectum until the level of the pelvic floor. A 10 9 3 cm polypropylene mesh was utilized to fix the ventrally mobilized rectum to the sacral promontory with 3-0 polypropylene sutures. The first two stiches anchored the lower end of the mesh to the posterior vaginal wall. Finally, the peritoneum was closed with 3-0 V-lock sutures leaving the mesh extraperitoneal in order to prevent mesh related complications. The patient was discharged on postoperative day 2. At follow-up of 1 year pelvic pain and other symptoms had disappeared completely. Robotic ventral mesh rectopexy can be an alternative to a conventional laparoscopic surgical approach for complicated pelvic floor diseases. The robotic platform seems to overcome some of the limitations of the laparoscopic technique in confined spaces like the pelvis.

Totally Robotic Total Mesorectal Excision with High Vascular Tie for Rectal Cancer- A Video Vignette

(1)TME with high tie of the inferior mesenteric artery was firstly described by Moynihan (2). It is now accepted practice during surgery for rectal cancer (1)The technique is associated with reduced recurrence rates, preservation of the g anal sphincters and a reduction in bladder and sexual dysfunction. High tie of the inferior mesenteric vein is also advised to minimise tension while performing colorectal anastomoses. Robotic techniques are evolving in colorectal surgery. Until recently robotic techniques necessitated laparoscopic assistance. The use of the Xi platform and robotic staplers enables to g total mesorectal excision using robotic techniques alone. This educational video describes totally robotic total mesorectal excision with high vascular tie of the inferior mesenteric artery and vein for rectal cancer. This article is protected by copyright. All rights reserved.