VM86 - Robotic Right Hemicolectomy with Enbloc Common Iliac Artery Resection

Purpose/Background: To describe a novel technique of removing locally advanced right colic cancers to include the right common iliac artery and ureter enbloc, using a robotic platform.

This 39 year old male with micro satellite stable tumour presents with constipation, weight loss and iron deficiency. A colonoscopy revealed a biopsy proven caecal cancer. CT revealed a large caecal mass adherent to the right common iliac artery, down to the iliac bifurcation, with an involved right ureter. Following the formation of a defunctioning loop ileostomy, neoadjuvant chemoradiotherapy was given, and a femoral-femoral crossover graft was fashioned, in light of performing a minimally invasive radical enbloc resection of the tumour.

Methods/Interventions: Following takedown of the loop ileostomy, a DaVinci Xi 4 arm platform was used to perform the resection. The robot was also used to perform the ureteric replant, and subsequent bowel anastomosis.

Results/Outcomes: Histology revealed a T4N1 tumour, with R0 resection. Additional benefits to the patient include minimal blood loss, minimal abdominal wall morbidity, and short inpatient stay.

Conclusion/Discussion: We demonstrate here that the resection of advanced right sided cancers with ureteric and major vessel involvement can be safely performed using a robotic platform, while still being oncologically sound.