VM45 - Right Sided Anastomotic Leak in Emergent Setting – Minimally Invasive (DaVinci Robotic) Approach with Inside-out Approach for Diverting Ostomies

Purpose/Background: This abstract showcases the efficacy and ease of robotic platform in treatment of anastomotic leaks in widespread contamination and feculent peritonitis. Traditionally these cases would be approached with a laparotomy which causes significant morbidity to the patient. This video shows how each surgical tool is used to minimize tissue trauma, identify the leak and repair. The inside to outside technique also demonstrates the ease of creating a diverting stoma in an acute setting, all with the benefit of small incisions.

Methods/Interventions: A 78-year-old female with a history of HTN, CAD, DM and malignant polyp, not amenable to endoscopic resection presented POD 8 after a robotic right colectomy with abdominal pain and free fluid noted on CT. IR drainage was pursued by the primary team which showed feculent output. To avoid the morbidity of a large laparotomy on an obese, frail woman; a minimally invasive approach was taken. The leak was noted on the staple line of the colon. The suction irrigator was used as a dissection tool and controlled contamination.

Results/Outcomes: The leak was clearly identified, controlled, and repaired using the davinci robot with minimal tissue handling and avoided the morbidity of open surgery. A novel technique of an inside to out loop ileostomy is showcased and was especially useful in this case of an obese patient or thickened, friable mesentery with friable bowel. The patient did well overall and recovered with the ileostomy functioning on day 2.

Conclusion/Discussion: This video serves as a model for broader adoption of minimally invasive techniques in the management of anastomotic leaks and other complex surgical scenarios in selected patients without sacrificing safety and efficiency.