VM17 - Robotic Enucleation of a Large and Intussuscepting Terminal Ileum Lipoma with an Intracorporeal Hand-sewn Closure

Purpose/Background: We present a patient with anemia and intermittent obstructive symptoms, who was noted to have an early mid- rectal cancer and a large terminal ileal lipoma causing intermittent ileocecal intussusception.

Methods/Interventions: Robotic ports were placed for a standard low anterior resection and an uneventful LAR with intracorporeal anastomosis was completed. An additional 8mm robotic port was placed through the 4 cm Pfannenstiel extraction site Gelpoint cap and the robot was redocked utilizing three arms and targeting the right lower quadrant. Terminal ileal intussusception was noted with a large intraluminal mass originating at about 7 cm from the ileocecal valve. This was enucleated via a longitudinal incision on the antimesenteric border of the terminal ileum overlying the presumed point of origin of the mass. The enterotomy was then closed transversely in two layers in the standard Heineke-Mikulicz fashion.

Results/Outcomes: At the completion of case, the bowel was patent and hemostatic. The patient developed postoperative ileus that resolved with conservative measures and was discharged home.

Conclusion/Discussion: Symptomatic small bowel lipomas can be enucleated in a safe and efficient manner using a small longitudinal enterotomy and then closed with a hand sewn transverse intracorporeal repair. In this video, we present the steps of the operation.