Ewha Med J.  2022 Oct;45(4):e16. 10.12771/emj.2022.e16.

Simultaneous Ileocecectomy and Anterior Resection with the da Vinci SP® Surgical System for Patient with Crohn’s Disease: A Case Report

• Kim HS
• Noh GT

• KMID: 2534741
• DOI: http://doi.org/10.12771/emj.2022.e16

Abstract

A 25-year-old female visited the clinic with abdominal pain and poor oral intake. She was diagnosed with Crohn’s disease and had a history of using infliximab for 4 years. She had no previous operative history. Magnetic resonance enterography demonstrated the progression of a penetrating complication that involved the distal ileum and complex entero-enteric fistula between the terminal ileum and sigmoid colon. Surgery was conducted using the da Vinci SP surgical system. In the operative field, severe adhesion was observed between the terminal ileum, adjacent ileum, cecum, and the sigmoid colon. After adhesiolysis of the small bowel and right colon was performed, the fistula tract between the sigmoid colon and terminal ileum was identified and resected. Then, simultaneous ileocecectomy and anterior resection was performed. The operation was completed without any intraoperative complications and patient’s recovery was uneventful. She was discharged postoperatively, after 8 days.

Keyword

da Vinci SP; Robotic surgical procedures; Crohn disease; Digestive system fistula

Figure

• 

  Fig. 1. Colonoscopy (A,B) and magnetic resonance enterography (C,D) images. (A) Colonoscopy shows a whitish scar with inflammatory pseudopolyps in cecum and mild stricture is observed in ileocecal valve, (B) in terminal ileum, ulcer with edematous mucosa and stenosis is observed, (C) the magnetic resonance enterography shows progression of a penetrating complication that involved distal ileum with complex entero-enteric fistula between terminal ileum and sigmoid colon, (D) another fistula tract is suspicious between distal ileum.

• 

  Fig. 2. Contrast-enhanced CT image after conservative management for 2 weeks. (A) Contrast-enhanced CT clearly reveals entero-enteric fistula despite improvements in the inflammatory change in the ileum (B) another fistula tract is also observed clearly.

• 

  Fig. 3. Immediate wound postoperatively. Drain is inserted through main wound used for single-incision robotic surgery with the da Vinci SP system.

Reference

References

1. Lu KC, Cone MM, Diggs BS, Rea JD, Herzig DO. Laparoscopic converted to open colectomy: predictors and outcomes from the Nationwide Inpatient Sample. Am J Surg. 2011; 201(5):634–639. DOI: 10.1016/j.amjsurg.2011.01.009. PMID: 21545913.

2. Wan J, Liu C, Yuan XQ, Yang MQ, Wu XC, Gao RY, et al. Laparoscopy for Crohn's disease: a comprehensive exploration of minimally invasive surgical techniques. World J Gastrointest Surg. 2021; 13(10):1190–1201. DOI: 10.4240/wjgs.v13.i10.1190. PMID: 34754387. PMCID: PMC8554722.

3. Hota S, Parascandola S, Smith S, Tampo MM, Amdur R, Obias V. Robotic and laparoscopic surgical techniques in patients with Crohn's disease. Surg Endosc. 2021; 35(8):4602–4608. DOI: 10.1007/s00464-020-07885-x. PMID: 32789588.

4. Hande Aydinli H, Anderson M, Hambrecht A, Bernstein MA, Grucela AL. Robotic ileocolic resection with intracorporeal anastomosis for Crohn's disease. J Robot Surg. 2021; 15(3):465–472. DOI: 10.1007/s11701-020-01125-z. PMID: 32725327.

5. Calini G, Abdalla S, Abd El Aziz MA, Saeed HA, D'Angelo ALD, Behm KT, et al. Intracorporeal versus extracorporeal anastomosis for robotic ileocolic resection in Crohn's disease. J Robot Surg. 2022; 16(3):601–609. DOI: 10.1007/s11701-021-01283-8. PMID: 34313950.

6. Sica GS, Biancone L. Surgery for inflammatory bowel disease in the era of laparoscopy. World J Gastroenterol. 2013; 19(16):2445–2448. DOI: 10.3748/wjg.v19.i16.2445. PMID: 23674844. PMCID: PMC3646133.

7. Maeda K, Nagahara H, Shibutani M, Fukuoka T, Inoue T, Ohira M. A review of reports on single-incision laparoscopic surgery for Crohn's disease. Surg Today. 2019; 49(5):361–368. DOI: 10.1007/s00595-018-1732-x. PMID: 30805721.

8. Gunnells D, Cannon J. Robotic surgery in Crohn’s disease. Clin Colon Rectal Surg. 2021; 34(5):286–291. DOI: 10.1055/s-0041-1729862. PMID: 34512197. PMCID: PMC8426043.