1. 台北醫學大學附設醫院 外科部 陳威智 大腸直腸外科 陳嘉哲 郭立人
外科醫學會 A Case report: robotic assisted subtotal colectomy with colon-rectal anastomosis under twice dockings I
台北醫學大學附設醫院
外科部 陳威智
大腸直腸外科 陳嘉哲 郭立人

2. Basic Profile Name :吳OO, Gender : Female, Age: 36 y/o
Height : 163 cm Weight : 50kg
Medical history: Nil
Surgical history: Nil
Allergy history: Nil
Family history: Nil
Travel history: Nil

3. Chief complaint
Bloody stool passage for months

4. Present illness Bloody stool passage for months with blood loss anemia
UGI endoscopy and colonoscopy were obtained and showed familial adenomatous polyposis and ulcerative tumors over upper rectum and rectosigmoid colon which adenocarcinoma was disclosed
Chest to abdomen CT and pelvis MRI were done for tumor staging and stage IIIC ( cT3N2bM0) rectal cancer was impressed

5. Present illness Post CCRT
Main tumor reveled shrinkage compared to previous study of colonoscopy

6. Significant PE & Lab Data
GCS : E4V5M6
Vital signs
BP 125/78mmHg
Pulse rate 86
Resp. rate 13
BT 36.6
Lab :
Hb 8.8 g/dl
WBC 4640/uL
Plt /uL
GPT 12 U/L
PT/INR 13.3/1.02
APTT 37.8
CEA 2.22ng/ml

8. Impression
Familial adenomatous polyposis with malignant transformation, rectum and rectosigmoid, stage IIIC ( cT3N2bM0) undergoing concurrent chemoradiotherapy
Ulcerative lesion noted over 8 cm from anal verge

9. Operation
Robotic (Xi) assisted subtotal colectomy with colon-rectal anastomosis and diverting ileostomy
Appendectomy 
OP time: 480 mins
Blood loss: <50ml

10. B C E A D F

12. Operative Findings：
2 ulcerative tumor noted over rectum and 1 in D-colon
Enlarged LNs (+)
Liver surface: a mass was noted

14. Intestine, large, colon, status post CCRT, Robotic assistant subtotal colectomy, 1) adenocarcinoma, five 2) tubular adenoma, multiple (consistent with familial adenomatous polyposis)
Lymph node, regional, lymphadenectomy, carcinoma, metastatic (12/94)
stage IIIC ( pT3N2bM0)

15. Discussion

16. 2018 Dec

17. This procedure was completed using a da Vinci Si system with 2 dockings
En bloc abdominal wall resection and high ligation of the right colic and middle colic pedicles
The anastomosis was performed via an extracorporeal technique through a Pfannenstiel incision

19. 1 2 3

20. Operation time : 640 min
Blood loss: 420 ml

21. Si vs. Xi