N.I.C.E. - Natural Orifice Intracorporeal Anastomosis with Extraction

Clinical History:

• Patient presents for surgical resection for complicated diverticulitis following numerous prior episodes including hospital admission for microperforation

• Clinical evaluation including colonoscopy and CT scan confirms diverticulitis with no evidence of malignancy

• She was optimized in regards to nutrition and placed on antibiotics to bridge to elective planned resection

Technique description:

1. Robotic total intracorporeal surgery 

2. Robotic colorectal left-sided resection

3. Natural orifice transrectal extraction of specimen

4. Intracorporeal colorectal anastomosis without the use of linear staplers 

Procedure steps:

1. Lateral to medial dissection with mobilization of splenic flexure

2. Proximal division of the colon, mesenteric sparing dissection followed by distal transection of the rectum

3. Natural orifice transrectal extraction of the specimen

4. Intracorporeal colorectal anastomosis

Trainings Objectives:

• Understand key concepts and considerations for robotic total intracorporeal surgery

• Gain exposure to left-sided colorectal resection using mesenteric sparing technique

• Learn techniques for safe and efficient natural orifice transrectal extraction of specimen

• Understand various tips and tricks for intracorporeal anastomosis without crossing staple lines