Hellow guys, Welcome to my website, and you are watching Robotic Hand Sewn End Ileostomy Reversal Salvage After Malfunction of Circular Stapler. and this vIdeo is uploaded by Stan Hewlett at 2017-01-23T16:12:55-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Robotic Hand Sewn End Ileostomy Reversal Salvage After Malfunction of Circular Stapler |
| Video Uploader | Video From Stan Hewlett |
| Upload Date | This Video Uploaded At 24-01-2017 00:12:55 |
| Video Discription | The patient is 2 years s/p a previous open abdomen after total abdominal colectomy & end ileostomy for severe C Diff Colitis complicating an extended illness of MOSF, etc. There is are a few asymptomatic ventral incisional midline hernias and significant adhesions. Goals of this surgery are reversal of the ileostomy only and to avoid midline access so as not address the hernias in a 'contaminated' case. The ileostomy was taken down and the fascia dissected with lysis of adhesions. The end was amputated and sized. A 29mm anvil was placed in a standard fashion with the reusable pursestring clamp and 00 Nylon. Robotic single site technique was used. A gel port was placed at the ileostomy takedown fascial defect after lysis of adhesions. The Xi camera and two arms were docked at the gel port. Lysis of adhesions and a firefly exam was done. There was a long rectal stump with the distal sigmoid colon draped over the left iliac fossa and the ureter. No ureteral stents were placed. The stump was densely adherent. It was left in situ. A new circular stapler was used from an unopened package. As you can see the stapler malfunctions. I had never seen this before (or heard of it). It apparently did not fire any staples, it did cut out doughnuts. It left two defects in the bowel. After deciding to proceed with a hand sewn salvage anastamosis of the two defects, the right arm (#3) was moved out of the gel port to a new trocar site in the right lower quadrant that will also be the exit site of the planned pelvic drain. The anastamosis was created using 000 pds 180 vloks. The posterior wall was done with two 6 inch sutures. Two 12 inch sutures were then used in a running Connellfashion after tying to each previous 6 inch suture to complete a single layer anastamosis. Next time I will start with two 12 inch sutures which are long enough to complete the whole thing (and not need the two 6 inch v loks). A leak test was done. The drain placed, and The ileostomy fascia site closed with a standard PDS. This wound was closed loosely over telfa wicks. The patient had a post-op ileum and did not have return of GI function for a week. |
| Category | Science & Technology |
| Tags | GI | Surgery | Robotics | ERCP | cicrcular | stapler | robot | Xi | DaVinci | Intuitive | Ethicon | psspc.com | Hand | sewn | end | ileostomy | reversal | salvage | after | malfunction | ILS | EEA | Intraluminal | insertion | needle | suture | 000 | PDS | vlok | v-lock | barbed | vlock | self-locking | anastamosis | ileum | rectum | colon | C Diff | Clostridium | Difficile | colitis | ostomy | misfire |
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