General Surgery
General and Digestive Surgeon, Instituto Quirúrgico Lacy and Hospital Clínic de Barcelona, Spain
Dr. Bravo Infante is a recognized specialist in General and Digestive Surgery. She has more than 15 years of experience in the profession and extensive training in various fields of the specialty.
Throughout her career she has combined her healthcare work with a very important research and dissemination activity, participating in several multidisciplinary committees related to pathologies such as colorectal cancer, morbid obesity, inflammatory bowel disease, pelvic floor pathology, or endometriosis. At the same time, she is also active in teaching in the fields and specialties mentioned above, is a regular speaker at conferences, and author of scientific articles.
Dr. Raquel Bravo is currently a specialist in General and Digestive Surgery at the Instituto Quirúrgico Lacy and at the Gastrointestinal Surgery Service of the Institut de Malalties Digestives i Metabòliques of the Hospital Clínic de Barcelona. She is also a reference physician at the intrahospital and extrahospital level. In this sense, she is the reference physician for the surgery and emergency department in complex colorectal pathology, esophagogastric pathology and morbid obesity at Hospital Clínic. At the level of other hospital services, he is a reference physician in the Urology service, the Gynecology service, the Gastroenterology service, the Oncology service and the Endoscopy service. Likewise, he is also a referral physician at the out-of-hospital level, in the context of patients diagnosed with rectal neoplasms and referred from other centers.
Selected publications from PubMed
Soft tissue epithelioid hemangioendothelioma on the palm of the hand. Case report.
Mesa F, Camargo M, Carvajal L, Bravo R
Case Reports Plast Surg Hand Surg. 2023;10(1):2256541 doi: 10.1080/23320885.2023.2256541.
Impact of pneumoperitoneum on intra-abdominal microcirculation blood flow: an experimental randomized controlled study of two insufflator models during transanal total mesorectal excision : An experimental randomized multi-arm trial with parallel treatment design.
de Lacy FB, Taurà P, Arroyave MC, Trépanier JS, Ríos J, Bravo R, Ibarzabal A, Pena R, Deulofeu R, Lacy AM
Surg Endosc. 2020 Oct;34(10):4494-4503 doi: 10.1007/s00464-019-07236-5.
Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis.
de Lacy FB, Roodbeen SX, Ríos J, van Laarhoven J, Otero-Piñeiro A, Bravo R, Visser T, van Poppel R, Valverde S, Hompes R, Sietses C, Castells A, Bemelman WA, Tanis PJ, Lacy AM
BMC Cancer. 2020 Jul 20;20(1):677 doi: 10.1186/s12885-020-07171-y.
[Mediation in public healthcare: opportunities for improvement].
Lagos Tissie D, Bravo R L
Rev Med Chil. 2020 Feb;148(2):211-215 doi: 10.4067/s0034-98872020000200211.
Recurrent volvular herniation of the ileal pouch: a case report and literature review.
Cárdenas G, Bravo R, Delgado S, Jiménez M, Martínez A, Díaz del Gobbo G, de Lacy B, Lacy AM
Int J Colorectal Dis. 2016 Mar;31(3):749-50 doi: 10.1007/s00384-015-2242-6.
Learn how to perform a combined two-teams, Cecil approach with the robotic surgical system, the advantages of the robotic assistance during TaTME for rectal cancer, the tips and tricks to perform the low pelvis dissection and which are the new complications that may arise during TaTME
Published
Dec 2021
We present an 81-year-old patient, with no known drug allergies, with a history of a labial neoplasm and a childhood TB who currently has a sigmoid colon neoplasm. Due to alterations in the depositional rhythm, a colonoscopy was performed that reported a large tumor 20 cm from the anal verge, whose pathological anatomy was compatible for adenocarcinoma. A complete study was performed, with the CT Scan showing a large neoproliferative lesion in the rectum-sigma junction that extended to the mesosigma and fistulized and infiltrated a segment of the proximal sigma. It also presented tumor implants in mesosigma and inflammatory changes by fistulization with two adjacent collections. Given the findings, it was decided to perform a Robotic Sigmoidectomy. After doing the docking and placing the auxiliary trocar in the usual way, the procedure started. The large tumor was attached to the bladder, as we suspected from previous imaging tests. We carefully began the dissection trying to separate the tumor from the bladder but taking into account that we should not go too close so as not perforate the tumor. Given the significant fixation of the tumor to the pelvis we decided to release part of the parietocolic and subsequently also access medially so as to gradually surround the large mass. For the medial approach, we proceeded to open the peritoneum from the oncological plane to approach the artery and the inferior mesenteric vein. Once dissected we carried out the section of both of them by means of clips and the Harmonic device used through the auxiliary trocar. Once the vessels were sectioned, after visualizing and preserving the left ureter, we went back to a lateral approach. Throughout the procedure, we changed the approach so as to be able to surround the tumor and release it from the area where it was most closely attached. All these maneuvers are facilitated by the wide range of mobility of the robotic instruments, the stable camera, and 3D vision that helps in difficult dissections like this case. Again we returned to the medial area, approaching the tumor from the back with good vision thanks to the 30º robotic camera. Edema and fibrosis caused by the tumor make dissection difficult, so care must be taken to avoid lesions to vascular structures or the ureter, or perforation of the colon or the tumor itself. Once the bladder was separated and the vessels were sectioned, we decided to change our strategy in order to release the most problematic area of the tumor. Therefore, we proceeded to section the mesocolon and the proximal colon, so that we could retract it and have a better view of the area closely attached to the left parietocolic. Using a mechanical suture device, we sectioned the colon through the auxiliary trocar. In this way we were able to pull the colon and perform a safer dissection. We can see how edema makes it difficult to differentiate a good plane. The surgical assistant’s work is very important here to keep the surgical field clean, improving vision and facilitating dissection. Through the electrocautery and the Harmonic device, we released the parietocolic area of the tumor, making sure not to injure any important structure. At this time we can see the ureter, which continues its path without being affected by the tumor and that we left aside to the left, without injuring it and keeping it in mind at all times to avoid potential inadvertent injuries. Gradually we released the colon and thus accessed the pelvis, going into the distal colon, finding the area where we could perform the rectum section. Once the tumor was passed, we proceeded to perform the circumference section of the mesorrectum using the electrocautery and the Harmonic device, already preparing the rectum for its section. Finally, we introduced the endo stapler through the auxiliary trocar and sectioned the distal rectum, checking that the colon and the tumor were completely released. After that, we completed the release of the left parietocolic to ensure correct mobilization of the proximal colon and perform an anastomosis with no tension. The next step is to check vascularization of the sectioned colon by means of indocyanine green, with correct perfusion of the proximal colon, except for the last 2 cm that would be subsequently sectioned, and thus placed the anvil of the mechanical suture and performed the anastomosis. At this moment the robotic surgery ended. The specimen was extracted through a Pfannenstiel incision and the anvil was placed in the proximal colon, to later finish the procedure with laparoscopic instruments. The end to end colorectal anastomosis was completed by means of a circular mechanical suture and the procedure ended with the placement of an intra-abdominal drainage. Outcomes The surgery took 185 minutes. Oral intake was initiated 4h after surgery following our ERAS protocol. The patient was discharged on the 2nd postoperative day with no complications. The pathology revealed a pT4N0 colon adenocarcinoma.
Published
Nov 2019
We present the case of a patient with a rectovaginal fistula in which we use the robotic approach as a minimally invasive technique of choice, with favorable results. Clinical case This is a 62-year-old patient, with no medical history, who underwent a transvaginal hysterectomy for uterine fibroids. 48 hours later she went to the emergency department, presenting with discharges of fecaloid material through the vagina. An abdominal CT scan was performed, objectifying a fistula between the rectum and the vaginal stump . Given these findings, it was decided to perform a surgical intervention: Resection of the affected rectum + anastomosis + closure of the vaginal stump through a robotic approach. When accessing the abdominal cavity we can objectify the blocked pelvis with a significant plastron at this level. The fallopian tubes are closely adhered to the sigma and the area of the alleged fistula. We initiate blunt dissection carefully until we access the fistula, where we observe the stitches made between the anterior side of the rectum and the vaginal stump.Little by little we release the different anatomical structures, cutting the stitches that establish the fistula. The articulated movements of the robot allow in this case for a careful and delicate dissection when working in a small and deep space. Finally, we identify the vagina and then proceed to release it from the rectum in order to identify a healthy area and perform resection of the affected segment. At all times, the help of the assistant is important. In this case, the vacuum cleaner is used to keep the surgical field clean. At this time we clearly identify the open vagina, having completely separated the anterior side of the rectum from it. Later we will proceed to section the mesocolon and the mesorectum to perform the resection of the segment affected by the fistula. For this we use the hook, opening the peritoneum and looking for the dissection plane first on the right side and then on the left, until a circumferential dissection is performed in search of a healthy rectal wall to perform the distal section. Again we see how we are working in a small and deep space, having total autonomy with the robot and with the dissection and the different movements being facilitated by the great range of movement of the robotic instruments. Through the hook we can perform the complete section of the mesorectum. Once the dissection is complete, we proceed to section the rectum by means of an endo stapler operated by the surgical assistant. The next step is to dissect the proximal area of the colon to be able to section it and perform the anastomosis. In this case we will perform a mechanical side to end anastomosis, using a circular endostapler. The mesocolon section is carefully performed with the robotic hook and with the ligasure used by the assistant. At this time, before performing the section of the colon, we introduce the anvil of the circular endostapler through the vaginal stump. Once we have the anvil in the abdominal cavity, we proceed to introduce it into the proximal colon to perform the anastomosis. At this time it is important to coordinate movements between the surgeon and the assistant to perform this step easily and without damaging the colon that will be part of the anastomosis. Once the anvil is placed, we proceed to section the colon by means of an endostapler managed by the assistant, thus completing the resection of the fistula area. The specimen is then extracted transvaginally, avoiding assistance incisions.Finally, before performing the anastomosis, we check the correct vascularization of the colon using indocyanine green and the Firefly robotic system. To complete the surgery, we perform the side-to-end colorectal anastomosis using the circular endostapler, without complications. As a last step, we reinforce the anastomosis with two stitches to avoid tension and close the vaginal stump with a continuous barbed suture. A drain is also placed in the surgical field, ending the intervention. Outcomes The surgery took 125 minutes. The patient started an oral diet 6 hours after the surgery. The postoperative course was correct, and the patient was discharged on the 4th postoperative day.
Published
Aug 2019
Following the five setup fundamentals creates important setup advantages: It helps enable instrument tips to reach where needed to complete the procedure. It adjusts the da Vinci robot to an appropriate starting position. It allows for a reproducible setup. It minimizes external arm-to-arm interferences. It minimizes intraoperative range-of-motion limits. Proper setup is crucial for a successful da Vinci procedure. 1. PORT PLACEMENT IDENTIFY THE SURGICAL WORKSPACE Identify where the instrument tips must reach in order to complete the procedure. If the surgical workspace of any procedure requires access to more than two quadrants, consider Dual Docking. DETERMINE THE TARGET ANATOMY The target anatomy is not the pathology. It is the area where the midline of the surgical workspace intersects with the far edge of the surgical workspace boundary. PLACE THE INITIAL ENDOSCOPE PORT Place the initial endoscope port 10–20 cm from the target anatomy, on the opposite edge of the surgical workspace boundary. DECIDE ON THE HAND CONTROLS Decide whether to control two instruments with the left hand or with the right hand. This determines port placement. Two da Vinci instrument ports will go to one side of the initial endoscope port, and one da Vinci instrument port will go to the other. PLACE THE DA VINCI PORTS Place the remaining da Vinci ports 8 cm apart, along a line perpendicular to the target anatomy. Port distance should range between 6 and 10 cm and be adapted according to the patient’s body habitus. Place the ports at least 2 cm away from any bony structures. Do not place ports between other ports and the target anatomy. PLACE THE ASSISTANT PORTS Place the assistant ports as needed, as far away as possible from the da Vinci ports (at least 7 cm). Ensure port location enables you to reach the desired anatomy. Ensure port location gives you physical access to the port. Consider placing the ports lateral to the da Vinci ports or triangulated between the da Vinci ports. Use bariatric-length laparoscopic instruments with assistant ports. Do not place any assistant ports between the da Vinci ports and the target anatomy. 2. DEPLOY FOR DOCKING SELECT THE ANATOMY Select the anatomic region of the desired surgical workspace on the Patient Cart helm. SELECT CART LOCATION Select how the Patient Cart will approach the patient: from the Patient’s Right, the Patient’s Left, or the Patient’s Legs. PRESS AND HOLD ‘DEPLOY FOR DOCKING’ Deploy for Docking adjusts the da Vinci to an appropriate starting position automatically. It automatically rotates and pivots the boom to optimize access to the patient. It readies the da Vinci to be driven to the patient. 3. DRIVE THE LASER LINES TO THE ENDOSCOPE PORT DRIVE THE CART Grasp the handlebars and the cart drive enable switches and slowly drive the Patient Cart to the operating table, monitoring patient clearance. DRIVE THE LASER LINES TO THE SCOPE PORT Drive the laser lines within 5 cm of the initial endoscope port. This positions the center of the da Vinci boom over the initial endoscope port. 4. TARGET DOCK THE INITIAL ENDOSCOPE ARM Dock the initial endoscope arm to the initial endoscope port. Insert the endoscope and ensure it is rotated to a ‘neutral’ horizon position before targeting. POINT THE ENDOSCOPE AT THE TARGET ANATOMY The target anatomy is not the pathology. It is the area where the midline of the surgical workspace intersects with the far edge of the surgical workspace. TARGET Hold the cannula with one hand to support it while it moves. Press and hold the targeting button on the endoscope. The boom will automatically rotate and orient itself toward the target anatomy. Hold the targeting button until the audible countdown completes and motion stops. Performing targeting simultaneously adjusts column height, boom extension, and boom rotation, and achieves the following: It centers the boom over the initial endoscope port. It rotates the boom to point toward the target anatomy. It adjusts column height to maximize sterility and ensure arms reach to all ports for docking. 5. PERFORM MANUAL ARM ADJUSTMENTS ALIGN THE ENDOSCOPE ARM Adjust the flex on the initial endoscope arm, using the laser lines as a positioning guide. Make the back of the arm parallel to the laser line. This aligns the arm with the target anatomy. DOCK THE REMAINING ARMS Dock the remaining arms to the corresponding ports. ADJUST THE SIDE WITH ONE (1) ARM Adjust the flex on the arm to maintain a minimum distance of one fist to the initial endoscope arm. ADJUST THE SIDE WITH TWO (2) ARMS Flex the outer arm away from the inner arm (the arm nearest to the endoscope) to get it out of the way for initial adjustment. Adjust the flex on the inner arm to maintain a minimum distance of one fist to the initial endoscope arm. Go back to the outer arm and adjust the flex back toward the inner arm to maintain a minimum distance of one fist. SPECIFIC CONFIGURATIONS BASED ON THE SURGICAL PROCEDURE Left colectomy, sigmoidectomy and high anterior resection Left colectomy, sigmoidectomy, and robotic high anterior resection are used for colon tumors located in the left colon, sigmoid, and rectum. Position: The robot cart is placed to the left of the patient, who is in the supine position with open legs, in the Trendelenburg position (> 10º), lateralized to the right (> 10º). Before connecting the robotic system, the patient’s position must be adjusted to ensure sufficient exposure of the surgical field. Subsequently, the operating table cannot be mobilized. Trocar placement: for trocar placement, a line can be drawn from the right femoral head (lateral edge of the inguinal triangle) to the left mid-clavicular line, crossing the left subcostal border. Port 2 should be placed at the junction of this line with the middle line, this port being the initial one. Then we place 1, 3 and 4 at a distance of 8 cm between them. Finally, the assistant’s port must be positioned as far as possible from the da Vinci ports and lateral to the right of the mid clavicular line. Mobilization of the splenic flexure: in order to mobilize the splenic flexure, it is necessary to mobilize the orientation of the robotic arms toward the upper left quadrant of the patient, beginning by adjusting arm 1 to the maximum possible flexion. The goal is to open up space between the arms to increase reach and avoid interference. Low anterior resection, tumors located in the pelvis Low resection is used for colon tumors located in the mid and lower rectum. Position: The robot car is placed to the left of the patient, who is in the supine position with open legs, in the Trendelenburg position (> 15º), with no lateralization and with the surgical table at the lowest possible height to avoid conflicts with the robot. Before connecting the robotic system, the patient’s position must be adjusted to ensure sufficient exposure of the surgical field. Subsequently, the operating table cannot be mobilized. Trocar placement in this case the initial port where the camera will go should be placed at the umbilical level. Port 1 on the left side, 8 cm from port 2 and 3, 4 on the right side to port 2, 8 cm from each other. The auxiliary port must be placed triangulating, as far as possible from the da Vinci ports between 3 and 4. Right colectomy and Extended right colectomy (intracorporeal anastomosis) Right colectomy and Extended right colectomy are used for colon tumors located in the right colon and proximal transverse. Position: The robot car is placed to the right of the patient, who is in the supine position, in the Trendelenburg position (> 10º), lateralized to the left (> 10º) and with the surgical table at the lowest possible height to avoid conflicts with the robot. Before connecting the robotic system, the patient’s position must be adjusted to ensure sufficient exposure of the surgical field. Subsequently, the operating table cannot be mobilized. Trocar placement: the first trocar should be placed 4-5 cm above the pubic symphysis. A line can then be drawn from port 1 to where the left clavicular midline crosses the left subcostal margin, placing ports 2, 3 and 4 at a distance of 8 cm from each other on the line. The auxiliary port should be placed triangulating, as far as possible from the da Vinci ports and lateral to the midline clavicular left. Another option would be chosen for localized tumors either in the hepatic flexure or in the transverse colon. In this case we can draw a transversal line 3 cm higher than the pubic symphysis. Place ports 2 and 3 on the transverse line, equidistant to 6 cm around the middle line. Port 1 is positioned 6 cm right side to port 2; port 4, 6 cm left side to port 3 and auxiliary port 5 cm directly top and side to 4. Segmental colon resections Segmental colon resections can be used for tumors located in the transverse colon or at the splenic flexure. Both robot position and trocar placement depend on the location of the tumor, being able to use a pelvic location or right, following the principles previously described depending on where the target anatomy is located. Double Docking Double docking is used when the surgical field is too large to be reached with single docking. After working toward the first target anatomy, the user undocks the da Vinci Xi, rotates its boom 180°, and docks again to the same ports. This enables reach towards the second target anatomy. It is used mainly when: The surgical field extends beyond two quadrants. The initial port of the endoscope is within the planned surgical field and is surrounded by most of it. Multi-organ resection Local invasion and distant metastasis are common in patients with colorectal cancer and, therefore, multiple organ resection is an important measure for radical resection of colorectal cancer. Robotic surgery is also applicable in combined resection, although it should only be performed by experienced surgeons after consultation with a multidisciplinary team. For locally advanced colorectal cancer with invasion of adjacent organs (mainly tumors that invade the urinary bladder, ovary, and uterus), robotic surgery can be performed safely. This type of surgery can also be applied in the synchronous resection of colorectal cancer with distant metastases, such as liver metastases. In addition, during resections of different lesions, the same ports can be used to minimize trauma. Currently, hepatic robotic resection has been shown to be safe and effective, but the long-term effects of synchronous resection of colorectal cancer and hepatic metastasis lesions are yet to be assessed. TAKE HOME MESSAGES Robotic surgery is growing rapidly in the world, and will possible become a standard tool in the future. A good learning curve with a sufficient number of cases is very important. The robot is a particularly useful tool in the dissection of the rectum, especially in male patients, obese patients, and patients with large tumors. It should be reserved for experienced centers and surgeons with a high volume of cases. The use of robotic surgery is promising but still limited, and still requires randomized studies. Large volume tumors and the involvement of neighboring or distant organs do not represent a contraindication to perform robotic surgery.
Published
Jul 2019
We report a case of a 36-year-old female with a 12-month history of chronic pelvic pain, dyschezia and rectal bleeding. These symptoms were refractory to hormonal, antispasmodic and opioid therapy. Magnetic resonance imaging detected a 2 x 2 cm nodule invading the rectal wall 10 cm from the dentate line. So we decided to perform an exploratory laparoscopy to resect the affected area. We found the nodule at the uterine posterior wall invading the rectal anterior wall. The nodule was invading to the rectum in a large area so we proceeded with segmental resection. We performed an anterior dissection in order to carry out the segmental resection of the rectum. We can see how the fibrous tissue makes surgical maneuvers difficult. It is important to be careful to avoid inadvertent injuries. In this case we used the hook to perform the dissection. The dissection progressed carefully, first on the anterior side, to then progress on to the posterior and lateral sides. It is important to be careful not to injure the surrounding structures such as the ureter and vessels that may be retracted near the affected area due to fibrosis. To help the release of the rectum a uterine mobilizer can be used that helps us to have traction to separate the anterior side of the rectum from the posterior side of the vagina. We continued with the dissection, passing the area affected by the endometrioma, until we found a rectal wall with no injury in order to perform the section and create a safe anastomosis. Once we founnd rectal wall in good condition, we proceeded to section the mesorectum by means of the hook and ligasure in order to perform the resection. We performed the rectum section using a 60 mm EndoGIA and a 30 mm EndoGIA. At the same time we introduced the anvil of the mechanical suture device through the vagina in order to create the circular anastomosis. We then just released the sigma to be able to perform the suture. At this moment we made an incision in the colon to introduce the anvil. Previously we had made a suture on the tip of the anvil to use the guide wire at the time of insertion into the colon. Finally, we closed and sectioned the colon with another 60 mm EndoGIA, obtaining the surgical specimen. The specimen is removed through the vagina, performing in this way a totally laparoscopic procedure with natural orifice specimen extraction. Finally we created the end to end circular anastomosis and closed the vagina, completing the surgery. Outcomes The total operative time was 100 minutes, the postoperative stay was uneventful and the patient was discharged on day four. The pathological report showed an endometrioma 4 x 4 cm length predominantly involving colonic muscularis propria. Laparoscopic surgery is a safe and feasible approach for the surgical management of deep infiltrating endometriosis of the rectum and the gold standard for female young patients that often need multiple surgeries. In addition natural orifice specimen extraction avoid potential complications of abdominal incisions.
Published
Apr 2019
The patient is supine in a modified lithotomy position with legs in adjustable stirrups and tilted right side down in a Trendelenburg position; angles should be adjusted prior to docking the robot. If the splenic flexure will be taken down, less Trendelenburg is preferred. You must keep at least 8 cm between robotic ports and 5 cm between the assistant port and the other robotic ports. In this case we placed 4 ports, where 1, 3 and 4 are work ports and port number 2 is for the scope. In addition, a 12 mm trocar is used as an assistant in the right flank. All port placement measurements must be taken after insufflation is performed. Then we proceed to establish the docking to attach the robot and start surgery. Once we locate the target anatomy we proceed to the exposure of the mesenteric vessels for proper section, as in laparoscopic surgery from medial to lateral. The dissection starts with an incision of the peritoneum in the mesentery. A cautery is used to open the peritoneum along this line, opening the plane cranially up to the origin of the inferior mesenteric artery, and caudally past the sacral promontory. We continue the medial to lateral dissection, taking care not to injure the iliac vessels or the left ureter. Blunt dissection is used to lift the vessels away from the retroperitoneum. Then the dissection of the inferior mesenteric artery ends. The 3D HD visualization provided by the Da Vinci System and the dexterity of the EndoWrist® instruments are crucial for an autonomic nerve-preserving dissection at the root of the IMA. The vessels are transected by LigaSureTM from the assistant trocar. We continue with the release of the left parietocolic. We perform the complete release of the colon taking care to avoid injury to retroperitoneal structures. We are able to easily change the approach, completing dissection from the left side connecting with the work done from the medial side. At this point we release the posterior side of the colon from medial to lateral up to the promontory. The 3 robot arms at all times allow us to have good traction and counter-traction for good exposure of the surgical field. At this point we use the LigaSureTM through the assistant trocar to section the mesocolon in order to prepare the transection of the proximal colon. When the section area is prepared, we use indocyanine green to check the correct vascularization of the proximal colon and then carry out a safe anastomosis. An EndoGIA TriStapleTM is then inserted through the assistant port and is used to divide the colon. Subsequently, we proceed to section the distal area at the level of the rectum. In this case we use the ligasure to section it. Once sectioned we can extract the specimen through the rectum with no need to make any auxiliary incisions. We also take advantage of this moment to introduce through the rectum the anvil of the suture device to perform the anastomosis. Finally we section and close the rectum with an EndoGIA TriStapleTM that we introduced from the assistant’s port. Now we are going to prepare the proximal colon to perform the anastomosis. First we open the colon with the hook and introduce the anvil. The movements of the robotic instruments facilitate these precise actions. Then we make a pursestring to fix the anvil and create a side to end anastomosis. Finally, we introduce the suture device through the rectum and create the anastomosis with no complications and in an easy and safe manner, previously checking that the mesocolon is in a correct position and not rotated. To finish, we make two stitches at the corners of the anastomosis as reinforcement and check that there is no tension to end the surgery. Outcome The surgery took 110 minutes. The patient started oral intake 6 hours after the surgery and left the hospital on the 3rd postoperative day. Pathological examination ruled out a colon adenocarcinoma pT1N0.
Published
Nov 2018
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