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Video

Session:: Ongoing Videos

V72 - Robotic Revision Low Anterior Resection with Deloyers Procedure for Anastomotic Stricture

Saturday, May 9, 2026
On-Demand

    Video Presentation(s)

  • Lucy N. Lan, MD

    Resident (PGY4)
    University of Toronto
    University of Toronto
    Toronto, ON, Canada

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Author(s)

  • Erin Kennedy, MD PhD FRCSC (she/her/hers)

    Head, Division of General Surgery
    Mount Sinai Hospital
    Toronto, Ontario, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • SC

    Sami A. A. Chadi, MD, MSc

    Surgeon
    University Health Network
    Toronto, Ontario, Canada

    Disclosure information not submitted.

CME Eligible

Purpose/Background: Robotic platforms provide significant technical advantages in colorectal surgery, including enhanced visualization of deep pelvic structures, and superior instrument dexterity for adhesiolysis, dissection of inflamed tissues, and intracorporeal suturing. Additionally, it mitigates surgeon fatigue during complex and prolonged operations. Here, we present a technically challenging case of a robotic revision low anterior resection, facilitated by colonic derotation to optimize conduit reach and restore bowel continuity.

Methods/Interventions: A 45 year-old male with a cT3N0M0 mid-rectal adenocarcinoma underwent neoadjuvant short-course radiation followed by laparoscopic-assisted low anterior resection. During the index operation, the proximal colonic margin was revised to the proximal descending colon due to poor perfusion, necessitating transverse colon mobilization to achieve adequate length for anastomosis. Flexible sigmoidoscopy six months postoperatively revealed an ischemic anastomotic stricture. The patient remained diverted and elected to undergo revision low anterior resection with a planned Deloyers procedure, given preoperative concerns regarding colonic length.

Results/Outcomes: This video demonstrates key operative steps, including trocar placement, mobilization of the colonic conduit, excision of the previous anastomosis, colonic derotation, and re-anastomosis. Pelvic dissection and reconstruction were completed robotically, whereas mobilization of the right colon was completed laparoscopically. There were no intraoperative complications. Postoperatively, the patient developed a transient acute kidney injury which resolved with intravenous fluids, and he was discharged on postoperative day six.

Conclusion/Discussion: This case highlights the role of the robotic platform in enabling precise dissection and reconstruction during complex revision colorectal surgery. The combination of a robotic approach with a Deloyers procedure allowed restoration of colonic continuity in a patient with limited residual colonic length. As robotic techniques continue to evolve globally, novel adaptations of established techniques will further enhance functional and oncologic outcomes in colorectal surgery.