V64 - Robotic intra-corporeal colorectal anastomosis through the vaginal cuff following hysterectomy

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Olivia Ziegler, MD

Resident
Penn State Health
Penn State Milton S Hershey Medical Center
Hummelstown, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

EM

Eric Moyer, MD

General surgery Resident
Penn State health Milton S Hershey Medical Center
Columbia, Pennsylvania, United States

Disclosure information not submitted.
ZD

Zachary Delgado, MD

Resident physician
Penn State Hershey Medical Center
Hummelstown, Pennsylvania, United States

Disclosure information not submitted.
nE

nina Eng, MD

Resident physician
Penn state Hershey medical center
Hershey, Pennsylvania, United States

Disclosure information not submitted.
PL

Patricio B. Lynn, MD

Assistant Professor of Surgery
Penn State University
Hummelstown, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AK

Audrey S. Kulaylat, MD MSc

Assistant Professor
Penn State Health
Hershey, Pennsylvania, United States

Disclosure information not submitted.
JS

Jeffrey S. Scow, MD, FACS, FASCRS

Associate Professor of Surgery
Milton S. Hershey Medical Center, Penn State Health
Hershey, Pennsylvania, United States

Disclosure information not submitted.
AD

Arpit Dave, M.D.

Assistant Professor of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery
Penn State Health Milton S. Hershey Medical Center
Harrisburg, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

HC

Heather Carmichael, MD

Assistant Professor
Department of Surgery, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Olivia Ziegler, MD: This individual has no financial relationships with ineligible companies.

Patricio B. Lynn, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: Natural orifice surgery is advantageous in the avoidance of additional incisions for specimen extraction and to accommodate stapling devices without upsizing ports. This minimizes the risk of hernia, post-operative pain, and the potential for poor cosmesis. In the setting of hysterectomy with concomitant colorectal resection, the vaginal cuff can function as an ideal working port and extraction site. Here, we present an intracorporal colorectal anastomosis performed with aide of the already open vaginal cuff for stapling, specimen extraction, and as an access point for hand-assisted surgery

Methods/Interventions: This is the case of a woman in her 40s with longstanding cyclic pelvic pain associated with menses; her pre-operative ultrasound demonstrated extensive deep infiltrating endometriosis of the sigmoid with left ovarian endometrioma and dense posterior uterine adhesions. She was evaluated by gynecology pre-operatively and consented for a robotic hysterectomy, bilateral salpingectomy, left oophorectomy, posterior peritonectomy and sigmoid colectomy. She underwent preoperative bowel preparation.

Intra-operatively she was found to have ASRM stage IV endometriosis. The case was completed with four 8mm robotic ports. Transection, EEA anvil placement, and specimen extraction was performed via the vaginal cuff. This obviated the need for additional incisions or port upsizing to accommodate a robotic/laparoscopic stapler.

Results/Outcomes: The patient had an uncomplicated post operative course and was discharged on post-operative day three. She did not use any opiates after discharge. On routine follow up she was without complaints and recovering appropriately.

Conclusion/Discussion: This case demonstrates the advantages of creative use of extant surgical sites and natural orifices. This technique should be considered in the frequent collaborative cases performed with colorectal surgery and gynecology to reduce cost and minimize both the number and size of necessary incisions and their potential attendant complications.