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Successful Robotic Colporrhaphy of Colonoscopic Perforation 

Keywords:
Minimally invasive, Robotic, Colonoscopy perforation

Background and Conclusions: Background

Colonoscopy remains the criterion standard for screening of colorectal cancer and a central adjunct in the workup of GI disorders. Although it is generally considered a safe procedure, complications during colonoscopy may occur. The most serious complication is iatrogenic perforation of the colon. The management of such perforations is usually surgical but there is debate as to the appropriate approach. Recent years have shown a trend towards a minimally invasive approach

Summary

Patient was a 71 y.o. female that presented to ED with diffuse abdominal pain after undergoing routine colonoscopy earlier that day. Colonoscopy was difficult due to her redundant sigmoid colon and required several adjunct maneuvers. Workup with CT revealed pneumoperitoneum with mild thickening and pericolonic fat stranding in the rectosigmoid region. Abdomen was entered in the LUQ under direct visualization with an optical port. A thick adhesive band was visualized going from the vaginal cuff to the sigmoid colon with an adjacent full thickness laceration. The injury appeared to have been caused by traction from the band during the colonoscopy.  Given that the tissue appeared healthy with no fecal contamination, a primary repair using the robot seemed appropriate. The laceration was repaired with a two layer fashion using 3-0 V-Loc suture. Intraoperative flexible sigmoidoscopy revealed a patent lumen and normal mucosa, as well as no fluid or bubbles in the pelvis suggestive of a leak.

Conclusions

Robotic colorraphy should be considered in selective patients for the management of colonoscopic perforations.

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