# Robotic sigmoid colectomy with intracorporeal anastomosis: IMV first approach—a video vignette

## TL;DR

This paper presents a video demonstrating a robotic sigmoid colectomy using a novel surgical approach and intracorporeal anastomosis, showing successful patient outcomes.

## Contribution

The paper introduces the 'IMV first' approach for robotic sigmoid colectomy with intracorporeal anastomosis, emphasizing its practical application and benefits.

## Key findings

- The robotic ICA procedure was completed in 120 minutes with minimal blood loss.
- The patient was discharged on postoperative day 3 with no complications within 30 days.
- The 'IMV first' approach is proposed as a structured training method for robotic-assisted left-sided resections.

## Abstract

This video vignette demonstrates a robotic sigmoid colectomy with iso-peristaltic intracorporeal colo-colonic anastomosis (ICA) utilising DaVinci Xi® platform. The dissection employs an’inferior mesenteric vein first(IMV) approach’, a structured technique for training in robotic assisted left sided colon and rectal resections. Robotic ICA offers advantages over extracorporeal anastomosis, enabling the surgeon to remain at the console for the entire procedure, thus enhancing surgical flow. Based on the literature ICA technique potentially improves patient outcomes, with reported reduction in incisional hernia, surgical site infections, and postoperative pain, particularly when Pfannenstiel incision is used for extraction of the specimen compared to periumbilical incision. The robot precision facilitates suturing including hand-sewn anastomosis formation. Our video featured a case of 72-year-old male diagnosed with mid sigmoid cancer, highlighting the practical application of ‘IMV First' approach. The total operative time was 120 min with minimal blood loss. Patient was discharged on postoperative day 3 with no complications within 30 days. Postoperative histology-pT3N0M0R0.

The online version contains supplementary material available at 10.1007/s10151-025-03249-6.