Introduction: Natural orifice specimen extraction can save patients from additional abdominal incisions and their associated complications when completed in a safe manner. We present a case of a patient with history of perforated diverticulitis successfully treated with robot assisted sigmoidectomy and small bowel resection with transrectal extraction of specimens.
Case: 66 year old man with history of perforated diverticulitis and percutaneous drainage of abscess presented for elective robotic sigmoidectomy. A loop of small bowel was adherent to sigmoid colon and anterior abdominal wall. After lysis of adhesions, there was evidence of small bowel to large bowel fistula, necessitating small bowel resection. After sigmoidectomy was performed, the specimens were delivered transrectally by placing a wound protector through the anus and rectum. An assistant passed ring forceps transanally out of the rectal stump and the specimen was passed off. Subsequent completion of descending colon to rectum and side to side small bowel anastomosis were uncomplicated. Patient recovered well, tolerating a regular diet and passing flatus overnight. He was discharged home on post-operative day one.