Robot-Assisted Ileocecal Resection for Ascending Colon Cancer in a Patient With an Ileal Conduit: A Case Report

We present a case of robot-assisted ileocecal resection for ascending colon cancer in a patient with an ileal conduit, safely performed using indocyanine green (ICG) fluorescence imaging to ensure the safe preservation of the ileal conduit. An 85-year-old woman with hematochezia was diagnosed with ascending colon cancer (cT3N0M0: stage IIA). She had undergone robot-assisted radical cystectomy with ileal conduit construction eight months earlier. Given her advanced age, a robot-assisted ileocecal resection was performed as a minimally invasive approach. Due to previous surgeries, dense adhesions around the ileal conduit and terminal ileum distorted the local anatomy, making the identification of the ileocecal region challenging. However, by modifying the surgical approach and performing meticulous dissection, the procedure was completed safely. Additionally, ICG fluorescence imaging confirmed adequate blood flow to the ileal conduit. She was discharged on postoperative day 7 without complications. In patients with colorectal cancer who have undergone total cystectomy with ileal conduit construction, preserving the conduit's blood supply is essential, making right-sided colon cancer surgery particularly challenging. Because of these technical difficulties, open surgery is typically preferred. Nonetheless, we report the first case of robotic surgery performed in such a patient. Robotic surgery enabled the precise dissection and safe preservation of the ileal conduit, taking advantage of enhanced visualization and multi-articulated instruments. Furthermore, ICG fluorescence imaging enabled the real-time assessment of conduit perfusion, helping to avoid postoperative complications. This case highlights the feasibility of robotic surgery as a safe and effective option for colorectal cancer in patients with an ileal conduit.