Skip to main content

Robotic Abdominoperineal Resection

  • Chapter
Robotic Approaches to Colorectal Surgery

Abstract

Robotic utilization in rectal cancer has several distinct advantages. The clear benefits of the magnification and visualization, combined with the improved dexterity in confined places such the true pelvis, make robotic-assisted surgery optimal for distal rectal cancers. Current literature shows short-term outcomes comparable with laparoscopic approach. Large prospective international studies are underway to provide an answer about the short-and long-term oncologic and functional outcomes with this technique. In this chapter, we provide the reader with detailed description of how to perform robotic APR. Attention to patient selection, the importance of preoperative stoma marking, positioning, room arrangement, and troubleshooting in an emergency situation are illustrated. Literature review and outcomes are described with the most up-to-date short-term and oncologic outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Turnbull G, Erwin-Toth P. Ostomy care: foundation for teaching and practice. Ostomy Wound Manage. 1999;45(Suppl):23S–30S.

    CAS  PubMed  Google Scholar 

  2. American Society of Colon & Rectal Surgeons and Wound Ostomy & Continence Nurses Society. ASCRS and WOCN Joint Position Statement on the Value of Preoperative Stoma. Wound, Ostomy and Continence Nurse Society. http://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/docs/0807stomamarkingps.pdf?hhSearchTerms=%22stoma+and+siting%22

  3. Bass E, Del Pino A, Tan A, Pearl R, Orsay C, Abcarian H. Does preoperative stomal marking and education by the enterostomal therapist affect outcome ? Dis Colon Rectum. 1997;40(4):440–2.

    Article  CAS  PubMed  Google Scholar 

  4. Gulbiniene J, Markalis R, Tamelis A, Salazinaskas Z. The impact of preoperative stoma siting and stoma care education on patient’s quality of life. Medicina (Kaunas). 2004;41(1):1045–53.

    Google Scholar 

  5. Park J, Del Pino A, Orsay C, et al. Stoma complications. Dis Colon Rectum. 1999;42(12):1575–80.

    Article  CAS  PubMed  Google Scholar 

  6. Pittman J, Baka T, Ellett M, Sloan R, Rawl SM. Psychometric evaluation of the ostomy complication severity index. J Wound Ostomy Continence Nurs. 2014;41(2):147–57.

    Article  PubMed  Google Scholar 

  7. Pittman J, Rawl SM, Schmidt CM, et al. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Continence Nurs. 2008;35(5):493–503.

    Article  PubMed  Google Scholar 

  8. Carmel JE, Goldberg M. Preoperative and postoperative management. In: Colwell J, Goldberg MT, Carmel J, editors. Fecal and urinary diversions: management principles. St. Louis, MO: Mosby; 2004. p. 207–39.

    Google Scholar 

  9. Huettner F, Pacheco PE, Doubet JL, Ryan MJ, Dynda DI, Crawford DL. One hundred and two consecutive robotic-assisted minimally invasive colectomies—an outcome and technical update. J Gastrointest Surg. 2011;15(7):1195–204.

    Article  PubMed  Google Scholar 

  10. deSouza AL, Prasad LM, Marecik SJ, Blumetti J, Park JJ, Zimmern A, et al. Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance. Dis Colon Rectum. 2010;53(12):1611–7.

    Article  PubMed  Google Scholar 

  11. Scarpinata R, Aly EH. Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum. 2013;56(2):253–62.

    Article  PubMed  Google Scholar 

  12. Kim HJ, Choi GS, Park JS, Park SY. Multidimensional analysis of the learning curve for robotic total mesorectal excision for rectal cancer: lessons from a single surgeon’s experience. Dis Colon Rectum. 2014;57:1066–74.

    Article  PubMed  Google Scholar 

  13. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25(3):855–60.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc. 2013;27(9):3297–307.

    Article  PubMed  Google Scholar 

  15. Jimenez-Rodriguez RM, Diaz-Pavon JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis. 2013;28(6):815–21.

    Article  PubMed  Google Scholar 

  16. Keller DS, Hashemi L, Lu M, Delaney CP. Short-term outcomes for robotic colorectal surgery by provider volume. J Am Coll Surg. 2013;217(6):1063–9.e1.

    Article  PubMed  Google Scholar 

  17. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg. 1998;133:894–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.

    Article  CAS  PubMed  Google Scholar 

  19. Martling AL, Holm T, Rutqvist LE, et al. Effect of a surgical training programme on outcome of rectal cancer in the county of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356:93–6.

    Article  CAS  PubMed  Google Scholar 

  20. Nagtegaal ID, van de Velde CJH, Marijnen CA, et al. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23:9257–64.

    Article  PubMed  Google Scholar 

  21. West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26:3517–22.

    Article  PubMed  Google Scholar 

  22. Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN, Norwegian Rectal Cancer Group, Norwegian GI Cancer Group. Inadvertent perforation during rectal cancer resection in Norway. Br J Surg. 2004;91:210–6.

    Article  CAS  PubMed  Google Scholar 

  23. Marecik SJ, Zawadzki M, de Souza AL, Park JJ, Abcarian H, Prasad LM. Robotic cylindrical abdominoperineal resection with transabdominal levator transection. Dis Colon Rectum. 2011;54:1320–5.

    Article  PubMed  Google Scholar 

  24. Hara M, Sng K, Yoo BE, Shin JW, Lee DW, Kim SH. Robotic-assisted surgery for rectal adenocarcinoma: short-term and midterm outcomes from 200 consecutive cases at a single institution. Dis Colon Rectum. 2014;57:570–7.

    Article  PubMed  Google Scholar 

  25. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, Colorectal Cancer Laparoscopic or Open Resection II (COLO R II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–8.

    Article  PubMed  Google Scholar 

  26. Kang J, Yoon KJ, Min BS, et al. The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison—open, laparoscopic, and robotic surgery. Ann Surg. 2013;257:95–101.

    Article  PubMed  Google Scholar 

  27. Bianchi PP, Ceriani C, Locatelli A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010;24:2888–94.

    Article  CAS  PubMed  Google Scholar 

  28. Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:2095–101.

    Article  PubMed  Google Scholar 

  29. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASI CC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.

    Article  PubMed  Google Scholar 

  30. Musters GD, Buskens CJ, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum. 2014;57:1129–39.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jorge A. Lagares-Garcia M.D., F.A.C.S., F.A.S.C.R.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Lagares-Garcia, J.A., Firilas, A., Parra, C.M., Long, M.A., Heredia, R.G. (2015). Robotic Abdominoperineal Resection. In: Ross, H., Lee, S., Champagne, B., Pigazzi, A., Rivadeneira, D. (eds) Robotic Approaches to Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-09120-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09120-4_14

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09119-8

  • Online ISBN: 978-3-319-09120-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics