Robotic Intersphincteric Resection with Lymph Node Dissection for Low Rectal Cancer

  • Nam Kyu Kim

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This video describes minimally invasive techniques for intersphincteric resection with lymph node dissection in patients with low rectal cancer. The progress in safe application of preoperative chemoradiation for distal rectal cancer has led to improved local control and an increase in the rate of anal sphincter preservation. The video first introduces the surgical anatomy of the internal and external anal sphincter and explains the indications for the minimally invasive approach in selected patients. Transabdominal and transanal procedures are then described step by step with the aim of enabling surgeons to achieve optimal functional and oncologic outcomes.

Acknowledgements

Ho Seung Kim (Department of surgery, Yonsei University College of Medicine)

Eman Adnan Zakarneh (Department of general surgery, king Fahad military medical complex, Saudi Arabia)

Manar Mohammed Nassr (Royal Hospital, Ministry of health, Oman)

Introduction

This video describes minimally invasive techniques for intersphincteric resection with lymph node dissection in patients with low rectal cancer.

About The Author

Nam Kyu Kim

Dr. Nam Kyu Kim had performed over 10,000 cases of colorectal cancer so far, since2003, he started laparoscopic surgery for colorectal cancer. There after 2007 he also started robotic approach for rectal cancer, another over 2,000 cases would be IBD, diverticular disease and benign anorectal disease. He has served as 1st president of Asian pacific society of colorectal cancer, and president of Korean coloproctology and also president of Korean society of surgical oncology and president of Korean colorectal cancer study group. He published over 390 peer reviewed articles and author of chapter and books.

 

About this video

Author(s)
Nam Kyu Kim
DOI
https://doi.org/10.1007/978-981-33-6123-2
Online ISBN
978-981-33-6123-2
Total duration
34 min
Publisher
Springer, Singapore
Copyright information
© Springer Nature Singapore Pte Ltd. 2020

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Video Transcript

[MUSIC PLAYING]

In this session, I’d like to tell about the minimally invasive intersphincteric resection with a lymph node dissection for low rectal cancer.

The first part of presentation will be case presentation. A 65-year-old lady she complain of the hematochezia. She doesn’t have any specific medical history and surgical history. Colonoscopy found that the ulcerofungating mass was noted just at three centimeters from the end approach.

And the left side photo is initial colonoscopy finding. But we planning to give the long-course chemoradiation treatment in this patient. And the six weeks after completion with a period of long-course chemo-radiation, colonoscopy found masses shrinked. We think as you can get good tumor response And then you can see the right side of colonoscopy finding and this is after CRT.

And also I try to show the initial MRI of the patients. As you can see, the coronal T2 images show that tumor seems to be involve the internal sphincter, as you can see, but not beyond to the external sphincter. So we think about the tumor is just confined to the internal sphincter.

So we are planning to ISR. After CRT as you can see the marked decreased in the tumor size, and mainly the tumor replaced by fibrotic tissues. So we proceeded to ISR procedures. So also rectal exam and endoscopic ultrasound examination was as well done.

So we proceed with robotic intersphincteric resection with a lymph node dissection.