Abstract
Since total mesorectal excision (TME) was introduced in 1982 [1], it has become a standard procedure for the treatment of rectal cancer. For low rectal cancer, coloanal anastomosis (CAA) [2] after ultralow anterior resection (uLAR) or intersphincteric resection (ISR) [3] along with TME has provided positive functional, psychological, and oncological outcomes. These outcomes of surgical techniques are also owed to the development of anatomical knowledge and perioperative treatment [4]. Robotic systems offer surgeons several benefits, though there have been controversial issues. Recent reports have indicated that robotic surgery is feasible and safe compared to laparoscopic surgery [5–7]. Robotic surgery enables easier performance of intersphincteric dissection for very low-lying rectal cancer, especially when accompanied with unfavorable factors such as high body mass index or preoperative radiation, leading to satisfactory surgical, functional, and oncological outcomes compared to conventional laparoscopy [8]. It also provides earlier recovery of sexual and bladder functions [6], lower conversion rate, and shorter hospital stay [9]. Although multicenter, randomized prospective trials are needed, robot-assisted TME with CAA with or without ISR has potential benefits for low rectal cancer.
In this chapter, the authors introduce the robotic approach of TME with CAA, which is performed with or without ISR. The procedures include patient positioning, trocar placement, docking, abdominal/pelvic phases, and useful technical tips as well as CAA and ISR.
References
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.
Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg. 1982;69(6):301–4.
Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81(9):1376–8.
Rullier E, Goffre B, Bonnel C, Zerbib F, Caudry M, Saric J. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg. 2001;234(5):633.
Leong QM, Son DN, Cho JS, Baek SJ, Kwak JM, Amar AH, et al. Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc. 2011;25(9):2987–92.
Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc. 2013;27(1):48–55.
Kuo LJ, Lin YK, Chang CC, Tai CJ, Chiou JF, Chang YJ. Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis. 2014;29(5):555–62.
Yoo B-E, Cho J-S, Shin J-W, Lee D-W, Kwak J-M, Kim J, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol. 2015;22(4):1219–25.
Baek SJ, Sami A-A, Jeong DH, Hur H, Min BS, Baik SH, et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc. 2013;27(11):4157–63.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Japan
About this chapter
Cite this chapter
Kwak, H.D., Kim, SH. (2018). Robot-Assisted TME with Coloanal Anastomosis. In: Dapri, G., Marks, J. (eds) Surgical Techniques in Rectal Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55579-7_18
Download citation
DOI: https://doi.org/10.1007/978-4-431-55579-7_18
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-55578-0
Online ISBN: 978-4-431-55579-7
eBook Packages: MedicineMedicine (R0)