International Journal of Colorectal Disease

, Volume 32, Issue 8, pp 1137–1145 | Cite as

Robot-assisted intersphincteric resection facilitates an efficient sphincter-saving in patients with low rectal cancer

  • Jin Cheon KimEmail author
  • Jong Lyul Lee
  • Abdulrahman Muaod Alotaibi
  • Yong Sik Yoon
  • Chan Wook Kim
  • In Ja Park
Original Article



Few investigations of robot-assisted intersphincteric resection (ISR) are presently available to support this procedure as a safe and efficient procedure. We aimed to evaluate the utility of robot-assisted ISR by comparison between ISR and abdominoperineal resection (APR) using both robot-assisted and open approaches.


The 558 patients with lower rectal cancer (LRC) who underwent curative operation was enrolled between July 2010 and June 2015 to perform either by robot-assisted (ISR vs. APR = 310 vs. 34) or open approaches (144 vs. 70). Perioperative and functional outcomes including urogenital and anorectal dysfunctions were measured. Recurrence and survival were examined in 216 patients in which >3 years had elapsed after the operation.


The robot-assisted approach was the most significant parameter to determine ISR achievement among potent parameters (OR = 3.467, 95% CI = 2.095–5.738, p < 0.001). Early surgical complications occurred more frequently in the open ISR group (16 vs. 7.7%, p = 0.01). The voiding and male sexual dysfunctions were significantly more frequent in the open ISR (p < 0.05). The fecal incontinence and lifestyle alteration score was greater in the open ISR than in the robot-assisted ISR at 12 and 24 months, respectively (p < 0.05). However, the 3-year cumulative rates of local recurrence and survival did not differ between the two groups.


The current procedure of robot-assisted ISR replaced a significant portion of APR to achieve successful SSO via mostly transabdominal approach and double-stapled anastomosis. The robot-assisted ISR with minimal invasiveness might be a help to reduce anorectal and urogenital dysfunctions.


Rectal cancer Intersphincteric resection Abdominoperineal resection Robot Open 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Role of the funding source


Supplementary material

384_2017_2807_Fig4_ESM.gif (291 kb)
Supplementary Fig 1

Completely trans-abdominal ISR (A) and trans-abdominal ISR combined with trans-anal ISR. Longitudinal sections demonstrate evenly dissected circumferential margin in the former (A, right) and curvilinear or layered one in the latter (B, left). ① mucosa and submucosa, ② internal anal sphincter, ③ intersphincteric longitudinal muscle. (GIF 290 kb)

384_2017_2807_MOESM1_ESM.tif (3.1 mb)
High resolution image (TIFF 3140 kb)
384_2017_2807_MOESM2_ESM.docx (17 kb)
Supplementary Table 1 Parameters associated delayed operative time during robot-assisted ISR. (DOCX 17 kb)
384_2017_2807_MOESM3_ESM.docx (19 kb)
Supplementary Table 2 Parameters associated with an increased incontinence score at postoperative 6, 12, and 24 months in patients who underwent robot-assisted ISR. (DOCX 19 kb)
384_2017_2807_MOESM4_ESM.docx (18 kb)
Supplementary Table 3 Parameters associated with an increased incontinence score at postoperative 6, 12, and 24 months in patients who underwent open ISR. (DOCX 18 kb)
384_2017_2807_MOESM5_ESM.mp4 (73.5 mb)
Supplementary video-clip 1 (MP4 75289 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Jin Cheon Kim
    • 1
    Email author
  • Jong Lyul Lee
    • 1
  • Abdulrahman Muaod Alotaibi
    • 1
  • Yong Sik Yoon
    • 1
  • Chan Wook Kim
    • 1
  • In Ja Park
    • 1
  1. 1.Department of Surgery, College of Medicine and Institute of Innovative Cancer Research, Asan Medical CenterUniversity of UlsanSeoulSouth Korea

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