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Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer

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Abstract

Background

Our objective was to evaluate the quality of surgery regarding application of the robotic approach to perform D3 lymph node dissection over the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) and autonomic nerves for the treatment of distal rectal cancer, which has not been reported before, although it has been successfully performed by some surgeons laparoscopically.

Methods

Patients with distal rectal cancer posing risk factors for anastomotic leakage were recruited and underwent the present robotic procedure, which was standardized and presented in the attached video file. Patients’ surgical outcomes were prospectively evaluated.

Results

A total of 26 patients with distal rectal cancer were operated on via the present robotic approach. The number of cleared lymph nodes was 26.1 ± 7.2 (range 10–44). The operation time was 307.3 ± 74.1 min (including docking time). The blood loss was 190.5 ± 225.8 ml. Anastomotic leakage occurred in one (1/16, 6 %) patient without preoperative chemoradiation therapy, and wound infection of port sites was detected in two (2/26, 7.6 %) patients. The patients had quick convalescence, as evaluated by the recovery of flatus passage (48.0 ± 12.0 h), hospitalization (14.6 ± 4.8 days), and degree of postoperative pain (2.5 ± 0.5, visual analog scale). The median duration for indwelling urine Foley catheter was 6.0 days (range 3.0–28). The voiding function after removal of the urine Foley catheter was good (International Prostate Score Symptom [IPSS] 0–7) in 22 (84.6 %) patients, fair (IPSS 8–14) in three (11.5 %), and poor (IPSS 15–35) in one (3.8 %). The median time of return to partial activity, full activity, and work was 2.0, 4.0, and 6.0 weeks, respectively.

Conclusions

By using the three-armed Da Vinci® robotic system in our clinical setting, quality surgery of the D3 lymph node dissection around the IMA with preservation of the LCA and autonomic nerves, in which the adequacy of lymph node harvest and the security of blood supply over distal colon were juggled, can be achieved for patients with distal rectal cancer posing risk factors of anastomotic failure.

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Disclosure

The authors, Dr. Jin-Tung Liang and Dr. Hong-Shiee Lai have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Jin-Tung Liang.

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Supplementary material 1 (MPG 9368 kb)

Supplementary material 2 (MPG 9981 kb)

Supplementary material 3 (MPG 9995 kb)

Supplementary material 4 (MPG 9967 kb)

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Liang, J., Lai, H. Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer. Surg Endosc 28, 1727–1733 (2014) doi:10.1007/s00464-013-3340-6

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Keywords

  • Robotic surgery
  • LCA preservation
  • D3 lymphadenectomy
  • Rectal cancer