Techniques in Coloproctology

, Volume 21, Issue 11, pp 893–895 | Cite as

Totally robotic single docking low anterior resection for rectal cancer: pearls and pitfalls

  • J. W. T. Toh
  • A. Zakaria
  • I. Yang
  • S. H. KimEmail author
How I do it


Total robotic resection of mid- and low rectal cancers confers technical advantages within the confines of the pelvis and allows difficult rectal cancer cases to be performed efficiently with less risk of conversion to open. To maximize the advantage of robotic surgery, we utilize the technique of single docking totally robotic dissection for rectal cancer for both the Da Vinci Si and Xi Surgical Systems. All steps are performed robotically, with the surgery divided into two phases. The first phase consists of inferior mesenteric artery and vein ligation, sigmoid and descending colon mobilization and splenic flexure takedown. Phase two is rectal dissection and pelvic total mesorectal excision. In this article, which is complemented by a video, we describe in detail our surgical technique for totally robotic dissection for rectal cancer using a standardized ‘medial to lateral’ approach with emphasis on the pearls and pitfalls of this surgery.


Colorectal surgery Robotic surgery Single docking Rectal Cancer Total mesorectal excision 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. Dr. James W. T. Toh received the Royal Australian College of Surgeons Morgan Travelling Fellowship to visit Korea University Anam Hospital as the International Visiting Surgeon in Robotic Surgery.


This study was not funded.

Ethical approval

This study is in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained for the surgical procedure. All patient information was de-identified and no formal consent was required for the study.

Supplementary material

Supplementary material 1 (MP4 467559 kb)


  1. 1.
    Kim J, Baek SJ, Kang DW et al (2017) Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum 60(3):266–273PubMedGoogle Scholar
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    Kamali D, Omar K, Imam SZ, Jha A, Reddy A, Jha M (2017) Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum. Tech Coloproctol 21:355–361. CrossRefPubMedGoogle Scholar
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    Toh JWT, Kim SH (2017) Port positioning and docking for single-stage totally robotic dissection for rectal cancer surgery with the Si and Xi Da Vinci surgical system. J Robot Surg. PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • J. W. T. Toh
    • 1
    • 2
  • A. Zakaria
    • 1
  • I. Yang
    • 1
  • S. H. Kim
    • 1
    Email author
  1. 1.Division of Colorectal Surgery, Department of Surgery, South Korea University Anam HospitalKorea University College of MedicineSeoulSouth Korea
  2. 2.Division of Colorectal Surgery, Department of Surgery, Westmead HospitalThe University of Sydney Westmead Clinical SchoolSydneyAustralia

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