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Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization

Surgical Endoscopy volume 23, pages 447–451 (2009)Cite this article

Abstract

Some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of the robotic da Vinci system, and its use in gastrointestinal procedures is evolving. However, difficulties accessing multiple quadrants of the abdomen with the first robotic system led to a rather slow introduction of the da Vinci into the field of abdominal surgery compared with its success with urologic and cardiac procedures. The new da Vinci S HD system offers improved range of motion that allows for easier access to a wider surgical field. The authors developed a new “one-step” setup to perform a low anterior resection with total mesorectal excision and splenic flexure mobilization for rectal cancer using a completely robotic approach. This technical report describes all the major aspects for successful performance of this complex minimally invasive procedure.

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References

  1. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068

    Google Scholar 

  2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term end points of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 365:1718–1726

    Google Scholar 

  3. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Google Scholar 

  4. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424

    PubMed  Article  Google Scholar 

  5. Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173

    PubMed  Article  Google Scholar 

  6. Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782

    PubMed  Article  Google Scholar 

  7. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21

    PubMed  Article  Google Scholar 

  8. DeNoto G, Rubach E, Ravikumar TS (2006) A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A 16:551–556

    PubMed  Article  Google Scholar 

  9. D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168

    PubMed  Article  Google Scholar 

  10. Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20:1713–1718

    PubMed  Article  CAS  Google Scholar 

  11. Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14:311–315

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Minia Hellan & Alessio Pigazzi

  2. Department of Clinical Development Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA

    Hubert Stein

Authors
  1. Minia Hellan
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  2. Hubert Stein
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  3. Alessio Pigazzi
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Correspondence to Alessio Pigazzi.

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Hellan, M., Stein, H. & Pigazzi, A. Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc 23, 447–451 (2009). https://doi.org/10.1007/s00464-008-0193-5

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  • DOI: https://doi.org/10.1007/s00464-008-0193-5

Keywords

  • Totally robotic rectal resection
  • Robotic surgery
  • Rectal cancer
  • Total mesorectal excision