Abstract
Background
Since 2018, we have performed robotic rectal cancer surgery at our institution via the umbilical mini-laparotomy-first approach. In the present technical note, we introduce the advantages of this approach.
Methods
In this approach, a 3-cm mini-laparotomy and the wound protector attachment are performed prior to port placement for the da Vinci® Xi system. During robotic surgery, the assistant can adjust the location of the camera port within the wound protector.
Results
This approach is only different from the standard port placement in terms of the timing of minilaparotomy; therefore, there is no additional cost. This approach has several advantages. 1: Intraabdominal adhesion around the umbilicus can be dissected under direct vision. 2: Robot arm collision can be diminished. 3: The diverting stoma can be located just at the preoperative stoma-site marking. 4: The da Vinci® camera is less likely to be dirty. 5: Assistant ports can be added through the wound protector. However, sometimes interference between the wound protector extends inside the abdomen and other ports can be a problem, especially in small patients. A smaller-size wound protector is thus recommended in such cases.
Conclusions
The umbilical minilaparotomy-first approach in robotic rectal cancer surgery is a simple and feasible technique with great advantages for not only ensuring successful robotic surgery but also reducing the stoma-associated complications.
This is a preview of subscription content, log in via an institution to check access.
References
Phan K, Kahlaee HR, Kim SH, Toh JWT (2019) Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol 23(3):221–230. https://doi.org/10.1007/s10151-018-1920-0
Polat F, Willems LH, Dogan K, Rosman C (2019) The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study. Surg Endosc 33(11):3644–3655. https://doi.org/10.1007/s00464-018-06653-2
Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R et al (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg 270(1):59–68. https://doi.org/10.1097/sla.0000000000003227
Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A et al (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 267(6):1034–1046. https://doi.org/10.1097/sla.0000000000002523
Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2016) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today 46(8):957–962. https://doi.org/10.1007/s00595-015-1266-4
Aliyev V, Arslan NC, Goksoy B, Guven K, Goksel S, Asoglu O (2022) Is robotic da Vinci Xi® superior to the da Vinci Si® for sphincter-preserving total mesorectal excision? Outcomes in 150 mid-low rectal cancer patients. J Robot Surg. https://doi.org/10.1007/s11701-021-01356-8
Yamaguchi T, Akiyoshi T, Fukunaga Y, Nagayama S, Nagasaki T, Mukai T et al (2020) Robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection for rectal cancer. Tech Coloproctol 24(10):1093–1094. https://doi.org/10.1007/s10151-020-02256-z
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hiyoshi, Y., Yamaguchi, T., Matsuura, N. et al. Advantages of the umbilical minilaparotomy-first approach in robotic rectal cancer surgery. Tech Coloproctol 27, 71–74 (2023). https://doi.org/10.1007/s10151-022-02662-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-022-02662-5