Avoid common mistakes on your manuscript.
Recently, the adoption of robot-assisted surgery for rectal cancer has been increasing. External manipulation through a small umbilicus or Pfannenstiel incision is the mainstream to perform the anastomosis with EEA stapler. Herein, we report a robotic surgery for rectal cancer resection with complete intracorporeal double-stapling technique (CI-DST). Whether intracorporeal or extracorporeal anastomosis is planned, mechanical bowel preparation with isotonic polyethylene glycol and sennoside, and chemical bowel preparation with kanamycin and metronidazole are performed on the day before surgery. We will present the CI-DST technique in the low anterior resection (total mesorectal excision). Operative time was 272 min in this case.
There are some advantages in performing CI-DST. First, as the docking/undocking can be omitted, the ability to continuously maintain pneumoperitoneum allows for continuous surgical field development without the small intestine falling into the pelvis. Our standard port placement for rectal cancer resection is to place the camera port at the umbilicus using E-Z Access™ and Lap Protector™ (Hakko, Nagano, Japan) and remove the specimen from the same site. If a transverse low-abdomen incision (like Pfannenstiel) is used, it may be beneficial in terms of hernia reduction. Second, the stability and multi-articulation of robotic surgery enables us to perform intracorporeal dissection and suturing, which is easier compared to laparoscopic surgery. Third, before the anvil head is placed, blood flow can be confirmed by indocyanine green on both the proximal and distal sides simultaneously. Fourth, we believe this surgical procedure is advantageous for future remote surgeries, as there is no need for manipulation outside the body, allowing one remote surgeon and one local assistant to perform the anastomosis.
The disadvantage is the incision length, which is slightly longer than that with the natural orifice specimen extraction (NOSE) technique [1,2,3]. However, we believe that this technique is universal and is not affected by the site of the tumor or oncologic factors. It has been reported that NOSE can result in a slightly increased incidence of local recurrence for deep tumors (T4) [1, 4]. In addition, it is difficult to extract bulky tumors from the rectum. Furthermore, whether using the anastomosis with a circular stapler or single stapling technique, anastomosis cannot be performed after specimen removal unless a slightly longer distal margin is taken. Although there is no data with strong evidence for oncologic outcomes with robotic rectal surgery, this procedure may be an optimal alternative to extracorporeal anastomosis or NOSE, emphasizing the continuity with the conventional anastomosis that had been performed universally and can be used for any rectal cancer.
Date availability
This manuscript does not report data generation or analysis.
References
Chang SC, Lee TH, Chen YC et al (2021) Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study. Surg Endosc. https://doi.org/10.1007/s00464-020-08250-8
Zhou ZQ, Wang K, Du T et al (2020) Transrectal natural orifice specimen extraction (NOSE) with oncological safety: a prospective and randomized trial. J Surg Res 254:16–22. https://doi.org/10.1016/j.jss.2020.03.064
Wolthuis AM, Buck van Overstraeten A, D’Hoore A (2014) Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol. https://doi.org/10.3748/wjg.v20.i36.12981
Kim HJ, Choi GS, Park JS, Park SY, Ryuk JP, Yoon SH (2014) Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study. Surg Endosc 28:2342–2348. https://doi.org/10.1007/s00464-014-3466-1
Funding
None.
Author information
Authors and Affiliations
Contributions
Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: Junichi Mazaki, Tetsuo Ishizaki Drafting the work or revising it critically for important intellectual content: Yu Kuboyama, Ryutaro Udo, Tomoya Tago, Kenta Kasahara, Kenichi Iwasaki, Yuichi Nagakawa
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Informed consent
This study was reviewed and approved by the institutional review board of our institute, and the requirement for written informed consent was waived due to the retrospective design.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 236874 KB)
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Mazaki, J., Ishizaki, T., Kuboyama, Y. et al. Robotic surgery for rectal cancer resection with complete intracorporeal double-stapling technique. Tech Coloproctol 28, 54 (2024). https://doi.org/10.1007/s10151-024-02935-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10151-024-02935-1