Totally Robotic Low Anterior Resection

  • J. Joshua Smith
  • Leandro Feo
  • Julio Garcia-AguilarEmail author


Rectal cancer surgery is complex and technically challenging. This is largely because the surgical field is in the bony pelvis, a restrictive anatomical area. Robotic technology allows the surgeon to maneuver, despite these restrictions, in a more precise and safe way. From the surgeon’s point of view, the superior precision and dexterity of the four-arm da Vinci robotic system (Intuitive) give it a clear advantage over conventional laparoscopy. Robotic low anterior resection (LAR) is for patients who present with mid and low rectal cancers that do not invade the sphincters. A thorough understanding of the principles of total mesorectal excision (TME) and an adequate yearly volume of rectal surgical procedures are required to ensure patient safety and optimal perioperative and oncologic outcomes. Recent review of outcomes associated with robotic-assisted colorectal surgery, laparoscopic, and open surgical approaches indicates that robotic surgical approaches are safe and feasible with comparable short-term and long-term outcomes to open and laparoscopic procedures. In this chapter we describe our rationale, technique, and considerations for robotic LAR.


Rectal cancer Total mesorectal excision (TME) Low anterior resection (LAR) Robotic total mesorectal excision (RTME) 

Supplementary material

Video 22.1

In this video, the surgeon demonstrates his approach to totally robotic low anterior resection. (WMV 111692 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • J. Joshua Smith
    • 1
  • Leandro Feo
    • 1
  • Julio Garcia-Aguilar
    • 2
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryBenno C. Schmidt Chair in Surgical Oncology, Memorial Sloan Kettering Cancer CenterNew YorkUSA

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