Totally Robotic Low Anterior Resection
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.
KeywordsRectal cancer Total mesorectal excision (TME) Low anterior resection (LAR) Robotic total mesorectal excision (RTME)
In this video, the surgeon demonstrates his approach to totally robotic low anterior resection. (WMV 111692 kb)
- 1.McKay GD, Morgan MJ, Wong SK, Gatenby AH, Fulham SB, Ahmed KW, et al. Improved short-term outcomes of laparoscopic versus open resection for colon and rectal cancer in an area health service: a multicenter study. Dis Colon Rectum. 2012;55(1):42–50. doi: 10.1097/DCR.0b013e318239341f.PubMedCrossRefGoogle Scholar
- 4.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26. doi: 10.1016/s0140-6736(05)66545-2.PubMedCrossRefGoogle Scholar
- 21.Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010;24(11):2888–94. doi: 10.1007/s00464-010-1134-7.PubMedCrossRefGoogle Scholar
- 23.Patel CB, Ragupathi M, Ramos-Valadez DI, Haas EM. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperaive and postoperative outcomes in minimally invasive colorectal surgery. Dis Colon Rectum. 2011;54(2):144–50. doi: 10.1007/DCR.0b013e3181fec377.PubMedCrossRefGoogle Scholar
- 29.Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg. 2014. doi: 10.1097/SLA.0000000000000613.