Advertisement

Totally Robotic Low Anterior Resection

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

Abstract

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.

Keywords

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)

References

  1. 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
  2. 2.
    Row D, Weiser MR. An update on laparoscopic resection for rectal cancer. Cancer Control. 2010;17(1):16–24.PubMedGoogle Scholar
  3. 3.
    Milsom JW, de Oliveira Jr O, Trencheva KI, Pandey S, Lee SW, Sonoda T. Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum. 2009;52((7)):1215–22. doi: 10.1007/DCR0b013e3181a73e81.CrossRefGoogle Scholar
  4. 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
  5. 5.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8. doi: 10.1200/jco.2006.09.7758.PubMedCrossRefGoogle Scholar
  6. 6.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10(1):44–52. doi: 10.1016/S1470-2045(08)70310-3.PubMedCrossRefGoogle Scholar
  7. 7.
    Kim JY, Kim YW, Kim NK, Hur H, Lee K, Min BS, et al. Pelvic anatomy as a factor in laparoscopic rectal surgery: a prospective study. Surg Laparosc Endosc Percutan Tech. 2011;21(5):334–9. doi: 10.1097/SLE.0b013e31822b0dcb.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim YW, Lee HM, Kim NK, Min BS, Lee KY. The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech. 2012;22(5):400–5. doi: 10.1097/SLE.0b013e3182622c2d.PubMedCrossRefGoogle Scholar
  9. 9.
    Baek SK, Carmichael JC, Pigazzi A. Robotic surgery: colon and rectum. Cancer J. 2013;19(2):140–6. doi: 10.1097/PPO.0b013e31828ba0fd.PubMedCrossRefGoogle Scholar
  10. 10.
    Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JR. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011;17(47):5214–20. doi: 10.3748/wjg.v17.i47.5214.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Wexner SD, Bergamaschi R, Lacy A, Udo J, Brolmann H, Kennedy RH, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc. 2009;23(2):438–43. doi: 10.1007/s00464-008-0202-8.PubMedCrossRefGoogle Scholar
  12. 12.
    Trakarnsanga A, Weiser MR. Minimally invasive surgery of rectal cancer: current evidence and options. Am Soc Clin Oncol. 2012;32:214–8. doi: 10.14694/EdBook_AM.2012.32.214.Google Scholar
  13. 13.
    Peterson CY, Weiser MR. Robotic colorectal surgery. J Gastrointest Surg. 2014;18(2):398–403. doi: 10.1007/s11605-013-2313-3.PubMedCrossRefGoogle Scholar
  14. 14.
    Hui VW, Guillem JG. Minimal access surgery for rectal cancer: an update. Nat Rev Gastroenterol Hepatol. 2014;11:158–65. doi: 10.1038/nrgastro.2013.203.PubMedCrossRefGoogle Scholar
  15. 15.
    Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22(7):1601–8. doi: 10.1007/s00464-008-9752-z.PubMedCrossRefGoogle Scholar
  16. 16.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16(6):1480–7. doi: 10.1245/s10434-009-0435-3.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg. 2014;18:816–30. doi: 10.1007/s11605-014-2469-5.PubMedCrossRefGoogle Scholar
  18. 18.
    Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg. 2010;251(5):882–6. doi: 10.1097/SLA.0b013e3181c79114.PubMedCrossRefGoogle Scholar
  19. 19.
    Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc. 2011;25(2):521–5. doi: 10.1007/s00464-010-1204-x.PubMedCrossRefGoogle Scholar
  20. 20.
    Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, et al. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 2010;17(6):1614–20. doi: 10.1245/s10434-010-0909-3.PubMedCrossRefGoogle Scholar
  21. 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
  22. 22.
    Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011;54(2):151–6. doi: 10.1007/DCR.0b013e3181fec4fd.PubMedCrossRefGoogle Scholar
  23. 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
  24. 24.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum. 2008;51(11):1627–32. doi: 10.1007/s10350-008-9334-0.PubMedCrossRefGoogle Scholar
  25. 25.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25(3):855–60. doi: 10.1007/s00464-010-1281-x.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Robot-assisted total mesorectal excision: is there a learning curve? Surg Endosc. 2012;26(9):2471–6. doi: 10.1007/s00464-012-2216-5.PubMedCrossRefGoogle Scholar
  27. 27.
    Turchetti G, Palla I, Pierotti F, Cuschieri A. Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc. 2012;26(3):598–606. doi: 10.1007/s00464-011-1936-2.PubMedCrossRefGoogle Scholar
  28. 28.
    Jimenez-Rodriguez RM, Diaz-Pavon JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis. 2013;28(6):815–21. doi: 10.1007/s00384-012-1620-6.PubMedCrossRefGoogle Scholar
  29. 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.

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

Personalised recommendations