Considerations in the Robotic Case

  • Hester Y. S. CheungEmail author
  • Cliff C. C. Chung
  • Michael K. W. Li


This chapter outlines the use of the robot in colorectal surgery, defining the benefits and the operative set-up. Robotic-assisted colorectal surgery has developed as a natural extension of advanced laparoscopy, providing potential improvements in operative view and operative instrumental dexterity. This particularly applies in the limited pelvic environment, with improvements in precise movement and fine tissue dissection, and is discussed as a translation from the urological experience in the management of prostate cancer to the field of pelvic coloproctology.


Robotic-assisted laparoscopic surgery Total mesorectal excision (TME) Rectal cancer Sphincter-saving TME 

Supplementary material

VTS_01_1 (MP4 22,328 KB)


  1. 1.
    Fazio VW, Fletcher J, Montague D. Prospective study of the effect of resection of the rectum on male sexual function. World J Surg. 1980;4:149–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Chang PL, Fan HA. Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol. 1983;130:948–51.PubMedGoogle Scholar
  3. 3.
    Kinn AC, Ohman U. Bladder and sexual function after surgery for rectal cancer. Dis Colon Rectum. 1986;29:43–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Santangelo ML, Romano G, Sassaroli C. Sexual function after resection for rectal cancer. Am J Surg. 1987;154:502–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Masui H, Ike H, Yamaguchi S, Oki S, Shimada H. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum. 1996;39:1140–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996;182:495–502.PubMedGoogle Scholar
  7. 7.
    Enker WE, Havenga K, Polyak T, Thaler H, Cranor M. Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg. 1997;21:715–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM, Van de Velde CJ. Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg. 1998;85:92–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg. 2000;87:206–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, Min JS. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum. 2002;45:1178–85.PubMedCrossRefGoogle Scholar
  11. 11.
    Martel G, Boushey RP. Laparoscopic colon surgery: past, present and future. Surg Clin North Am. 2006;86:867–97.PubMedCrossRefGoogle Scholar
  12. 12.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg. 2004;239:14–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Patel VR, Chammas Jr MF, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract. 2007;61:309–14.PubMedCrossRefGoogle Scholar
  14. 14.
    Ballanttbe GH, Merola P, Weber A, et al. A robotic solutions to the pitfalls of laparoscopic colectomy. Osp Ital Chir. 2001;7:405–12.Google Scholar
  15. 15.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20:1521–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1061–8.Google Scholar
  17. 17.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional colorectal surgery. Dis Colon Rectum. 2003;46:1633–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Anvari M, Virch DW, Bamehriz F, Gryfe R, Chapman T. Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech. 2004;14:311–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum. 2008;51:1627–32.PubMedCrossRefGoogle Scholar
  20. 20.
    Chung CC, Ha JPY, Tsang WWC, Li MKW. Laparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction. Surg Endosc. 2001;15:1098–101.PubMedCrossRefGoogle Scholar
  21. 21.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group. MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter randomised controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRefGoogle Scholar
  22. 22.
    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;251:882–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Ng KH, Lim YK, Ho KS, Ooi BS, Eu KW. Robotic-assisted surgery for low rectal dissection: from better views to better outcome. Singapore Med J. 2009;50:763–7.PubMedGoogle Scholar
  24. 24.
    D’Annibale A, Pernazza G, Morpurgo E, Monsellato I, Pende V, Lucandri G, Termini B, Orsini C, Sovernigo G. Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease. Ann Surg Oncol. 2010;17:2856–62.PubMedCrossRefGoogle Scholar
  25. 25.
    de Souza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H. Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum. 2010;53:1000–6.CrossRefGoogle Scholar
  26. 26.
    Leong QM, Son DN, Cho JS, Baek SJ, Kwak JM, Amar AH, Kim SH. Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc. 2011;25(9):2987–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Patel CB, Ramos-Valadez DI, Haas EM. Robotic-assisted laparoscopic abdominoperineal resection for anal cancer: feasibility and technical considerations. Int J Med Robot. 2010;6:399–404.PubMedCrossRefGoogle Scholar
  28. 28.
    Pedraza R, Patel CB, Ramos-Valadez DI, Haas EM. Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis. Minim Invasive Ther Allied Technol. 2011;20(4):234–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Ragupathi M, Ramos-Valadez DI, Patel CB, Haas EM. Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature. Surg Endosc. 2011;25:199–206.PubMedCrossRefGoogle Scholar
  30. 30.
    Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L. Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg. 2009;16:450–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Gilbert JM. The EndoAssist robotic camera holder as an aid to the introduction of laparoscopic colorectal surgery. Ann R Coll Surg Engl. 2009;91:389–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M. The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc. 2006;20:1389–93.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Hester Y. S. Cheung
    • 1
    Email author
  • Cliff C. C. Chung
    • 1
  • Michael K. W. Li
    • 1
  1. 1.Department of SurgeryPamela Youde Nethersole Eastern HospitalHong KongChina

Personalised recommendations