Robotic Low Anterior Resection with Pelvic Autonomic Nerve Preservation

  • Nam Kyu Kim

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This video describes how to perform robotic low anterior resection with total mesorectal excision (TME) and preservation of the pelvic autonomic nervous system based on detailed knowledge of surgical anatomy. All essential components of this robotic procedure for the treatment of rectal cancer are clearly explained. After description of the surgical anatomy, patient preparation is outlined and all steps in the procedure are presented, including medial dissection, high or low ligation of the inferior mesenteric vessels, lateral dissection, mobilization of the splenic flexure, TME with autonomic nerve preservation, and anastomosis. The video will assist in the minimally invasive, safe performance of complete TME and in the achievement of optimal oncologic and functional outcomes.


Ho Seung Kim (Department of surgery, Yonsei University College of Medicine)

Eman Adnan Zakarneh (Department of general surgery, king Fahad military medical complex, Saudi Arabia)

Manar Mohammed Nassr (Royal Hospital, Ministry of health, Oman)


This video describes step by step the performance of robotic low anterior resection with total mesorectal excision and preservation of the pelvic.

About The Author

Nam Kyu Kim

Dr. Nam Kyu Kim had performed over 10,000 cases of colorectal cancer so far, since2003, he started laparoscopic surgery for colorectal cancer. There after 2007 he also started robotic approach for rectal cancer, another over 2,000 cases would be IBD, diverticular disease and benign anorectal disease. He has served as 1st president of Asian pacific society of colorectal cancer, and president of Korean coloproctology and also president of Korean society of surgical oncology and president of Korean colorectal cancer study group. He published over 390 peer reviewed articles and author of chapter and books.


About this video

Nam Kyu Kim
Online ISBN
Total duration
42 min
Springer, Singapore
Copyright information
© Springer Nature Singapore Pte Ltd. 2020

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Video Transcript


Let me talk about the case presentation of the robotic low anterior resection for rectal cancer. 49-year-old gentlemen– actually, he doesn’t have any medical history. He underwent colonoscopy for physical check-up. We found the mass in the rectum, and the tissue confirmed adenocarcinoma.

As you can see, the endoscope findings show that ulcerofungating mass at 8 centimeter from the anal verge. Based on the MRI of the rectum, it seems to be clinical T3 and node positive. So we recommend preoperative chemoradiation, and then he received this treatment. And we restaged him with an MRI seven weeks after completion of the long course chemoradiation.

As you can see, the sagittal view and transverse view of the rectal MRI, it shows that it decreases in size of primary rectal cancer. And also, the tumor can be down staged with the fibrosis with mrTRG 3. But fortunately, tumor doesn’t have any CRM involvement, and also, there’s no evidence of EMVI, and possibly, no other nodal enlargement at the mesorectum.

So we’re planning to– robotic low anterior resection with the pelvic autonomic-nerve preservation. Thank you.