Four-arm single docking full robotic surgery for low rectal cancer: techniques and post-operative outcomes

Abstract

Background laparoscopic rectal surgery has not yet achieved a high penetration rate because of its steep learning curve and its relatively high conversion rate. Robotic rectal resection represents the main indication of the use of the robotic platform in colorectal surgery. The aim of this study was to present an early experience with robotic surgery to treat mid and low rectal cancer focusing on the technique and early postoperative outcomes. Methods from December 2012 to October 2013, a total of 16 patients with colorectal diseases were operated on using a four-arm single docking full robotic procedure (daVinci Si Surgical System). The treatment of six consecutive patients who underwent robotic rectal cancer surgery for mid or low rectal adenocarcinoma was prospectively analyzed regarding technique standardization, pathological findings and postoperative outcomes. Results there were no conversions and one intraoperative complication. The mean operative time was 245 min (180–360 min). The mean console time was 170 min (110–240 min). All patients underwent a standardized totally robotic rectal dissection. There were no mortality or urinary dysfunction and one complication (postoperative ileo-16%). The median length of hospital stay was 6 (4–11 days). The median number of lymph nodes harvested was 22 (7–38), and distal and circumferential resection margins were negative in all specimen. R0 resection was achieved in all cases and complete total mesorectal excision in five specimen and nearly complete in one. Conclusion standardized robotic rectal surgery is a promising alternative to treat patients with mid or low rectal cancer and is expected to overcome the low penetration rate of laparoscopic surgery in this field. This technique was successfully performed in six patients with excellent immediate postoperative and pathological results. Additional studies in a large series of patients are necessary to confirm those advantages.

Lateral pelvic lymph node dissection for low rectal cancers: A review on current practice

“…The most favoured robotic system at present is the Da Vinci S (Intuitive Surgical, Sunnyvale, CA, USA). The system is docked between the legs of the patient, and once the colonic part of the operation has been completed, the fenestrated forceps is used to maintain steady traction on the vessel or fat, and the lymph node dissection is performed using hot shears (arm 1) and bipolar forceps (arm 2) …”