Anatomic Landmarks for Transabdominal Robotic-Assisted Intersphincteric Dissection for Ultralow Anterior Resection

Piozzi, Guglielmo Niccolò; Park, Hyunmi; Kim, Jinhyun; Choi, H C; Lee, Tae‐Hoon; Baek, Sehyun; Kwak, Jung‐Myun; Kim, Jin; Kim, Seon Hahn

doi:10.1097/dcr.0000000000001988

Cited by 16 publications

(27 citation statements)

References 9 publications

(14 reference statements)

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“…Three different regions (posterior, anterior, and lateral) characterize the deep pelvis, each with specific anatomical landmarks for a correct oncologically safe dissection of the intersphincteric plane (ISP) [ 20 , 21 ].…”

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

“…The ISP is located between the outer surface of the LM and the inner surface of the EAS. The HL is the surgical landmark for the posterior region of the deep pelvis and has to be dissected close to the posterior aspect of the rectum to access the posterior ISP [ 21 ]. Care must be taken not to perforate the rectum anteriorly or run through the RIP, into the deep post-anal space, posteriorly.…”

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

“…Because of the deep and anterior location of the RU, its visualization and dissection are challenging through open and laparoscopic approaches, according to the authors’ experience. The robotic platform, with a magnified three-dimensional stereoscopic view, optimizes the identification of the RU that appears as small bundles of fibers detaching from the LM and running anteriorly on a plane parallel to the pelvic floor [ 21 ].…”

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

“…The Denonvilliers’ fascia and the RU are the anterior landmarks for the correct anterior dissection in males during an ISR, while the RVS and the anterior dense area of muscular intermingling are for the females. Because the anterior region misses a clear surgical plane, the anterolateral region of the rectum should be previously dissected to optimize the anterior dissection during ISR [ 21 , 33 ].…”

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

“…Third, the overlap between the LAM and the EAS increases as it moves posteriorly [ 30 ]. The surgical landmark for a correct lateral dissection is the plane found between the medial edge of the LAM (that can be easily identified through muscle contraction with electrocautery) and the rectum [ 21 ].…”

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

See 4 more Smart Citations

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

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The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.

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Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

Section: Anatomy Of the Deep Pelvismentioning

confidence: 99%

See 3 more Smart Citations

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

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Quality of laparoscopic camera navigation in robot‐assisted versus conventional laparoscopic surgery for rectal cancer: An analysis of surgical videos through a video processing computer software

Kim

Piozzi

Kwak

et al. 2022

Robotics Computer Surgery

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Background To compare laparoscopic camera navigation (LCN) quality between robot‐assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS). Methods 20 recordings were selected by propensity score matching and subjected to Python® software to generate single frames at one second intervals. For each frame, the pixel where the camera should be centred, based on instrument position, current action (dissection/haemostasis/traction) in the frame, was detected. LCN quality was reviewed by two independent surgeons to evaluate erroneous LCN. Results RALS had higher incidence of centred views (83.1 ± 4.02% vs. 76.0 ± 2.38%, p < 0.05) and a shorter distance between actual and optimal frame centres (123.3 ± 9.8 vs. 144.8 ± 13.9, p < 0.05) compared to CLS. Erroneous camera navigations were more frequent in CLS regarding total time of horizontal alignment failure (2.1 ± 2.2 vs. 6.0 ± 5.4 min, p = 0.063) and number of excessive zoom‐in visualization (0.1 ± 0.3 vs. 1.9 ± 1.4, p = 0.003). Conclusions RALS provided higher LCN quality than did CLS, emphasising the benefits of a surgeon‐controlled view.

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Robotic intersphincteric resection for low rectal cancer: a cumulative sum analysis for the learning curve

Gao,

Pan,

et al. 2024

Surg Today

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Anatomic Landmarks for Transabdominal Robotic-Assisted Intersphincteric Dissection for Ultralow Anterior Resection

Cited by 16 publications

References 9 publications

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Quality of laparoscopic camera navigation in robot‐assisted versus conventional laparoscopic surgery for rectal cancer: An analysis of surgical videos through a video processing computer software

Robotic intersphincteric resection for low rectal cancer: a cumulative sum analysis for the learning curve

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