Recurrent perineal hernia repair: perineal approach – a video vignette

Abstract

Less frequently, they are located along the digestive tract. Rectal leiomyoma is a rare entity, comprising about 0.03%-0.05% of all rectal tumours [1]. Robotic surgery has been proposed over the last decade as a valid option to treat gastrointestinal neoplasms with different grades of malignancy in a minimally invasive method [2]. The most convincing indications for robotic surgery are procedures that involve a small, narrow operating field or that require extreme accuracy, fine dissection and endoscopic suturing. Thus, the major technical advantages of robot assistance in benign or low-malignant lesions may be appreciated in terms of an organ-preserving procedure for critical anatomical localization, such as a rectal leiomyoma [3]. We present the case of a 54-year-old woman (body mass index 26.7) with a 7 9 5 9 3.5 cm leiomyoma located posterolaterally to the middle-low rectum. Surgery was carried out with the da Vinci robot system Xiâ (Intuitive Surgical, Sunnyvale, California, USA) with a single docking approach. Six trocars were used. The patient underwent a total robotic transabdominal extra-mucosal rectal enucleation. A direct hand-sewn suture of the incision was performed. The hydropneumatic test was negative. Histological examination confirmed the diagnosis of leiomyoma. The postoperative period was uneventful, and the patient was discharged after 5 days. Video S1 shows that robotics represent a valid option for organ-preserving surgical treatment of benign or low-malignant neoplasms in difficult anatomical locations.