Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report

Abstract

BackgroundApproximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so.Case presentationAn 80-year-old man with incomplete paralysis of the lower limbs as well as bladder–rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO.ConclusionsRALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.

Oncologic impact of colonic stents for obstructive left-sided colon cancer

“…The safety and efficacy of robot-assisted laparoscopic surgery after SEMS placement have also been reported recently[ 64 ]. Li et al [ 65 ] analyzed 79 cases where SEMS placement was performed for OCC in the largest single center in Singapore from 2013 to 2020.…”

Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST)

“…Surgical procedures, other than the mesorectal division, were the same in both the SST and conventional RALS (non-SST) groups. We performed procedures in both the colonic phase and pelvic phase using the surgical robotic system, da Vinci Si Surgical System (Intuitive Surgical, Inc.) with a single docking technique from the left caudal direction to the patient, as previously reported [10]. The standardized operative procedures for TSME were according to the guidelines for the treatment of colorectal cancer of the Japanese Society for Cancer of the Colon and Rectum [16].…”

“…Generally, robot-assisted laparoscopic surgery (RALS) has advantages over conventional laparoscopic surgery because of the former's ability to allow delicate operations with a stable operating view of the deep and narrow pelvis with the three-dimensional (3-D) view scope and the flexible robotic instruments [10]. However, even in some cases of RALS, mesorectal division remains difficult.…”