Robotic total intersphincteric resection with total mesorectal excision in low rectal cancer – a video vignette

Abstract

We present a stepwise approach to performing laparoscopic anterior resection along with Total Mesorectal Excision (TME). The video illustrates a modular approach for set up and resection, performed on a 68-years old female patient with low rectal cancer. We have divided the procedure into its key steps, which include: patient position, port placement and anatomical exposure, medial to lateral dissection and vessel control, lateral and splenic flexure mobilisation, TME and division and anastomosis of the rectum. We have included animated graphics highlighting key regional anatomy. We also believe that using monopolar hook diathermy allows precise dissection and helps in the clear demonstration of surgical planes. This is valuable when teaching the steps of the surgery to trainees.

Comparative study of functional outcomes between ultra‐low anterior resection and inter‐sphincteric resection: a propensity matched analysis

“…No colonic pouch was created in any of the ISR patients. Both the abdominal and perineal inter‐sphincteric dissections techniques have been previously described 12,13 …”

“…Both the abdominal and perineal inter-sphincteric dissections techniques have been previously described. 12,13 All patients underwent a diverting ostomy at the time of surgery that was closed on completion of adjuvant chemotherapy or at least 3 months after surgery in patients not receiving adjuvant therapy. All patients received postoperative sphincter rehabilitation with pelvic floor exercises.…”