Standardizing robotic transanal minimally invasive surgery in lithotomy using the Xi platform – a video vignette

Abstract

before establishing the TaTME plane posteriorly first, before proceeding laterally then anteriorly. The dissection was continued superiorly towards the peritoneal reflection, positively identifying important landmarks anteriorly, including periprostatic tissue and the endopelvic fascia, maintaining a complete mesorectal envelope. Once the peritoneal cavity was breached circumferentially, the dissection was continued through the transabdominal approach. Conventional robotic anterior resection and transabdominal TME is performed with mobilization of the splenic flexure to provide a tension-free anastomosis. Our preference is to extract the specimen through a Pfannenstiel incision, especially for a bulky mesorectum and tight anal sphincter, in order to prevent tractional injury [7]. A conventional TaTME end-to-end colorectal anastomosis was performed with a Covidien haemorrhoidal stapler (DST Series TM Technology, Covidien, Dublin, Ireland), with a covering loop ileostomy through a right iliac fossa port site. The total operative time was 210-250 min for the transanal phase and 160 min for the transabdominal phase. We have presented a novel modification of the Da Vinci Xi robotic platform, to perform a single-surgeon total robotic transabdominal TME and TaTME. We have demonstrated the feasibility of this novel approach and an expansion of the use of the Da Vinci Xi platform.