Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis.

BACKGROUND

As the use of a surgical robot allows for improved dexterity and visual field, we successfully conducted transabdominal intersphincteric resection (ISR) and perineal coloanal anastomosis for a very low lying rectal cancer. The aim of this study was to evaluate the technical feasibility of this procedure.

MATERIALS AND

METHODS

Eight patients underwent robotic-assisted transabdominal ISR with coloanal anastomosis for low rectal cancers. The surgical procedures included 5 steps: colonic mobilization with ligation of inferior mesenteric vessels, total mesorectal excision, intersphincteric dissection with rectal transection, specimen retrieval, and coloanal anastomosis.

RESULTS

The median operation time was 210 minutes, and the median estimated blood loss was 40.0 mL. The hypogastric nerve and pelvic nerve plexus was preserved in all patients. No intraoperative-related or robotic system-related morbidities were observed. In all patients, R0 resection was achieved, and the quality of the total mesorectal excision was optimal.

CONCLUSIONS

Robotic transabdominal ISR is a safe operation with an expectation of future advances in pathologic quality and functional preservation. Additional work in a larger series of patients is necessary to refine this technique and to establish its efficacy.