Annals of Surgical Oncology

, Volume 16, Issue 5, pp 1274–1278 | Cite as

Full Robotic Left Colon and Rectal Cancer Resection: Technique and Early Outcome

  • Fabrizio Luca
  • Sabine Cenciarelli
  • Manuela Valvo
  • Simonetta Pozzi
  • Felice Lo Faso
  • Davide Ravizza
  • Giulia Zampino
  • Angelica Sonzogni
  • Roberto Biffi
Gastrointestinal Oncology

Abstract

Objective

The technique for robotic resection of the left colon and anterior resection of the rectum with total mesorectal excision is not well defined. In this study we describe a method that standardizes robot and trocar position, and allows for a complete mobilization of the left colon and the rectum, without repositioning of the surgical cart. Outcome and pathology findings are also reported.

Methods

From January 2007 to May 2008 a total of 55 consecutive patients affected by rectal and left colon cancer were operated on, with full robotic technique, using the Da Vinci robot. Data regarding outcome and pathology reports were prospectively collected in a dedicated database.

Results

The following procedures were performed 27 left colectomies, 17 anterior resections, 4 intersphincteric resections, 7 abdominoperineal resections. There were 21 female and 34 male patients with a mean age of 63 ± 9.9 years. Mean operative time was 290 ± 69 minutes, ranging from 164 to 487 min., none were converted to open surgery. The median number of lymph nodes harvested was 18.5 ± 8.3 (range 5-45), and circumferential margin was negative in all cases. Distal margin was 25.15 ± 12.9 mm (range 6-55) for patients with rectal cancer, and 31.6 ± 20 mm for all the patients in this series. Anastomotic leak rate was 12.7% (7/55); in all cases conservative treatment was successful.

Conclusions

Full robotic colorectal surgery is a safe and effective technique that exploits the advantages of the Da Vinci robot during the whole intervention, without the need to make use of hybrid operations. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.

Keywords

Anterior Resection Total Mesorectal Excision Splenic Flexure Inferior Mesenteric Artery Inferior Mesenteric Vein 

References

  1. 1.
    Baik SH, Ko YT, Kang CM, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short- term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1601–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A. Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol. 2007;14:3168–73.PubMedCrossRefGoogle Scholar
  3. 3.
    D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum. 2004;47:2162–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum. 2008;51:1627–32.PubMedCrossRefGoogle Scholar
  5. 5.
    DeNoto G, Rubach E, Ravikumar TS. A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A. 2006;16:551–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Baik SH, Kang CM, Lee WJ, et al. Robotic total mesorectal excision for the treatment of rectal cancer. J Robot Surg. 2007;1:99–102.CrossRefGoogle Scholar
  7. 7.
    Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T. Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech. 2004;14:311–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Bärlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc. 2005;19:757–66.PubMedCrossRefGoogle Scholar
  9. 9.
    den Dulk M, Noter SL, Hendriks ER, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. DOI: 10.1016/j.ejso.2008.04.009.
  10. 10.
    Uğraş B, Giriş M, Erbil Y, et al. Early prediction of anastomotic leakage after colorectal surgery by measuring peritoneal cytokines: prospective study. Int J Surg. 2008;6:28–35.PubMedCrossRefGoogle Scholar
  11. 11.
    Ptok H, Marusch F, Meyer F, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Kariv Y, Delaney CP. Robotics in colorectal surgery. Minerva Chir. 2005;60:401–16.PubMedGoogle Scholar
  13. 13.
    Rawlings A, Woodland J, Crawford D. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc. 2006;20:1713–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRefGoogle Scholar
  16. 16.
    Kuhry E, Bonjer HJ, Haglind E, et al, for the COLOR Study Group. Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc. 2005;19:687–92.Google Scholar
  17. 17.
    Woeste G, Bechstein WO, Wullstein C. Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis. 2005;20:253–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Rockall TA, Darzi A. Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am. 2003;83:1463–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Soravia C, Schwieger I, Witzig JA, et al. Laparoscopic robotic-assisted gastrointestinal surgery: the Geneva experience. J Robot Surg. 2008;1:291–5.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Fabrizio Luca
    • 1
  • Sabine Cenciarelli
    • 1
  • Manuela Valvo
    • 1
  • Simonetta Pozzi
    • 1
  • Felice Lo Faso
    • 1
  • Davide Ravizza
    • 2
  • Giulia Zampino
    • 3
  • Angelica Sonzogni
    • 4
  • Roberto Biffi
    • 1
  1. 1.Division of Abdomino-Pelvic SurgeryEuropean Institute of OncologyMilanoItaly
  2. 2.Division of EndoscopyEuropean Institute of OncologyMilanoItaly
  3. 3.Division of Medical OncologyEuropean Institute of OncologyMilanoItaly
  4. 4.Division of PathologyEuropean Institute of OncologyMilanoItaly

Personalised recommendations