Proctectomy and Rectopexy: Hybrid Robotic Approach

  • Monica T. YoungEmail author
  • Joseph C. Carmichael
  • Alessio Pigazzi


Due to advances in technology and surgical technique, the da Vinci robot has become increasingly relevant in the field of colorectal surgery. This approach is particularly applicable to the technical challenges of pelvic dissection, which require precise movements in a confined space. Improved visualization can lead to lower conversion rate to open surgery, fewer complications, and shorter hospital stay (Baik et al., Ann Surg Oncol 16(6):1480–1487, 2009). This chapter will review the operative techniques of a hybrid robotic-assisted low anterior resection, abdominoperineal resection, and rectopexy.


Proctectomy Rectopexy Hybrid robotic approach Colorectal surgery 

Supplementary material

Video 18.1

Total mesorectal excision (TME) posterior dissection (MP4 116846 kb)

Video 18.2

Total mesorectal excision (TME) opening peritoneum (MP4 53346 kb)

Video 18.3

Total mesorectal excision (TME) anterior dissection (MP4 179501 kb)

Video 18.4

Total mesorectal excision (TME) lateral stalk division (MP4 91308 kb)

Video 18.5

Robotic total mesorectal excision (TME) (MP4 342457 kb)

Video 18.6

Robotic posterior mobilization (MP4 57250 kb)

Video 18.7

Robotic suture rectopexy (MP4 135488 kb)


  1. 1.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16(6):1480–7. PubMed PMID: 19290486.CrossRefPubMedGoogle Scholar
  2. 2.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20(10):1521–5. PubMed PMID: 16897284.CrossRefPubMedGoogle Scholar
  3. 3.
    Wormer BA, Dacey KT, Williams KB, Bradley 3rd JF, Walters AL, Augenstein VA, et al. The first nationwide evaluation of robotic general surgery: a regionalized, small but safe start. Surg Endosc. 2014;28(3):767–76. PubMed PMID: 24196549.CrossRefPubMedGoogle Scholar
  4. 4.
    Ng KH, Lim YK, Ho KS, Ooi BS, Eu KW. Robotic-assisted surgery for low rectal dissection: from better views to better outcome. Singap Med J. 2009;50(8):763–7. PubMed PMID: 19710972.Google Scholar
  5. 5.
    Saklani AP, Lim DR, Hur H, Min BS, Baik SH, Lee KY, et al. Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Colorectal Dis. 2013;28(12):1689–98. PubMed PMID: 23948968.CrossRefPubMedGoogle Scholar
  6. 6.
    Lim DR, Min BS, Kim MS, Alasari S, Kim G, Hur H, et al. Robotic versus laparoscopic anterior resection of sigmoid colon cancer: comparative study of long-term oncologic outcomes. Surg Endosc. 2013;27(4):1379–85. PubMed PMID: 23239297, Pubmed Central PMCID: 3599163.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc. 2012;26(1):1–11. PubMed PMID: 21858568.CrossRefPubMedGoogle Scholar
  8. 8.
    Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23(7):703–7. PubMed PMID: 18379795.CrossRefPubMedGoogle Scholar
  9. 9.
    Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P, Dutch Colorectal Cancer G, et al. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23(36):9257–64. PubMed PMID: 16361623.CrossRefPubMedGoogle Scholar
  10. 10.
    Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Soreide O, et al. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum. 2004;47(1):48–58. PubMed PMID: 14719151.CrossRefPubMedGoogle Scholar
  11. 11.
    West NP, Anderin C, Smith KJ, Holm T, Quirke P, European Extralevator Abdominoperineal Excision Study G. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97(4):588–99. PubMed PMID: 20186891.CrossRefPubMedGoogle Scholar
  12. 12.
    Kang CY, Carmichael JC, Friesen J, Stamos MJ, Mills S, Pigazzi A. Robotic-assisted extralevator abdominoperineal resection in the lithotomy position: technique and early outcomes. Am Surg. 2012;78(10):1033–7. PubMed PMID: 23025934.PubMedGoogle Scholar
  13. 13.
    Schiergens TS, Thomas MN, Thasler WE. Rectal prolapse. J Gastrointest Surg. 2012;16(12):2336–7. PubMed PMID: 23054898.CrossRefPubMedGoogle Scholar
  14. 14.
    Athanasiadis S, Heiligers J, Kuprian A, Heumuller L. Surgical therapy of rectal prolapse using rectopexy and resection. Effect of resection treatment on postoperative constipation and sphincter muscle function – a follow-up study of 112 patients. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 1995;66(1):27–33. PubMed PMID: 7889787. Chirurgische Therapie des Rectumprolapses mittels Rectopexie und Resektion. Einfluss der Resektionsbehandlung auf postoperative Obstipation und Schliessmuskelfunktion – eine Follow-up-Studie bei 112 Patienten.PubMedGoogle Scholar
  15. 15.
    Fang SH, Cromwell JW, Wilkins KB, Eisenstat TE, Notaro JR, Alva S, et al. Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis. Dis Colon Rectum. 2012;55(11):1167–72. PubMed PMID: 23044678.CrossRefPubMedGoogle Scholar
  16. 16.
    Melton GB, Kwaan MR. Rectal prolapse. Surg Clin N Am. 2013;93(1):187–98. PubMed PMID: 23177071.CrossRefPubMedGoogle Scholar
  17. 17.
    Kellokumpu IH, Vironen J, Scheinin T. Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function. Surg Endosc. 2000;14(7):634–40. PubMed PMID: 10948299.CrossRefPubMedGoogle Scholar
  18. 18.
    Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2000;(2):CD001758. PubMed PMID: 10796817.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Monica T. Young
    • 1
    Email author
  • Joseph C. Carmichael
    • 1
  • Alessio Pigazzi
    • 2
  1. 1.Department of SurgeryUniversity of California, Irvine School of MedicineOrangeUSA
  2. 2.Division of Colorectal Surgery, Department of SurgeryUniversity of California, Irvine School of MedicineOrangeUSA

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