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Robotic Abdominoperineal Resection

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Abstract

The robotic approach to cancer surgery has grown increasingly popular over the last decade. Colorectal surgery is among the latest disciplines to apply this technology to pelvic surgery as surgeons have recognized the potential technical advantages of the robotic platform particularly for minimally invasive rectal surgery. Robotic technology is particularly applicable to abdominoperineal resection (APR) for distal rectal cancer by facilitating precision, dissection, and wide division of the pelvic floor. In this chapter, the key aspects of robotic APR are highlighted, including patient selection, preoperative preparation, the critical elements of operative technique, and the management of postoperative complications.

Keywords

  • Robotic Surgery
  • Proctectomy
  • Abdominoperineal Resection

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Correspondence to George J. Chang M.D., M.S., F.A.C.S., F.A.S.C.R.S. .

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Electronic Supplementary Material

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In this video, the surgeon demonstrates his approach to robotic abdominoperineal resection. (WMV 56771 kb)

Key Operative Steps

  1. 1.

    The patient is placed in low lithotomy position with the robot docked between the legs.

  2. 2.

    Trocars are placed for robotic abdominoperineal resection.

  3. 3.

    Lymphovascular dissection and high vascular ligation of the inferior mesenteric artery is performed.

  4. 4.

    Lateral mobilization of the descending and sigmoid colon joins the medial retromesocolic dissection plane.

  5. 5.

    Total mesorectal excision is performed.

  6. 6.

    Transabdominal incision of the levator ani muscles.

  7. 7.

    Perineal resection and specimen extraction.

  8. 8.

    Maturation of end colostomy.

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Bednarski, B.K., Chang, G.J. (2015). Robotic Abdominoperineal Resection. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_25

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_25

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