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Essentials and Future Directions of Robotic Rectal Surgery

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Essentials of Robotic Surgery

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Abstract

Laparoscopic colon and rectal surgery is currently considered both from an oncologic and overall patient care standpoint (including costs) comparable or even superior to open procedures. For rectal cancer specifically, revised practice parameters published by the American Society of Colon and Rectal Surgeons indicate that laparoscopic rectal resection can be performed “with equivalent oncological outcomes in comparison with open TME when performed by experienced laparoscopic surgeons.” The da Vinci robotic system can be described as an alternative platform for performing “laparoscopic” minimally invasive surgery, since it adopts most of the principles of laparoscopic surgery. Improved optics and wrist-function instruments have allowed it to emerge as an alternative to standard laparoscopy when operating in a confined space such as the pelvis, making it an attractive option for rectal resection and pelvic dissection. Even though increased cost associated to robotic surgery remains a problem for widespread adoption of this technology, published data as well as national database reviews suggest that robotic surgery has a lower conversion to open surgery when compared to laparoscopy in rectal cancer. Further studies are needed to asses if lower conversion rates and shorter postoperative recovery compared to open surgery could help offset overall procedural costs.

This chapter will focus on the role of robotics in rectal surgery. Detailed description of technical steps of common procedures, such as low anterior resection, abdominoperineal resection, and rectopexy, will be presented. Specific situations such as transanal specimen extraction with hand-sewn coloanal anastomosis versus double-purse-string stapled anastomosis techniques will be also discussed during the course of this chapter.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of California, Irvine, Orange, CA, USA

    Raul Martin Bosio M.D., MS & Alessio Pigazzi M.D., MS

Authors
  1. Raul Martin Bosio M.D., MS
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  2. Alessio Pigazzi M.D., MS
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Corresponding author

Correspondence to Raul Martin Bosio M.D., MS .

Editor information

Editors and Affiliations

  1. Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA

    Matthew Kroh

  2. Surgical Operations, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA

    Sricharan Chalikonda

Electronic Supplementary Material

Video 8.1

Medial-to-lateral mobilization of the left colon starting at the level of the inferior mesenteric vein (M4V 160331 kb)

Video 8.2

Robotic rectal resection with total mesorectal excision (M4V 325695 kb)

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© 2015 Springer International Publishing Switzerland

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Bosio, R.M., Pigazzi, A. (2015). Essentials and Future Directions of Robotic Rectal Surgery. In: Kroh, M., Chalikonda, S. (eds) Essentials of Robotic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-09564-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-09564-6_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09563-9

  • Online ISBN: 978-3-319-09564-6

  • eBook Packages: MedicineMedicine (R0)

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