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Robot-Assisted Multiport TME with Low Colorectal Anastomosis

  • Hye Jin Kim
  • Gyu-Seog Choi
Chapter

Abstract

Rectal cancer, especially complex cases such as low-lying or irradiated cancer in a narrow pelvis, and cases involving men or obese patients, is one of the most common indications for the robotic approach. The surgical robot (da Vinci® surgical system, Intuitive Surgical, Sunnyvale, CA, USA) has the advantages of stable traction and countertraction, three-dimensional magnified vision, endo-wrist instrument function, simultaneous control of the instruments, and endoscope by the surgeon’s intention. However, a limited range of surgical field, difficulty in manipulating redundant organs, and lack of tactile sense are some of disadvantages of the currently available surgical robot. Moreover, despite the mechanical advantages of robot over laparoscopy, at present, there are few evidences supporting the usefulness of robots for treating rectal cancer. This chapter will cover the basic operating room setup and techniques of standard total mesorectal excision (TME), with some modifications of the procedures on using robot. Hybrid fashion of laparoscopic mobilization of the left colon and robotic TME with prior version (da Vinci® S or Si system) and fully robotic low anterior resection with the latest da Vinci® Xi system are described here based on our experience.

Keywords

Robotic surgery Rectal cancer Total mesorectal excision 

References

  1. 1.
    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(11):3168–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Choi DJ, Kim SH, Lee PJ, Kim J, Woo SU. Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients. Dis Colon Rectum. 2009;52(11):1824–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, et al. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 2010;17(6):1614–20.CrossRefPubMedGoogle Scholar
  4. 4.
    deSouza AL, Prasad LM, Marecik SJ, Blumetti J, Park J, Zimmern A, et al. Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance. Dis Colon Rectum. 2010;53(12):1611–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Kang J, Min BS, Park YA, Hur H, Baik SH, Kim NK, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery. World J Surg. 2011;35(11):2555–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Park JS, Choi GS, Lim KH, Jang YS, Jun SH. Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol. 2010;17(12):3195–202.CrossRefPubMedGoogle Scholar
  7. 7.
    Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc. 2011;25(2):521–5.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011;54(2):151–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Park JS, Choi GS, Lim KH, Jang YS, Jun SH. S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc. 2011;25(1):240–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, et al. The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison--open, laparoscopic, and robotic surgery. Ann Surg. 2013;257(1):95–101.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim JC, Yang SS, Jang TY, Kwak JY, Yun MJ, Lim SB. Open versus robot-assisted sphincter-saving operations in rectal cancer patients: techniques and comparison of outcomes between groups of 100 matched patients. Int J Med Robot. 2012;8(4):468–75.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim YW, Lee HM, Kim NK, Min BS, Lee KY. The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech. 2012;22(5):400–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc. 2013;27(9):3297–307.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim HJ, Choi GS, Park JS, Park SY. Multidimensional analysis of the learning curve for robotic total mesorectal excision for rectal cancer: lessons from a single surgeon's experience. Dis Colon Rectum. 2014;57(9):1066–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS, et al. Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc. 2014;28(10):2821–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP. Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc. 2014;28(1):212–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Aly EH. Robotic colorectal surgery: summary of the current evidence. Int J Color Dis. 2014;29(1):1–8.CrossRefGoogle Scholar
  19. 19.
    Scarpinata R, Aly EH. Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum. 2013;56(2):253–62.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19(12):3727–36.CrossRefPubMedGoogle Scholar
  22. 22.
    Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Color Dis. 2012;14(4):e134–56.CrossRefGoogle Scholar
  23. 23.
    Mak TW, Lee JF, Futaba K, Hon SS, Ngo DK, Ng SS. Robotic surgery for rectal cancer: a systematic review of current practice. World J Gastrointest Oncol. 2014;6(6):184–93.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19(7):2095–101.CrossRefPubMedGoogle Scholar
  25. 25.
    Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, et al. Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg. 2013;257(4):672–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc. 2013;27(1):48–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Broholm M, Pommergaard HC, Gogenur I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Color Dis. 2015;17(5):375–81.CrossRefGoogle Scholar
  28. 28.
    Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JHA. Comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol. 2012;19(8):2485–93.CrossRefPubMedGoogle Scholar
  29. 29.
    Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg. 2010;251(5):882–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Baik SH, Kim NK, Lim DR, Hur H, Min BS, Lee KY. Oncologic outcomes and perioperative clinicopathologic results after robot-assisted tumor-specific mesorectal excision for rectal cancer. Ann Surg Oncol. 2013;20(8):2625–32.CrossRefPubMedGoogle Scholar
  31. 31.
    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 Color Dis. 2013;28(12):1689–98.CrossRefGoogle Scholar

Copyright information

© Springer Japan 2018

Authors and Affiliations

  1. 1.Department of Surgery, Colorectal Cancer Center, Kyungpook National University Medical Center, School of MedicineKyungpook National UniversityDaeguSouth Korea

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