Skip to main content
SpringerLink
Log in

Robot-Assisted Reduced Port TME with Low Colorectal Anastomosis

  • Chapter
  • First Online:
Surgical Techniques in Rectal Cancer

  • 1102 Accesses

Abstract

Advances in minimally invasive laparoscopic surgery have grown to reduced-port surgery (RPS). Single-incision laparoscopic surgery (SILS) is considered the ultimate RPS for improving cosmesis and reducing postoperative pain and the risk of abdominal wall morbidities. Several reports have described both superior short-term and similar long-term results of SILS for colorectal malignancies when compared with standard laparoscopic surgery. However, there are some limitations such as instrument collision and insufficient countertraction. In a recent attempt to overcome the technical issues in SILS, by combining the use of the da Vinci robotic surgical system with the single-incision platform, the recognized challenges are somewhat simplified. Only a few reports of single-port robotic surgery for rectal disease have been conducted; however, the current robotic arm and equipment are still rather bulky and have a limited intrapelvic range of motion. Pure single approach may be not suited for sufficient oncological clearance.

We have developed the novel approach for minimally invasive surgery for rectal malignancies with combination of the da Vinci robotic surgical system and the concept of RPS, which is robot-assisted reduced-port total mesorectal excision (RARPTME). Our procedure is well suited for good countertraction and smooth maneuverability and can provide improved cosmesis and theoretically reduced postoperative pain when compared with standard robotic surgery that usually needs at least six or more scars.

Herein, we describe our techniques for RARPTME with low colorectal anastomosis in detail. Our procedure makes standardization of safe and certain RARPTME possible.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Curcillo PG 2nd, Podolsky ER, King SA. The road to reduced port surgery: from single big incisions to single small incisions, and beyond. World J Surg. 2011;35:1526–31.

    Article  PubMed  Google Scholar 

  2. Takemasa I, Sekimoto M, Ikeda M, Mizushima T, Yamamoto H, Doki Y, Mori M. Video. Transumbilical single-incision laparoscopic surgery for sigmoid colon cancer. Surg Endosc. 2010;24:2321.

    Article  PubMed  Google Scholar 

  3. Papaconstantinou HT, Thomas JS. Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery. 2011;50:820–7.

    Article  Google Scholar 

  4. Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, Haas EM. Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc. 2012;26:96–102.

    Article  PubMed  Google Scholar 

  5. Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, Oh ST. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg. 2011;254:933–40.

    Article  PubMed  Google Scholar 

  6. Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP. Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg. 2012;255:66–9.

    Article  PubMed  Google Scholar 

  7. Takemasa I, Uemura M, Nishimura J, Mizushima T, Yamamoto H, Ikeda M, Sekimoto M, Doki Y, Mori M. Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison. Surg Endosc. 2014;28:1110–8.

    Article  PubMed  Google Scholar 

  8. Hiraki M, Takemasa I, Uemura M, Haraguchi N, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M. Evaluation of invasiveness in single-site laparoscopic colectomy, using “the PainVision system” for quantitative analysis of pain sensation. Surg Endosc. 2014;28:3216–23.

    Article  PubMed  Google Scholar 

  9. Yun JA, Yun SH, Park YA, Huh JW, Cho YB, Kim HC, Lee WY. Oncologic outcomes of single-incision laparoscopic surgery compared with conventional laparoscopy for colon cancer. Ann Surg. 2016;263(5):973–8.

    Article  PubMed  Google Scholar 

  10. Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Azuma D, Kohama S. Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases. Surg Endosc. 2015;30(4):1317–25.

    Article  PubMed  Google Scholar 

  11. Hamabe A, Takemasa I, Uemura M, Nishimura J, Mizushima T, Ikeda M, Yamamoto H, Sekimoto M, Doki Y, Mori M. Feasibility of single-port laparoscopic surgery for sigmoid colon and rectal cancers and preoperative assessment of operative difficulty. J Gastrointest Surg. 2014;18:977–85.

    Article  PubMed  Google Scholar 

  12. Haber GP, Autorino R, Laydner H, Yang B, White MA, Hillyer S, Altunrende F, Khanna R, Spana G, Wahib I, Fareed K, Stein RJ, Kaouk JH. SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application. Eur Urol. 2012;61:415–22.

    Article  PubMed  Google Scholar 

  13. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg. 2004;239:14–21.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010;252:254–62.

    Article  PubMed  Google Scholar 

  15. 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;17:3195–202.

    Article  PubMed  Google Scholar 

  16. Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH. Multicentric study on robotic tumorspecific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 2010;17:1614–20.

    Article  PubMed  Google Scholar 

  17. White MA, Haber GP, Autorino R, Khanna R, Altunrende F, Yang B, Stein RJ, Kaouk JH. Robotic laparoendoscopic single-site surgery. BJU Int. 2010;106:923–7.

    Article  PubMed  Google Scholar 

  18. Rane A, Autorino R. Robotic natural orifice translumenal endoscopic surgery and laparoendoscopic single-site surgery: current status. Curr Opin Urol. 2011;21:71–7.

    Article  PubMed  Google Scholar 

  19. Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ. Robotic single-port transumbilical surgery in humans: initial report. BJU Int. 2009;103:366–9.

    Article  PubMed  Google Scholar 

  20. Ragupathi M, Ramos-Valadez DI, Pedraza R, Haas EM. Roboticassisted single-incision laparoscopic partial cecectomy. Int J Med Robot. 2010;6:362–7.

    Article  PubMed  Google Scholar 

  21. Ostrowitz MB, Eschete D, Zemon H, DeNoto G. Robotic-assisted single-incision right colectomy: early experience. Int J Med Robot. 2009;5:465–70.

    Article  PubMed  Google Scholar 

  22. Joseph RA, Goh AC, Cuevas SP, Donovan MA, Kauffman MG, Salas NA, Miles B, Bass BL, Dunkin BJ. “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc. 2010;24:1331–5.

    Article  PubMed  Google Scholar 

  23. Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988;81:503–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2:996–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan

    Ichiro Takemasa M.D., Ph.D., Emi Akizuki M.D., Ph.D., Tomomi Ueki M.D., Ph.D., Toshihiko Nishidate M.D., Ph.D., Kenji Okita M.D., Ph.D. & Tomohisa Furuhata M.D., Ph.D.

Authors
  1. Ichiro Takemasa M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emi Akizuki M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomomi Ueki M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshihiko Nishidate M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenji Okita M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomohisa Furuhata M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ichiro Takemasa M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Saint-Pierre University Hospital, Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium

    Giovanni Dapri

  2. Minimally Invasive Colorectal Surgery, Lankenau Medical Center, Main Line Healthcare, Wynnewood, Pennsylvania, USA

    John H Marks

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Japan

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Takemasa, I., Akizuki, E., Ueki, T., Nishidate, T., Okita, K., Furuhata, T. (2018). Robot-Assisted Reduced Port TME with Low Colorectal Anastomosis. In: Dapri, G., Marks, J. (eds) Surgical Techniques in Rectal Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55579-7_14

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-55579-7_14

  • Published:

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55578-0

  • Online ISBN: 978-4-431-55579-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation