Robot-Assisted Reduced Port TME with Low Colorectal Anastomosis
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.
KeywordsRobotic surgery Reduced-port surgery Rectal cancer Low anterior resection
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