Robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection for rectal cancer

Excerpt

Extended rectal surgery beyond total mesorectal excision (TME) (e.g., multivisceral resection and lateral lymph node dissection) is commonly required for R0 resection of locally advanced rectal cancer. Technical challenges of extended rectal surgery include complicated anatomy outside TME, a limited surgical view within the deep pelvis, difficulty in controlling venous bleeding, and a high postoperative morbidity rate. Minimally invasive surgery with a magnified laparoscopic surgical view provides significant benefits to overcome these challenges, resulting in reduced venous bleeding by pneumoperitoneum and a low morbidity rate [1]. However, surgeons often encounter technical difficulties with a conventional laparoscopic approach because of ergonomic limitations associated with traditional, non-wristed laparoscopic instrumentation and optical limitations associated with two-dimensional laparoscopic imaging. The robotic platform has emerged as a viable alternative surgical approach that provides high-quality three-dimensional imaging, ergonomic multi-joint instruments, and a motion scaling function. Few publications have described a robotic approach for extended rectal resections [2‐4]; however, favorable outcomes of robotic TME with reduced open conversion rates compared to laparoscopic TME indicate that a robotic approach may overcome difficulties and improve resection outcomes [5]. …