Single-Stage Totally Robotic Dissection for Rectal Cancer Surgery: Technique and Short-Term Outcome in 50 Consecutive Patients

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Abstract

PURPOSE:

To overcome the pitfalls of laparoscopy, a robotic system has been introduced in rectal cancer surgery. However, there is no standard procedure to maximize the advantages of the da Vinci® S Surgical System. Therefore, we describe our technique of applying the robotic system during all of the steps of dissection in rectal cancer surgery and the short-term outcome.

METHODS:

Prospectively collected data were reviewed from 50 consecutive patients who underwent single-stage, totally robotic dissection for rectal cancer resection between July 2007 and June 2008. Robotic dissection was performed following these steps: 1) ligation of the inferior mesenteric vessels and medial to lateral dissection, 2) mobilization of the sigmoid/descending/splenic flexure colon, and 3) rectal dissection. The remaining steps including rectal transection and anastomosis were performed by a conventional laparoscopic method.

RESULTS:

There were 32 (64%) men and 18 (36%) women. The mean distance from the anal verge to the tumor margin was 7.3 (range, 2–13) cm. The conversion rate was 0%. The mean operative time was 304.8 (range, 190–485) minutes, and 20.6 (range, 6–48) lymph nodes were harvested. The circumferential margin was positive in one patient. The length of hospital stay after surgery was 9.2 (range, 5–24) days. Anastomotic leak rate was 8.3%, and all of the patients with leakage were managed conservatively.

CONCLUSIONS:

Single-stage robotic dissection for rectal cancer surgery is feasible, and its short-term outcome is acceptable. Our technique can be a suitable procedure to maximize the advantages of the da Vinci® system.

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