Rectal Tumors Robotic Treatment: the Savona’s Experience

Antonio Langone, MD, Lorenzo Monteleone, MD, Ilario Caristo, MD, Domenico Aiello, MD, Massimo Bianchi, MD, Umberto Cosce, MD, Giorgio Gasloli, MD, Giovanni Sicignano, MD, Guido Griseri, MD, Angelo Schirru, MD. SC Chirurgia Generale, ASL2 Savonese Osp. S. Paolo Savona

 

 Introduction: The development of the robotic system "Da Vinci" (Intuitive Surgical) has gone over the main technical limitations of laparoscopic surgery, due to the inadequacy of the normal surgical instruments, which does not allow articulated movement, and lacks of 3D vision. These improved features, stand out especially in highly complex interventions such as rectal surgery.
Materials and methods: In the period January 2007 – June 2011 29 patients were subjected to TME resection of the rectum with robot technology; 12 patients with high rectal cancer and 17 patients with low rectal cancer.
In 20 patients an anterior resection was performed with mechanical anastomosis, (3 of these resection with colo-anal anastomosis intersfinterica), in 8 patients amputation sec. Miles, and 1 patient a resection sec. Hartmann. All patients underwent radiotherapy / neoadjuvant chemotherapy. The series is mono / dual operator. Our technique involves the use of 3-arm robotic system (now an old design), plus one or two trocars for the laparoscopic assistance. The time to lower the splenic flexure was performed with conventional laparoscopic technique in 24 of 29 patients, while in 5 patients with a totally robotic technique. (5 patients with double set-up). The service access was a minilaparotomy sec.Pfannenstiel (about 7 cm). A protection ileostomy sec. Turnbull was performed in 21 cases.
Results: Conversion rate was 6.8% (2 / 29 pcs.), One because of advanced disease, one for anesthesiologic reasons. Morbidity rate was 6.8%: 1 anastomotic dehiscence and 1 post-operative bleeding which required laparoscopic revision. Average time of execution of the intervention was 320 min (240-445), in the last 5 patients of 290 cases. And the average time of use of the robot was 190 min (120 – 380).
Average distance on the distal margin was 2.5 cm (0.6 – 3.8), average radial distance was 0.7 cm (0.1-1.5), average number of lymph nodes was 12 (4-20). We had no pelvic recurrences (in the short follow-up period).
Conclusions: As there is are not randomized trials on robotic surgery of the rectum, according to data in the literature we believe that the method may be feasible, safe and effective and particularly suited for rectal surgery. The global increase in operative time and costs are outweighed by technical advantages (strereoscopica vision, endo-wrist, no tremor) and by benefits hard to classify such as greater safety feeling and efficacy in the dissection. We also consider the short learning curve, especially for our solid experience in videolaparoscopic colon surgery.


Session Number: Poster – Poster Presentations
Program Number: P585
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