Robotic-Assisted AbdominoPerineal Resection: Efficacy and Safety in a community hospital setting..

Marcus F Yarbrough, MD, *Subhasis Misra, MD, MS, FACCWS. Department of Surgery CTCA – Midwestern Hospital, Zion, IL. *Texas Tech University Health Science Center – Amarillo, TX.

Background: Robotic assisted (® da Vinci System, Intuitive Surgical, Inc) surgery for abdominoperineal resection (APR), can be a challenging procedure for approach to low rectal and anal cancers. This study presents a case series to highlight the safety and efficacy of robotic assisted APR even in a community setting. A review of the literature follows.

Methods: A retrospective analysis was done of 10 consecutive APR procedures performed by a single surgeon between January 2012 and December 2012. Six cases were open and four were done with robotic resection using the da Vinci robotic system. Patient demographics, perioperative, intraoperative and postoperative outcomes were reviewed retrospectively and prospectively as part of clinical follow up. Literature review was performed analyzing multicenter studies.

Results: 10 patients; 6 males and 4 females underwent abdominoperineal resection (APR).

6 patients were in the open group (OG) and 4 were in the robotic group (RG). Mean age was 49.1 years and the mean Body Mass Index (BMI) was 28.8kg/m (2).

The median American Society of Anesthesiologist (ASA) classification was 3.

Average blood loss was lower in the robotic group at 265cc versus 596cc in the open group. Robotic docking time averaged 20.5 minutes and the console time was 80.0 minutes. Robotic operative time (OT) was 218 minutes +/- 35 minutes. Open APR operative time was 274 minutes. Surgical margins were adequate in all cases.

There was one postoperative complication consisting of delayed perineal wound healing and there was a single intraoperative complication of bleeding towards the end of the robotic case for which the procedure was converted to open

Conclusion: Robotic assisted APR can be safe and effective in a community hospital setting. Operative exposure is enhanced deep in the pelvis. The tridimensional view and endowrist instruments with the robotic systems allowed adequate maneuverability and microdissection in the background of irradiated fields. Perioperative and oncologic outcomes were similar compared to open surgery.

Key words: Robotic abdomionperineal resection, safety, efficacy, microdissection

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