Robotic Assisted Rectal Resection: the Initial Experience

Wai Lun Law, MD, Jensen T Poon, MD, Joe K Fan, MD. The University of Hong Kong

BACKGROUND: Robotic-assisted laparoscopic surgery is associated with some advantages over conventional laparoscopic surgery and is widely practiced in pelvic surgery such prostatectomy and hysterectomy. Recently it has gained enthusiasm for application in colorectal surgery. We presented our initial experience of robotic assisted rectal surgery for neoplasm.
METHODS: During the study period, robotic-assisted laparoscopic low anterior resection was performed in 37 patients for rectal neoplasm. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.
RESULTS: Robotic assisted rectal resection was performed in 21 male (56.8%) and 16 female (43.2%) patients with a diagnosis of rectal neoplasm. The mean patient age was 66.6 years (range = 45-88 years). All except one patient had cancer of the rectum. The procedures required a median of 15 min for robotic docking and the median total operative time was 305 min. The median blood loss was 135 ml. Synchronous total hysterectomy was performed in 2 patients and prior metallic stent was inserted for relieving acute large bowel obstruction in one patient. An anterior resection or low anterior resection was performed in 34 patients and three patients underwent an abdominoperitoneal resection. There were no significant intraoperative complications, and one patient required conversion to an open operation because of bleeding. There was no operative mortality. Postoperative complications occurred in 6 patients (16.2%) and with one anastomotic leakage, requiring laparoscopy and division colostomy. The median length of hospital stay was 6 days.
CONCLUSIONS: Robotic-assisted laparoscopic technique is a safe and feasible option for the surgical treatment of rectal neoplasm. The wide application should be studied with randomized trials.