Afag Aghayeva, MD, Deniz Atasoy, Onur Bayraktar, Volkan Ozben, Ismail Hamzaoglu, Tayfun Karahasanoglu, Bilgi Baca. Acibadem Mehmet Ali Aydinlar University, School of Medicine
Introduction: Laparoscopic approach for rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to development of robotic platform. Unstable camera and assistant’s traction is overcome with the help of robotic approach. The robotic surgery, with its enhanced dexterity and increased range of motion is being increasingly utilized in colorectal field especially in narrow cavity like pelvis.
Herein, we present our case of robotic total mesorectal excision (TME) for rectum cancer.
Methods and Procedures: For robotic TME four 8-mm, one 12-mm robotic trocar, and one 5-mm assistant trocar for bedside surgeon were used. Single docking was utilized during the operation. The peritoneum is incised at the sacral promontorium and the aortomesenteric window was opened, preserving the left ureter, gonadal vessels and autonomic nerves. Inferior mesenteric artery (IMA) was skeletonized and ligated. High ligation of inferior mesenteric vein (IMV) was performed near the inferior border of the pancreas. Continued freeing the mesentery from the medial to laterally staying between embryologic planes. Posterior dissection of rectum was continued until internal sphincter was seen. Care must be taken during posterior dissection to preserve autonomic nerves. Then, dissection was continued along the left and right pelvic wall. Final dissection of rectum was continued with anterior pelvic dissection. Rectum was prepared circumferentially for stapler. 8-mm robotic trocar was changed with 12-mm robotic trocar for stapler using. Rectum was transected by robotic staples and end-to-end colorectal anastomosis with circular staple was performed.
Results: The docking and operative times were 5 min and 330 min, respectively. The blood loss was 20ml. Postoperative course was uneventful.
Conclusion: Robotic surgery is feasible and seems to overcome some technical limitations of laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87043
Program Number: V252
Presentation Session: Friday Video Loop (Non CME)
Presentation Type: VideoLoop
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