Robot-Assisted Multiport TME with Low Colorectal Anastomosis

Rectal cancer, especially complex cases such as low-lying or irradiated cancer in a narrow pelvis, and cases involving men or obese patients, is one of the most common indications for the robotic approach. The surgical robot (da Vinci® surgical system, Intuitive Surgical, Sunnyvale, CA, USA) has the advantages of stable traction and countertraction, three-dimensional magnified vision, endo-wrist instrument function, simultaneous control of the instruments, and endoscope by the surgeon’s intention. However, a limited range of surgical field, difficulty in manipulating redundant organs, and lack of tactile sense are some of disadvantages of the currently available surgical robot. Moreover, despite the mechanical advantages of robot over laparoscopy, at present, there are few evidences supporting the usefulness of robots for treating rectal cancer. This chapter will cover the basic operating room setup and techniques of standard total mesorectal excision (TME), with some modifications of the procedures on using robot. Hybrid fashion of laparoscopic mobilization of the left colon and robotic TME with prior version (da Vinci® S or Si system) and fully robotic low anterior resection with the latest da Vinci® Xi system are described here based on our experience.

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