Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Chenhao Hu; Zhe Zhang; Lei Zhang; Ruihan Liu; Jun Yan; Qi Sun; Guanghui Wang; Junjun She

doi:10.3791/62919

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Method Article

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

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DOI:

10.3791/62919

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February 12th, 2022

Chenhao Hu^*¹^,²^,³ , Zhe Zhang^*¹^,²^,³ , Lei Zhang¹^,²^,³ , Ruihan Liu²^,³ , Jun Yan¹^,²^,³ , Qi Sun¹^,²^,³ , Guanghui Wang¹ , Junjun She¹^,²^,³

¹Department of General Surgery, The First Affiliated Hospital of Xian Jiaotong University, ²Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xian Jiao tong University, ³Department of High Talent, The First Affiliated Hospital of Xian Jiaotong University

^* These authors contributed equally

Summary

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

Abstract

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi'an Jiaotong University.

Introduction

Since their approval for clinical use by the United States Food and Drug Administration in 2000, da Vinci surgical robots have been increasingly utilized across different surgical specialties¹. The robotic surgical system has the advantages of using flexible multijoint arms, a high-quality three-dimensional camera, tremor filtration, and greatly improved ergonomics, which can minimize the invasiveness of the operation and thus making it ideal for complex procedures.

For decades, total mesorectal excision (TME) has been the standard for the treatment of resectable rectal cancer. However, for advanced (T3/T4) rectal ca....