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Clin Colon Rectal Surg 2021; 34(05): 311-316
DOI: 10.1055/s-0041-1726449
Review Article

Options for Low Rectal Cancer: Robotic Total Mesorectal Excision

Felipe F. Quezada-Diaz
1   Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
J. Joshua Smith
1   Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract

Low rectal cancers (LRCs) may offer a difficult technical challenge even to experienced colorectal surgeons. Although laparoscopic surgery offers a superior exposure of the pelvis when compared with open approach, its role in rectal cancer surgery has been controversial. Robotic platforms are well suited for difficult pelvic surgery due to its three-dimensional visualization, degree of articulation of instruments, precise movements, and better ergonomics. The robot may be suitable especially in the anatomically narrow pelvis such as in male and obese patients. Meticulous dissection in critical steps, such as splenic flexure takedown, nerve-sparing mesorectal excision, and distal margin clearance, are potential technical advantages. In addition, robotic rectal resections are associated with lower conversion rates to open surgery, less blood loss, and shorter learning curve with similar short-term quality of life outcomes, similar rates of postoperative complications, and equivalent short-term surrogate outcomes compared with conventional laparoscopy. Robotic surgery approach, if used correctly, can enhance the skills and the capabilities of the well-trained surgeon during minimally invasive procedures for LRC.

Keywords

low rectal cancer - low anterior resection - robotic surgical procedures


Publication History

Article published online:
08 September 2021

© 2021. Thieme. All rights reserved.

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