PROPOSAL FOR STANDARDIZATION OF TOTAL MESORECTAL EXCISION SURGERY ON THE ROBOTIC PLATFORM

Introduction The robotic platform has been established with the aim of minimizing the difficulties associated with videolaparoscopy. However, despite these promises, robotic surgery (RS) is still not standardized in some specialties and surgical techniques, mainly due to the difficulty of access to technology. Unlike videolaparoscopy, which has a standardized technique, usually involving dissection of the mesocolon and retrocavity from medial to lateral, through a high-resolution video of total mesorectal excision surgery on the robotic platform, we propose identifying the ureter and dissecting the parietocolic gutter and retrocavity from lateral to medial.

Method Demonstration of surgical steps through a high-resolution video of total mesorectal excision surgery. The proposed steps of the surgery are: laparoscopy with cavity inventory, robot docking, identification and dissection of the inferior mesenteric vein (IMV), opening of the retrocavity above the IMV followed by ligation, pancreas and retroperitoneum release, transverse colon and splenic flexure release, repositioning of the patient and re-docking with release of the descending colon and sigmoid and identification of the ureter from lateral to medial, mesocolon dissection until identification of the inferior mesenteric artery (IMA), medial exposure of the IMA followed by its dissection and ligation, dissection and preservation of the hypogastric nerves, mesorectal dissection down to the pelvic floor, rectal resection with endo-stapler, specimen removal, colo-anal anastomosis with circular stapler, methylene blue test.

Discussion The lateral-to-medial approach, performed in laparotomy, was not reproduced in videolaparoscopic surgery mainly due to the difficulty of exposure and the limited movement range of the camera and forceps to perform safe lateral dissection. In our experience, the robotic platform and the endowrist technology, coupled with three-dimensional vision, enable dissection of the parietocolic gutter and safe identification of the left ureter from lateral to medial, also facilitating the medial dissection of the IMA with preservation of the mesocolic plane.

Conclusion We propose these surgical steps with the aim of standardizing and facilitating the training of new surgeons, as the standardized technique compartmentalizes and organizes intraoperative care, enhancing the safety of the procedure.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025