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Total Mesorectal Excision for Rectal Cancer: The Potential Advantage of Robotic Assistance

deSouza, Ashwin L. M.S.2; Prasad, Leela M. M.D.1,2,3; Marecik, Slawomir J. M.D.1,2,3; Blumetti, Jennifer M.D.2,3; Park, John J. M.D.1,2; Zimmern, Andrea M.D.2; Abcarian, Herand M.D.2,3

doi: 10.1007/DCR.0b013e3181f22f1f
Original Contribution

PURPOSE: The purpose of this study was to analyze the safety, feasibility, and efficacy of the da Vinci S HD robotic system in mesorectal excision for rectal adenocarcinoma, with the aim to identify areas of potential advantage for the robot in this procedure.

METHODS: This study was conducted as a retrospective review of a prospectively maintained database of 44 consecutive cases of robot-assisted mesorectal excision for rectal adenocarcinoma performed between August 2005 and February 2010. Patient demographics, perioperative outcomes, and complications were evaluated and compared with similar published reports and relevant literature.

RESULTS: There were 28 (63.6%) men and 16 (36.4%) women, with a mean age of 63 years. The majority of patients were either overweight or obese and 88.7% of lesions were in the mid or low rectum. We performed 36 low anterior resections (6 intersphincteric) and 8 abdominoperineal resections with a median blood loss of 150 mL (range, 50–1000), a median operative time of 347 minutes (range, 155–510), and a median length of stay of 5 days (range, 3–36). The median lymph node yield was 14 (range, 5–45) and the circumferential resection margin was negative in all patients. We had 1 distal margin positivity (2.7%), 2 anastomotic leaks (5.6%), 1 death (2.7%), and 2 conversions (4.5%) to the open approach. No robot-associated morbidity occurred in this series.

CONCLUSIONS: This series compares favorably with similar published reports with regard to the safety and feasibility of robotic assistance in total mesorectal excision for rectal cancer. The lower conversion rates reported for robotic rectal resection compared with laparoscopy require validation in large randomized trials.

1 Center for Robotic Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois

2 Division of Colon and Rectal Surgery, University of Illinois at Chicago Medical Center, Chicago, Illinois

3 Division of Colon and Rectal Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois

Financial Disclosures: Dr Prasad received honoraria from Intuitive Surgical, Ethicon, and Covidien and fellowships from Ethicon and Covidien. The remaining authors have no relevant disclosures.

Correspondence: Leela M Prasad, M.D., Chief, Division of Colon and Rectal Surgery/Minimally Invasive and Robotic Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood St, Suite 518(E) CSB, Chicago, IL 60612. E-mail: leelamprasad@gmail.com

© The ASCRS 2010