Robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection f
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Robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection for rectal cancer T. Yamaguchi1 · T. Akiyoshi1 · Y. Fukunaga1 · S. Nagayama1 · T. Nagasaki1 · T. Mukai1 · R. Nakanishi1 · T. Konishi1 Received: 3 May 2020 / Accepted: 25 May 2020 © Springer Nature Switzerland AG 2020
Extended rectal surgery beyond total mesorectal excision (TME) (e.g., multivisceral resection and lateral lymph node dissection) is commonly required for R0 resection of locally advanced rectal cancer. Technical challenges of extended rectal surgery include complicated anatomy outside TME, a limited surgical view within the deep pelvis, difficulty in controlling venous bleeding, and a high postoperative morbidity rate. Minimally invasive surgery with a magnified laparoscopic surgical view provides significant benefits to overcome these challenges, resulting in reduced venous bleeding by pneumoperitoneum and a low morbidity rate [1]. However, surgeons often encounter technical difficulties with a conventional laparoscopic approach because of ergonomic limitations associated with traditional, nonwristed laparoscopic instrumentation and optical limitations associated with two-dimensional laparoscopic imaging. The robotic platform has emerged as a viable alternative surgical approach that provides high-quality three-dimensional imaging, ergonomic multi-joint instruments, and a motion scaling function. Few publications have described a robotic approach for extended rectal resections [2–4]; however, favorable outcomes of robotic TME with reduced open conversion rates compared to laparoscopic TME indicate that a robotic approach may overcome difficulties and improve resection outcomes [5].
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02256-z) contains supplementary material, which is available to authorized users. * T. Yamaguchi [email protected] * T. Konishi tkonishi‑[email protected] 1
In this video, we present a step-by-step procedure describing a robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection for T4b locally advanced rectal cancer. The patient was a 77-year-old woman. Initial staging with computerized tomography and magnetic resonance imaging showed cT4bN1M0 invading the uterus, posterior vagina, and right coccygeus and iliococcygeus muscles. The patient received six cycles of induction mFOLFOX6 with 5 mg/ kg bevacizumab followed by chemoradiotherapy (50.4 Gy). Although the tumor shrank, the invasion still remained. Robotic extralevator abdominoperineal resection without pelvic reconstruction, en bloc right-sided lateral lymph node dissection, and combined resection of the uterus, posterior vagina, right coccygeus and iliococcygeus muscles was safely conducted. The operating time was 415 min and blood loss volume was 120 mL. The postoperative course was uneventful, except for transient urinary retention. Pathological examinati
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