Totally robotic low anterior resection (RLAR) with trans-anal specimen extraction and single stapling technique
Epublication WebSurg.com, Jul 2009;09(07). URL: http://websurg.com/doi/vd01en2699
We present the case of a 76-year-old woman with a low rectal cancer (T3N0 at 7cm) status post-chemoradiation therapy. Using a four-arm DaVinci system, we carry out the dissection in a medial to lateral fashion dividing the inferior mesenteric vessels and mobilizing the splenic flexure. A total mesorectal excision is performed to the level of the pelvic floor. The specimen is delivered through a wound protector covering the anus. The sigmoid colon is divided extracorporeally, an anvil is secured. Using robotic instruments, a purse-string is sutured to the rectal stump and tied around the EEA stapler spike. An end-to-end anastomosis is created under vision. A diverting ileostomy is performed. This novel robotic procedure eliminates the need for an incision for specimen extraction and may facilitate transection of the rectum during RLAR.