Robotic total mesorectal excision for low rectal cancer: Transluminal illumination of the recto‐vaginal septum, transanal low rectal dissection and handmade low colorectal anastomosis—A video vignette

Résumé fourni par la source

The robotic platform has proven to be of considerable help in rectal cancer surgery and is gaining increasing acceptance worldwide [1]. Transillumination allows us to distinguish the walls of the rectum and the vagina clearly and to define the end of the mesorectum precisely. Natural orifice specimen extraction could be the key to reducing access trauma in colorectal surgery, and it allows for verification of mesorectal integrity [2-4]. We present the case of a 37-year-old female patient with a BMI of 29 kg/m2, affected by an adenocarcinoma of the rectum 5 cm from the anal verge, cT3 N1 M0. The patient underwent neoadjuvant chemoradiotherapy (CRT) with the aim of downstaging the tumour and preserving the sphincters [5]. Eight weeks after neoadjuvant CRT ended, we planned a robotic approach with transanal distal rectal dissection, specimen transanal extraction and handmade anastomosis. We injected indocyanine green below the tumour to check the distal margin and perform lymphangiography intraoperatively (Video 1). The operative time was 130 min and the hospital stay was 4 days. There were no postoperative complications. The final histology showed a complete pathological response, pT0 pN0 (0/14). There was no evidence of local recurrence or distant metastasis at the 1-year follow-up. Robotic rectal surgery combined with transanal low rectal dissection, transluminal illumination of the recto-vaginal septum, transanal specimen extraction, handmade anastomosis and transanal control is a reproducible and safe technique in selected patients in high-volume centres. It may be of great importance in obese male patients, particularly after CRT. This technique allows adequate surgical margins, combining the technical, functional and aesthetic advantages of the robotic approach. Francesco Crafa: Writing – original draft; conceptualization. Serafino Vanella: Writing – review and editing. Alfonso Amendola: Supervision. Emanuele Caruso: Investigation; supervision. The authors did not receive support from any organization for the submitted work. The authors have no conflict of interest to declare. Ethical approval has been obtained by the ‘Comitato Etico Campania Nord Per La Sperimentazione Clinica E Ricerca Biomedica’ Azienda Ospedaliera ‘San Giuseppe Moscati’ – Avellino, Italy. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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