Robot-assisted anterior resection of rectal cancer in a patient with abdominal aortic aneurysm using a monitoring laparoscope: a case report

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Introduction and importance: We present the first case of robot-assisted anterior resection for rectal cancer in a patient with abdominal aortic and common iliac aneurysms using a monitoring laparoscope for enhanced safety. Case presentation: An 86-year-old man presented with bloody stool and was diagnosed with Stage IIIB rectal cancer (T3N1aM0). Preoperative computed tomography revealed a 39-mm abdominal aortic aneurysm and 25-mm left common iliac aneurysm. Robot-assisted anterior resection with D2 lymph node dissection was performed using a 5-mm laparoscope to avoid contact between robotic forceps and aneurysm. The procedure was successful, and he was discharged from the hospital on the ninth postoperative day. Clinical discussion: Robotic surgery, owing to the lack of tactile sensation, is generally contraindicated in cases of abdominal aortic aneurysms because of the risk of vascular injury. However, this case demonstrates that real-time monitoring with a 5-mm laparoscope can effectively prevent accidental vascular injury during robotic surgery for rectal cancer. Conclusion: This case illustrates the appropriate modifications by which robotic surgery for rectal cancer can be safely performed in patients with abdominal aortic or common iliac artery aneurysms.

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