Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis.

BACKGROUND: As the use of a surgical robot allows for improved dexterity and visual field, we successfully conducted transabdominal intersphincteric resection (ISR) and perineal coloanal anastomosis for a very low lying rectal cancer. The aim of this study was to evaluate the technical feasibility of this procedure. MATERIALS AND METHODS: Eight patients underwent robotic-assisted transabdominal ISR with coloanal anastomosis for low rectal cancers. The surgical procedures included 5 steps: colonic mobilization with ligation of inferior mesenteric vessels, total mesorectal excision, intersphincteric dissection with rectal transection, specimen retrieval, and coloanal anastomosis. RESULTS: The median operation time was 210 minutes, and the median estimated blood loss was 40.0 mL. The hypogastric nerve and pelvic nerve plexus was preserved in all patients. No intraoperative-related or robotic system-related morbidities were observed. In all patients, R0 resection was achieved, and the quality of the total mesorectal excision was optimal. CONCLUSIONS: Robotic transabdominal ISR is a safe operation with an expectation of future advances in pathologic quality and functional preservation. Additional work in a larger series of patients is necessary to refine this technique and to establish its efficacy.

Robot-assisted right colectomy with lymphadenectomy and intracorporeal anastomosis for colon cancer: technical considerations.

BACKGROUND: A surgical robot (the da Vinci system) was developed to overcome the disadvantages of laparoscopic surgery, and applications of this system have been widely used. In this study, we present our standardized technique of robotic right colectomy with lymphadenectomy and intracorporeal anastomosis, with an assessment of feasibility in a series of 15 patients. METHODS: All robotic right colectomies with lymphadenectomy were performed by a single surgeon between April 2009 and March 2010. Robotic assistance was used for the colonic mobilization, lymphadenectomy, and bowel reconstruction. Patient demographics, perioperative clinical outcomes, and pathologic results were reviewed. RESULTS: Robotic-assisted right colectomy was successfully performed on 15 patients with colon cancer. The total operative time was 201.4 ± 8.1 minutes, with a mean robotic time of 114.4 ± 7.5 minutes. No patient required conversion to conventional surgery. The median time to clear liquid intake was 3 days, and the median length of stay after surgery was 8 days. The mean tumor diameter was 3.0 ± 0.3 cm, and the mean number of harvested lymph nodes was 24.2 ± 15.5. Tumors were diagnosed as stage I in 7 patients, stage II in 5, and stage III in 3. CONCLUSIONS: Robotic right colectomy with lymphadenectomy can be performed successfully and safely. The robotic system was safe and feasible for the following steps: accurate node dissection, suturing for intracorporeal anastomosis, and natural orifice specimen extraction. Further comparative studies must be performed to verify the advantages of robotic surgery over conventional laparoscopic surgery.

Influence of surgical manipulation and surgical modality on the molecular detection of circulating tumor cells from colorectal cancer.

PURPOSE: The aim of this study was to evaluate the relationship between the detection of circulating tumor cell molecular markers from localized colorectal cancer and the time-course of a surgical manipulation or surgical modality. METHODS: From January 2010 to June 2010, samples from the peripheral blood and the inferior mesenteric vein were collected from 42 patients with cancer of the sigmoid colon or rectum. Pre-operative, intra-operative (both pre-mobilization and post-mobilization), and post-operative samples were collected. We examined carcinoembryonic antigen (CEA) mRNA and cytokeratin-20 (CK20) mRNA by real-time reverse-transcriptase polymerase chain reaction. Changes in mRNA detection rates were analyzed according to the time of blood sample collection, the surgical modality, and patient clinicopathological features. RESULTS: mRNA expression rates before surgical resection did not differ between blood samples from the peripheral and inferior mesenteric veins. The detection rate for CEA and CK20 mRNA showed a tendency to increase after operative mobilization of the cancer-bearing bowel segment. Furthermore, the cumulative detection rates for CEA and CK20 mRNA increased significantly over the course of surgery (pre-mobilization vs. post-mobilization). The cumulative detection rate decreased significantly after surgical resection compared with the pre-operative rates. However, no significant difference was observed in the detection rates between different surgical modalities (laparoscopy vs. open surgery). CONCLUSION: The results of this study suggest that surgical manipulation has a negative influence on the dissemination of circulating tumor cells during operations on localized colorectal cancer. However, the type of surgical technique did not affect circulating tumor cells.