Robotic assisted Low Anterior Resection : Beyond TME – Left vascular approach with Pre-sacral fascia excision

This video was presented by Dr. Sanjeev Kumar, and was a Finalist at the 2019 KS National Robotic Surgery Awards at the Robotic Surgeons Council of India.  All authors and full information is contained in the following Abstract:

Title :  Robotic assisted Low Anterior Resection : Beyond TME – Left vascular approach with Pre-sacral fascia excision

Kumar S., Sasi P.S., Rohila J., Tantravahi U., Sharma V., Aggarwal N.,  Desouza  A., Saklani A

Tata Memorial Centre, Mumbai, India

Introduction :

This video describes extended TME resections for locally advanced rectal cancers which have persistent circumferential margin positivity and extra-mesorectal tissue involvement post long course neoadjuvant chemo-radiation.

Material and Method :

Robotic daVinci Xi system was used to perform the surgery. Standard robotic ports were used with left lower abdominal single docking. Left vascular approach was taken due to extra-mesorectal disease on the left side. Pre-sacral fascia was also excised as it was involved by the disease.

Results:

Surgery was uneventful. Intra-operative blood loss was 100mL and duration of surgery was 250 minutes. Stapled end-to-end colo-rectal anastomosis was performed. Diversion loop ileostomy was done using R3 robotic port site. Post-operative period was uneventful and the patient was discharged on POD 7. Final HPR showed pathological complete response.

Conclusion:

Robotic assisted extended TME is a feasible option. It gives the patient best chance of achieving margin negative resection in locally advanced rectal cancers with extra-mesorectal involvement.

Robotic surgery video, with PPT’s, MRI’s, photos, narrated, 07:23