Robotic Supra-Levator Posterior Exenteration: Technical Feasibility

KS Awards Finalist 7: This video is one of the 8- Finalists in consideration for the top three prizes to be announced February 6th, 2021: Robotic Supra-Levator Posterior Exenteration: Technical Feasibility

Introduction: Evidence for minimally invasive surgery (MIS) approach for Beyond – Total Mesorectal Excisions (b-TME) for rectal cancer is scarce and still evolving. Application of MIS approach in locally infiltrative rectal cancers is often associated with increased rates of margin positive resections with increased rates of conversion to open surgery, ultimately leading to inferior survival outcomes. However, with progress on the learning curve alongside technical advancements, MIS approach is finding its due place in the management of locally advanced rectal cancers.

Case Description: We present a video illustration of a Supra-levator posterior exenteration which was performed using the Da Vinci Xi robotic platform. Patient was a 52 years lady who presented with a locally advanced middle third rectal cancer invading the rectovaginal septum involving the mesorectal fascia laterally. She was operated upon 6 weeks after long course chemo-radiation. Four robotic ports with two assistant ports were used. Duration of the surgery was 400 minutes including a docking time of 60 minutes. She had an uneventful intraoperative and post-operative hospital course. A negative pathological circumferential resection margin was achieved with adequate nodal yield, thus supporting the oncological adequacy of the procedure.

Conclusion: Beyond TME resections for locally advanced rectal cancers can be conducted with equivalent short term outcomes using MIS approach.

CAUTION: contains narrated presentation of PowerPoints, Photos, Diagrams and robotic surgery footage, 07:11.