A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer

Background: The surgical robot (da Vinci S) is superior to conventional laparoscopy; it provides clearer, three-dimensional images and an extended range of motion for the instruments. We used this robot for laparoscopic surgery to perform a totally intracorporeal resection of the rectum and colorectal anastomosis, with transanal or transvaginal retrieval of specimens. Methods: We prospectively collected data on 13 patients who underwent robot-assisted rectal surgery by a single surgeon from January to March 2008. For low anterior resection (LAR), the splenic flexure was mobilized laparoscopically, followed by robotic rectal resection and anastomosis, and transanal removal of specimens in both male and female patients. We retrieved the specimen through the vagina in some female patients. Results: Eleven and two patients underwent LAR and anterior resection (AR), respectively. Mean operative time was 260.8 ± 62.9 (range 210-390) min with median robotic time of 118 ± 43.6 (range 122-186) min. There were three postoperative complications, in two patients. One patient had anastomotic bleeding and the other had anastomotic leakage following inferior mesenteric artery bleeding. The circumferential margins were clear. The tumor stage was I in four, II in two, and III in seven patients. In one patient, the distal resection margin was involved. The patients resumed an oral diet and were discharged on the third and seventh day after surgery. Conclusion: Robotic-assisted laparoscopic methods were safe for AR in patients with colorectal cancer. This approach made it easier to perform a total mesorectal excision, anastomosis, and closure of the vaginal wall, and avoided the traditional abdominal incision.