Robotic LAR with TaTME

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Procedure steps:

Abdominal Phase:

• Da Vinci surgical system docking
• Inferior mesenteric vessels division
• Left colon mobilization
• High mesorectal dissection
• “Rendez-vous” with the transanal team
• Colostomy creation
• Transanal Phase:Endoscopic platform introduction and placement of laparoscopic instruments, including a flexible tip 3D camera
• Closure of the rectal lumen and flood with cytocidal solution
• Rectotomy with electrocautery
• “Down-to-up” TME acute and circumferential dissection
• “Rendez-vous” with the abdominal team
• Specimen extraction

Learning Points:

• How to perform a combined two-tea, Cecil approach with the robotic surgical system
• The advantages of the robotic assistance during TaTME for rectal cancer
• Tips and tricks to perform the low pelvis dissection
• Which are the new complications that may arise during TaTME

Technical Investigations:

• 83-year-old man
• Cardiac failure
• COPD stage IV

Clinical Case:

• Rectal bleeding
• Colonoscopy:
• Tumour 10 cm from the anal verge
• Polypoid lesion 3 cm from the anal verge
• Pathology: adenocarcinoma
• CT, pelvic MRI and endoanal ultrasound: T3N0M0
• Faecal incontinence: endoanal manometry
• Blood test
• CEA 7.5
• Hb 10.9
• TAMIS of the polypoid lesion pathology: villous adenoma

83-year-old man with a medical history of dilated cardiac failure and COPD stage IV. The patient came to the outpatient clinic with a history of rectal bleeding and a colonoscopy was performed showing a tumor 10 cm from the anal verge and a 25-35mm polypoid lesion 3 cm from the anal verge. The rectal tumor 10 cm from the anal verge was staged as a T3N0M0 adenocarcinoma after A CT scan, pelvic MRI and endoanal ultrasound.

The patient described fecal incontinence which was confirmed by the endoanal manometry.

The blood test showed a CEA of 7.5 and Hb of 10.9.

Due to the presence of the rectal polyp 3 cm from the anal verge, a TAMIS was performed with Pathology showing a villous adenoma with no signs of malignancy.

Anterior rectal resection has been proposed 20 days after TAMIS