VM82 - Robotic Supralevator Posterior Exenteration

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Purpose/Background: to demonstrate a safe and effective way of performing an R0 resection by achieving complete clearance in a Supralevator Posterior Exenteratio perfomed robotically.

Methods/Interventions: The procedure was performed with consent of the patient for robotic surgery using the Da Vinci XI robot. An R0 resection was achieved by performing a posterior exenteration along with bilateral pelvic node dissection. A complete Total mesorectal Excision was performed using monopolar scissors and bipolar forceps, along with adequate mobilization of the colon to achieve a proper colorectal anastomosis without tension. Primary closure of the vagina was done with Barbed prolene sutures, performed robotically, a circular stapler was used for the colorectal anastomosis and a temporary diversion ileostomy was performed.

Results/Outcomes: The patient was middle aged female with a complete family, presenting with a moderately differentiated adenocarcinoma. The operating time including docking of the robot was 300 minutes with a blood loss of 800ml in total. The patient had an ICU stay of one day and was started on oral feeds from Post Operative Day 1. The pelvic drains were removed on day 4 and days 5 respectively and the patient was discharged on Post Operative Day 6 with no post operative complications.

Conclusion/Discussion: A safe and oncologically feasible procedure of performing a supralevator posterior exenteration can be achieved through a robotic approach for mid and lower rectal cancers of high grade