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Session: Ongoing Videos

VM97 - Robotic Intersphincteric Resection for Low Rectal Cancer

ONGOING VIDEOS
Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Maureen Elvira P. Villanueva, MD, FPSCRS, FPCS (she/her/hers)

    Consultant
    Philippine General Hospital
    Quezon City, National Capital Region, Philippines

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • LC

    Lionel Raphael Chen Hui, MD

    Consultant
    Singapore General Hospital
    Singapore, Singapore

    Disclosure information not submitted.

    • Senior Author(s)

  • ET

    Emile John Tan Kwong Wei, MD

    Senior Consultant
    Singapore General Hospital
    Singapore, Singapore

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Maureen Elvira P. Villanueva, MD, FPSCRS, FPCS: This individual has no financial relationships with ineligible companies.
Emile John Tan Kwong Wei, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Intersphincteric resection (ISR) allows anal preservation for low rectal cancer (within 5 cm from the anal verge). ISR requires thorough knowledge of pelvic anatomy and careful patient selection. The robotic platform provides an optimal view, superior ergonomics and efficient traction allowing precise pelvic dissections during ISR2 and provides comparable perioperative, oncological, and functional results compared to open ISR. We present our technique of performing a robotic ISR in a patient with a low rectal tumor.

Methods/Interventions: The patient is a 40 year old female who presented with rectal bleeding. Colonoscopy showed a fungating polypoid rectal tumor 2-4cm from anal verge, biopsy of the tumor revealed adenocarcinoma. Abdominal CT and Pelvic MRI showed a low rectal tumor, with its caudal edge at 2.7cm from anal verge with a depth up to the muscular propria and a clinical stage of T2N0M0.

Case: The patient is a 40 year old female who presented with rectal bleeding. Colonoscopy showed a fungating polypoid rectal tumor 2-4cm from anal verge, biopsy of the tumor revealed adenocarcinoma. Abdominal CT and Pelvic MRI showed a low rectal tumor, with its caudal edge at 2.7cm from anal verge with a depth up to the muscular propria and a clinical stage of T2N0M0.
Robotic low anterior resection was performed, starting with medial to lateral mobilization of the sigmoid and rectum, ligation of the inferior mesenteric artery and vein and splenic flexure mobilization. Total mesolectal excision was performed circumferentially down to the pelvic floor. Intersphincteric dissection was then performed, meticulously dissecting along the intersphincteric space. Dissection was carried down to the level of the dentate line. Rectotomy was performed in the perineal phase, with the mucosal incision at the level of of the dentate line, performing a partial ISR. The specimen was extracted transanally and a hand sewn colonial anastomosis was completed. A diverting ileostomy was fashioned

Results/Outcomes: The patient had an unremarkable postoperative course with preserved genitourinary function and was discharged to home on the 4th postoperative day. Stoma reversal was done 2 months post op with full continence to solid stools and mild low anterior resection syndrome, managed with dietary modification.

Conclusion/Discussion: Robotic ISR facilitates safe and precise intersphincteric dissection and allows adequate surgical margins to achieve oncologic anus-preserving resection for low rectal cancer.