Robotic-Assisted Extralevator Abdominoperineal Resection in the Lithotomy Position: Technique and Early Outcomes

Extralevator abdominoperineal resection (E-APR) has been advocated as a superior procedure to achieve negative circumferential resection margins (CRMs) for sphincter-invading rectal cancers. An open total mesorectal excision is performed followed by perineal dissection with resection of the levators...

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Published inThe American surgeon Vol. 78; no. 10; pp. 1033 - 1037
Main Authors KANG, Celeste Y, CARMICHAEL, Joseph C, FRIESEN, Jeffrey, STAMOS, Michael J, MILLS, Steven, PIGAZZI, Alessio
Format Conference Proceeding Journal Article
LanguageEnglish
Published Atlanta, GA Southeastern Surgical Congress 01.10.2012
SAGE PUBLICATIONS, INC
Subjects
Abdomen
Abdomen - surgery
Adult
Aged
Biological and medical sciences
Colorectal cancer
Digestive System Surgical Procedures - methods
Dissection
Female
General aspects
Humans
Male
Medical sciences
Middle Aged
Patient Positioning
Perineum - surgery
Rectal Neoplasms - surgery
Retrospective Studies
Robotics
Robots
Surgical techniques
Treatment Outcome
Medicine
Prognosis
Treatment
Telemedicine
Position
Surgery
Evolution
Early
Abdominoperineal resection
Technique
Lithotomy
Robotics
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Summary:Extralevator abdominoperineal resection (E-APR) has been advocated as a superior procedure to achieve negative circumferential resection margins (CRMs) for sphincter-invading rectal cancers. An open total mesorectal excision is performed followed by perineal dissection with resection of the levators in the prone position. We describe a novel minimally invasive robotic approach carried out in the lithotomy position. Using the robotic arms to dissect the rectum and divide the levator fibers at their origin, the dissection is carried out in the ischiorectal space as distally as possible. From May to July 2011, six cases of robotic E-APR for rectal cancer were performed. The mean age was 54.5 years old. Mean operating time was 335 minutes. Mean estimated blood loss was 250 mL. There were no conversions to the open approach. A cylindrical specimen was obtained in all patients without perforation. All CRMs were negative. Mean hospital stay was 5 days. Two patients developed perineal wound infections and one developed a small bowel obstruction postoperatively. Robotic-assisted E-APR performed in the lithotomy position is safe and feasible. Future studies are needed to define the benefits of this technique.
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ISSN:0003-1348
1555-9823
DOI:10.1177/000313481207801004