Nueva técnica de proctectomía trasanal con escisión total del mesorrecto totalmente robótica en el tratamiento del cáncer de recto

Abstract

IntroductionAnterior resection with total mesorectal excision is the standard method of rectal cancer resection. However, this procedure remains technically difficult in mid and low rectal cancer. A robotic transanal approach could overcome some of these limitations. A robotic transanal proctectomy with total mesorectal excision and laparoscopic assistance is reported after laboratory experience with robotic transanal total mesorectal excision using a new designed port. MethodsThe feasibility of robotic transanal total mesorectal excision and initial postoperative results are evaluated in a 57 year old male with BMI 32 kg/m2 and rectal adenocarcinoma T2N1M0 at 5cm from the dentate line. ResultsIt was possible to complete a proctectomy with transanal total mesorectal excision. Operating room time was 420min. Blood loss 100ml. Postoperative hospital stay was 6 days and no complications were observed. Pathological report showed a 33cm specimen with ypT2N0 adenocarcinoma at 2cm from the distal margin, complete TME and non affected circumferential resection margin. ConclusionUsing the robotic technology and a specifically designed port for robotic transanal access, total mesorectal excision was shown feasible with good initial postoperative results in an obese male with a mid rectal tumor. Robotic technology might reduce some technical difficulties associated with TEM/TEO or SILS platforms in transanal total mesorectal excision. Further clinical trials will be necessary to assess this technique.