[Robotic total mesorectal excision for rectal cancer].

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Laparoscopic total mesorectal excision (TME) is technically demanding in confined pelvic spaces, especially for obese patients with distal rectal tumors.
• Challenges include achieving adequate surgical margins and preserving hypogastric nerves due to un-ergonomic instruments and limited visibility.
• Robotic surgery aims to overcome these limitations, enhancing precision in minimally invasive rectal cancer treatment.

Observation:

• An 82-year-old obese male (BMI 32 kg/m2) with middle rectal adenocarcinoma underwent a hybrid laparoscopic-robotic TME.
• The patient had a history of smoking and prostate cancer.
• Preoperative staging indicated a T3-N0 tumor with free margins.

Findings:

• The hybrid procedure, combining laparoscopic and robotic TME, was performed safely in this obese patient.
• Robotic assistance facilitated dissection in the confined pelvis, enabling clear identification and preservation of hypogastric nerves.
• The patient recovered fully with no complications and was discharged on postoperative day three.
• Pathological analysis confirmed a pT3-pN0-pM0 (Stage II) adenocarcinoma with clear circumferential and distal margins and 24 negative lymph nodes.

Implications:

• Robotic TME can be a safe and effective option for obese patients undergoing rectal cancer surgery, overcoming limitations of pure laparoscopy.
• The technology aids in complex dissections within the narrow pelvic anatomy, crucial for oncological outcomes and nerve function.
• Further prospective randomized trials are needed to establish the definitive role of robotic surgery in rectal cancer treatment.