[Prevention of anastomotic leakage after robotic surgery for rectal cancer]

With popularity of robotic surgery system, robotic rectal cancer surgery is increasing. Precautionary measures of different perioperative periods should be taken to reduce the risk for anastomotic leakage. First, the general condition of patients should be acquainted and improved, and the risk for anastomotic leakage should be evaluated preoperatively. Preoperative neoadjuvant chemoradiotherapy may not increase the risk for anastomotic leakage after rectal surgery. The impact of routine bowel preparation to prevent anastomotic leakage needs to be verified further. Second, surgical techniques are crucial to prevent anastomotic leakage. Surgical procedures and resected intestines should be carefully selected. Careful surgery, adequate mobilization of the proximal colon, anastomosis with direct view will be required. Tension-free anastomosis and sufficient blood supply are necessary. We selected low ligation of the inferior mesenteric artery and preservation of the left colic artery in our routine practice to guarantee sufficient blood supply of the anastomosis site. Using the robotic Da Vinci system, indocyanine green(ICG) florescence can identify the collateral vessels in the inferior mesenteric artery zone. For patients with high risk for anastomotic leakage, pelvic drains, defunctioning stoma, and rectal tube may be useful to prevent anastomotic leakage. Early diagnosis and treatment are crucial for patients with anastomotic leakage.