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Advantages of the umbilical minilaparotomy-first approach in robotic rectal cancer surgery
Yukiharu Hiyoshi1, Tomohiro Yamaguchi2, Nobuko Matsuura3
1Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Background:
Since 2018, we have performed robotic rectal cancer surgery at our institution via the umbilical mini-laparotomy-first approach. In the present technical note, we introduce the advantages of this approach.
Methods:
In this approach, a 3-cm mini-laparotomy and the wound protector attachment are performed prior to port placement for the da Vinci® Xi system. During robotic surgery, the assistant can adjust the location of the camera port within the wound protector.
Results:
This approach is only different from the standard port placement in terms of the timing of minilaparotomy; therefore, there is no additional cost. This approach has several advantages. 1: Intraabdominal adhesion around the umbilicus can be dissected under direct vision. 2: Robot arm collision can be diminished. 3: The diverting stoma can be located just at the preoperative stoma-site marking. 4: The da Vinci® camera is less likely to be dirty. 5: Assistant ports can be added through the wound protector. However, sometimes interference between the wound protector extends inside the abdomen and other ports can be a problem, especially in small patients. A smaller-size wound protector is thus recommended in such cases.
Conclusions:
The umbilical minilaparotomy-first approach in robotic rectal cancer surgery is a simple and feasible technique with great advantages for not only ensuring successful robotic surgery but also reducing the stoma-associated complications.
