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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Key steps in exposure techniques for robotic total mesorectal excision (TME)
E P Tomada1,2, J Azevedo3,4, L M Fernandez5
1Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
Techniques in Coloproctology
|December 31, 2024
Summary
This study details robotic total mesorectal excision (TME) exposure techniques. A modular guide with macro- and microtractions enhances surgical precision and can serve as a training tool for rectal cancer surgery.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic surgery adoption is rapidly increasing.
- High-quality surgical training is crucial for optimal oncological outcomes.
- Standardized techniques are needed for complex procedures like robotic total mesorectal excision (TME).
Purpose of the Study:
- To define key exposure techniques in robotic TME.
- To develop a step-by-step technical guide for robotic TME exposure.
- To improve the safety and reproducibility of robotic rectal cancer surgery.
Main Methods:
- Analysis of 25 Da Vinci™ Xi robotic rectal resection videos.
- Modular division of robotic TME into 8 essential phases and 45 distinct steps.
- Classification of tissue manipulation into macrotraction (gross exposure) and microtraction (fine-tuning).
Main Results:
- Homogeneous surgical methodology observed across reviewed procedures.
- Detailed characterization of 8 modules and 45 steps in robotic TME.
- Description of macro- and microtraction techniques for optimized tissue exposure at each procedural step.
Conclusions:
- Precise tissue exposure techniques are fundamental for accurate dissection in robotic TME.
- The modular guide offers a reproducible system for safe robotic TME performance.
- Incorporating these exposure techniques can enhance training for robotic rectal cancer surgery.
