Complete Intracorporeal Single-Stapling Technique Anastomosis Using a Novel Detachable Purse-String Instrument in...

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Robotic colorectal surgery is advancing, yet rectal cancer procedures often require extracorporeal manipulation for anastomotic anvil placement.
• Transanal total mesorectal excision (TaTME) is gaining traction for lower rectal cancer, prioritizing oncological outcomes and functional preservation.
• Current TaTME methods typically involve extracorporeal anvil fixation, posing challenges in cases of bulky tumors or narrow pelves.

Purpose of the Study:

• To introduce and evaluate a complete intracorporeal single-stapling technique (SST) anastomosis in robotic low rectal cancer surgery using a novel detachable purse-string instrument (PSI).
• To present a minimally invasive alternative for anvil fixation in transanal total mesorectal excision (TaTME) when traditional methods are difficult.

Main Methods:

• The study details a technique involving complete intracorporeal SST anastomosis in robotic low rectal cancer surgery with TaTME.
• A novel detachable PSI is used for anvil fixation through a planned ileostomy site.
• Specimen exteriorization and subsequent SST anastomosis with the rectal stump are performed using a Powered Stapler.

Main Results:

• The technique allows for complete intracorporeal anvil fixation and specimen exteriorization via the ileostomy site.
• This method simplifies the process when perineal extraction of the specimen is challenging due to tumor size or pelvic anatomy.

Conclusions:

• The described minimally invasive technique using a detachable PSI offers a viable option for SST anastomosis in robotic rectal cancer surgery with TaTME.
• It is particularly beneficial when extracorporeal methods for anvil fixation are hindered by anatomical constraints.