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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Real-time surgical navigation for intraoperative lymph node localization during targeted robot-assisted pelvic and
Marijn A J Hiep1,2, Wouter J Heerink3, Harald C Groen3
1Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. ma.hiep@nki.nl.
Surgical Endoscopy
|July 27, 2026
Summary
Surgical navigation accurately locates metastatic lymph nodes during robot-assisted surgery. This safe and feasible technique enhances oncologic dissection and intraoperative decision-making for improved patient outcomes.
Area of Science:
- • Surgical oncology
- • Medical robotics
- • Image-guided surgery
Background:
- • Locating metastatic lymph nodes (LNs) during robot-assisted surgery is challenging due to anatomical variations and vital structures.
- • Image-guided navigation can potentially improve LN localization and the completeness of oncologic dissection.
Purpose of the Study:
- • To evaluate the accuracy and usability of surgical navigation for localizing suspected metastatic LNs.
- • To assess the role of navigation in robot-assisted pelvic and retroperitoneal lymphadenectomy.
Main Methods:
- • Prospective study including patients undergoing robot-assisted pelvic or retroperitoneal LN dissection.
- • Patient-specific 3D models registered intraoperatively using ultrasound and electromagnetic tracking.
- • Real-time navigation displayed via da Vinci® TilePro™, with accuracy measured by distance to the 3D model and usability assessed via SUS score.
Main Results:
- • 39 of 40 target LNs were successfully localized with a median accuracy of 0.8 mm.
- • Surgical navigation (SUS score 70) supported decision-making and LN localization.
- • Registration time averaged 7 minutes, with no navigation-related complications.
Conclusions:
- • Surgical navigation provides highly accurate LN localization in robot-assisted dissections.
- • The technique is safe, feasible, and aids targeted oncologic surgery and intraoperative decisions.
- • Future advancements like wireless tracking could broaden clinical implementation.
