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Updated: Aug 5, 2026
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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 localized metastatic lymph nodes during robot-assisted surgery. This safe and feasible technique enhances oncologic dissection and intraoperative decision-making for targeted cancer treatment.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Robotics
Background:
- Accurate localization of metastatic lymph nodes (LNs) is crucial for effective robot-assisted lymphadenectomy but challenging due to anatomical variations.
- Image-guided surgical navigation offers potential to improve intraoperative LN identification and the completeness of oncologic dissection.
Purpose of the Study:
- To evaluate the accuracy and usability of surgical navigation for localizing suspected metastatic lymph nodes (LNs) during robot-assisted pelvic and retroperitoneal lymph node dissection.
Main Methods:
- Prospective inclusion of patients undergoing robot-assisted pelvic or retroperitoneal lymph node dissection with suspected metastatic LNs.
- Intraoperative registration of patient-specific 3D models using ultrasound and real-time navigation display via da Vinci® TilePro™.
- Localization accuracy measured by the distance between indicated and 3D model LNs; usability assessed via System Usability Scale (SUS).
Main Results:
- 39 out of 40 target LNs were successfully localized in 20 patients with a median accuracy of 0.8 mm.
- Surgical navigation demonstrated high usability (SUS score 70) and supported surgical decision-making.
- No navigation-related complications occurred, with a median registration time of 7 minutes.
Conclusions:
- Surgical navigation provides highly accurate and safe LN localization for robot-assisted pelvic and retroperitoneal dissection.
- The technique is feasible, supports targeted oncologic surgery, and aids intraoperative decision-making.
- Future advancements like wireless tracking could broaden clinical implementation.
