Robotic Low Anterior Resection with Transanal TME

Transanal phase:

• Endoscopic platform introduction and placement of laparoscopic instruments, including a flexible tip 3D camera

• Closure of the rectal lumen and flood with cytocidal solution

• Rectotomy with electrocautery

• “Down-to-up” TME acute and circumferential dissection

• “Rendez-vous” with the abdominal team

• Specimen extraction

Learning Points:

• How to perform a combined two-tea, Cecil approach with the robotic surgical system

• The advantages of the robotic assistance during TaTME for rectal cancer

• Tips and tricks to perform the low pelvis dissection

• Which are the new complications that may arise during TaTME

Technical Investigations:

• 83-year-old man.

• Cardiac failure.

• COPD stage IV.

Clinical Case:

• Rectal bleeding.

• Colonoscopy:

• CT, pelvic MRI and endoanal ultrasound: T3N0M0.

• Faecal incontinence: endoanal manometry.

• Blood test

• TAMIS of the polypoid lesion. Pathology: villous adenoma.

83-year-old man with a medical history of dilated cardiac failure and COPD stage IV. The patient came to the outpatient clinic with a history of rectal bleeding and a colonoscopy was performed showing a tumor 10 cm from the anal verge and a 25-35mm polypoid lesion 3 cm from the anal verge. The rectal tumor 10 cm from the anal verge was staged as a T3N0M0 adenocarcinoma after A CT scan, pelvic MRI and endoanal ultrasound.

The patient described fecal incontinence which was confirmed by the endoanal manometry.

The blood test showed a CEA of 7.5 and Hb of 10.9.

Due to the presence of the rectal polyp 3 cm from the anal verge, a TAMIS was performed with Pathology showing a villous adenoma with no signs of malignancy.

Anterior rectal resection was proposed 20 days after TAMIS.