Division of Colon and Rectal Surgery, University of Illinois at Chicago Medical Center, Chicago, Illinois 60612, USA.
Dis Colon Rectum. 2011 Oct;54(10):1320-5. doi: 10.1097/DCR.0b013e31822720a2.
The extralevator approach to abdominoperineal resection is an emerging surgical option for patients with low rectal cancer. This technique involves a wide excision of the levator muscles that could reduce the high incidence of circumferential margin positivity associated with conventional abdominoperineal resections. We present our technique of robotic cylindrical abdominoperineal resection where the daVinci robot is used to perform a controlled transection of the levator muscles transabdominally under direct visualization.
Five patients with rectal adenocarcinoma within 5 cm of the anal verge underwent robot-assisted cylindrical abdominoperineal resection. Safety, feasibility, immediate postoperative outcomes, and pathological adequacy of the specimen were assessed.
The procedure was successfully completed in all 5 patients without any intraoperative complications, robot-associated morbidity, or conversion to the open approach. The mean operative time and length of hospital stay were 343 minutes and 5.8 days. An intact mesorectal envelope and negative circumferential margin was achieved in all cases. All specimens had a cylindrical shape.
Robotic assistance enables the transabdominal transection of the levator muscles in cylindrical abdominoperineal resection, with acceptable perioperative and pathological outcomes. Further studies are essential to objectively define the safety, efficacy, and long-term results of this new technique.
腹会阴联合切除术的肛提肌外途径是一种新兴的治疗低位直肠癌的手术选择。该技术涉及广泛切除肛提肌，从而降低了常规腹会阴联合切除术相关的环周切缘阳性率。我们介绍了一种使用达芬奇机器人经腹直视下控制切断肛提肌的机器人辅助圆柱形腹会阴联合切除术技术。
5 例距肛门缘 5cm 以内的直肠腺癌患者接受了机器人辅助圆柱形腹会阴联合切除术。评估了安全性、可行性、术后即刻结果和标本的病理学充分性。
所有 5 例患者均成功完成手术，无术中并发症、机器人相关并发症或转为开放手术。平均手术时间和住院时间分别为 343 分钟和 5.8 天。所有病例均获得完整的直肠系膜筋膜和阴性环周切缘。所有标本均呈圆柱形。
机器人辅助技术可用于圆柱形腹会阴联合切除术中经腹切断肛提肌，具有可接受的围手术期和病理学结果。需要进一步的研究来客观地定义这项新技术的安全性、疗效和长期结果。
