Robotic Treatment of Rectal Tumors

Colorectal cancer is the third most common cancer worldwide, and rectal cancer accounts for over one-third of cases. Surgery represents the cornerstone of colorectal cancer treatment. Anterior resection is the most common procedure for radical excision of rectal cancer and involves removal of the sigmoid colon and rectum along with total or partial excision of the mesorectum. Intestinal continuity is reestablished with a colorectal anastomosis, and a temporary diverting stoma is often performed. In selected patients in whom a standard anterior resection would not achieve an adequate distal margin, proctectomy with intersphincteric resection may be performed. This procedure involves partial or complete removal of the internal anal sphincter and coloanal anastomosis through an abdominal and perineal approach. Cancers affecting the external anal sphincter require an abdominoperineal resection, which involves complete excision of the rectum and anus by dissection through the abdomen and perineum, and permanent colostomy. Rectal surgery, especially low in a narrow pelvis, is one of the abdominal surgeries that has benefited most from the use of a robotic approach. This is mainly due to a three-dimensional magnified view, articulated instruments without tremor, and a stable camera platform. In this chapter, procedures using the da Vinci Xi platform are described.