Robotic Rectal Cancer Surgery

Minimally invasive surgery has influenced the approach used in a variety of operations. Laparoscopic surgery is an accepted modality for the treatment of colon cancer, resulting in superior short term functional outcome and equivalent survival when compared with open surgery (Veldkamp et al., 2004; Nelson et al., 2004). However, minimally invasive rectal cancer surgery is still a matter of great debate. The concept of a sharp total mesorectal excision (TME) has become standard of care for the treatment of rectal cancer with the lowest recurrence rates published in literature (Heald et al., 1998). TME includes the routine excision of the intact mesorectum by precise sharp dissection of the areolar tissue between the visceral and parietal layers of the fascia. Multiple authors have shown that this approach can be carried out laparoscopically offering the patient the advantages of minimally invasive over open techniques (Morino et al., 2003; Leroy et al., 2004; Leung et al., 2004). However, there is little doubt that laparoscopic TME is technically very challenging with a steep learning curve. We therefore began using robotic technology to facilitate the dissection in the pelvis, a confined space requiring precise movements, thus taking advantage of the enhanced dexterity of the robot. This chapter will review our operative technique of robotic-assisted total mesorectal excision for low rectal cancer as well as advantages and disadvantages of this technology.