VM60 - Local Recurrence of Rectal Cancer - Difficult Pelvic Dissection

Purpose/Background: Recent advancements in robotic technology have generated considerable interest in employing robotic platforms for rectal cancer resection. Robotic-assisted procedures offer distinct advantages including enhanced visualization of anatomical structures and reduced tissue manipulation. This leads to improved postoperative pain control, shorter hospital stays, and quicker return to normal bowel function. They also allow for low rectal dissections in difficulty cases with improved visualization.

Methods/Interventions: In this video, we demonstrate a robotic approach for the resection of recurrent rectal cancer in a patient with rectal sphincter dysfunction and challenging radiated pelvic dissection. This was completed using the Da Vinci Xi system by Intuitive Surgical. The robotic platform provides several key benefits, such as adaptable robotic arm placement for precise surgical needs and critical plane visualization, especially in radiated pelvic cases. These advantages contribute to a faster recovery and quicker resumption of daily activities post-surgery.

Results/Outcomes: We were able to successfully complete a LAR with end colostomy in a radiated pelvis. The dissection was very difficult due to the tissue quality, perforation of the tumor, previous scarring, and a large, heavy tumor. The patient was able to tolerate the procedure well and was discharged on post-operative day two.

Conclusion/Discussion: Approaching recurrent rectal cancer is a complex and challenging task, often accompanied by a latent fear of complications, particularly when patients have undergone neoadjuvant therapy. These complications can be further exacerbated by the effects of pelvic radiation, which transform the nature of tissues and render surgical intervention more demanding. In this context, the strategic placement of robotic arms takes on a pivotal role, enabling surgeons to adapt their approach to the unique demands of each case. The radiation-induced fibrosis and changes in tissue quality make precise dissection and the localization of surgical planes more daunting. Consequently, a surgical strategy must be adaptable and informed by both pre-operative imaging and a thorough understanding of each patient's unique circumstances.
Robotic-assisted surgery has emerged as a significant advancement in addressing these complexities. The flexibility in robotic arm placement enables us to navigate these challenges with a high degree of precision, optimizing the chances of a successful outcome.
The importance of communication within the surgical team cannot be overstated. Effective coordination, teamwork, and clear communication between the surgeon, assisting personnel, and other specialists are paramount. A multidisciplinary approach, which includes collaboration with radiologists, oncologists, and pathologists, ensures comprehensive care. This collaborative approach minimizes the associated risks.