Search

Introduction: Compared with laparoscopic surgery (LS), robotic surgery (RS) is considered to have acceptable outcomes in rectal cancer, but few reports have focused on chylous ascites in RS. The aim of this study was to investigate the incidence and etiology of chylous ascites after RS. Methods: This retrospective study included 291 patients with rectal cancer who underwent RS (n = 165) or LS (n = 126) with high ligation of the inferior mesenteric artery (IMA). Propensity score matching (PSM) was performed to compare the two groups. Results: \Dissection around the IMA was achieved using ultrasonic coagulating shears in most LS cases, and monopolar scissors in most RS cases, sometimes using bipolar vessel sealing device or bipolar forceps. The incidence of chylous ascites was 12.2% in RS and 4.1% in LS after PSM (P =.037). When limited to the RS group, multivariate analysis identified absence of lymphatic sealing at the left side of the IMA and shorter operative time as independent risk factors for chylous ascites. Except for duration of drain placement, no outcomes differed significantly with or without chylous ascites. One patient with chylous ascites developed later infection and required antibiotic treatment. Conclusion: The incidence of chylous ascites is significantly higher in RS than in LS, and RS with incomplete lymphatic sealing around the IMA is a risk factor for chylous ascites in rectal cancer. Although outcomes for patients with chylous ascites were acceptable, adequate lymphatic sealing during dissection around the IMA is crucial to prevent chylous ascites in RS. [ABSTRACT FROM AUTHOR]

Introduction: The best surgical technique for rectal cancer invading the prostate remains controversial. Rectal resection with en bloc prostatectomy using a standard retropubic approach is an option but has disadvantages. We report a new surgical procedure applying Retzius‐sparing robot‐assisted radical prostatectomy. Materials and Surgical Technique: First, the rectum was mobilized mainly at its dorsal side. Next, the prostate was separated from the bladder and urethra via the pouch of Douglas approach without opening the Retzius cavity, after which the surgical specimen was extracted through the perineal wound. Lateral pelvic lymph node dissection was performed after vesicourethral anastomosis. Discussion: This new robotic procedure minimizes surgical trauma and preserves normal pelvic anatomy. Furthermore, this approach makes it easy to perform subsequent lateral pelvic lymph node dissection. [ABSTRACT FROM AUTHOR]

Introduction: Robot‐assisted laparoscopic surgery has been performed in various fields, especially in the pelvic cavity. However, little is known about the utility of robot‐assisted laparoscopic rectal cancer surgery associated with robot‐assisted radical prostatectomy (RARP). We herein report the clinical impact of robot‐assisted laparoscopic rectal cancer surgery associated with RARP. Methods: We experienced five cases of robot‐assisted laparoscopic rectal cancer surgery associated with RARP. One involved robot‐assisted laparoscopic abdominoperineal resection with en bloc prostatectomy for T4b rectal cancer, and one involved robot‐assisted laparoscopic intersphincteric resection combined with RARP for synchronous rectal and prostate cancer. The remaining three involved robot‐assisted laparoscopic low anterior resection (RaLAR) after RARP. For robot‐assisted laparoscopic rectal cancer surgery, the da Vinci Xi surgical system was used. Results: We could perform planned robotic rectal cancer surgery in all cases. The median operation time was 529 min (373–793 min), and the median blood loss was 307 ml (32–1191 ml). No patients required any transfusion in the intra‐operative or immediate peri‐operative period. The circumferential resection margin was negative in all cases. There were no complications of grade ≥III according to the Clavien‐Dindo classification and no conversions to conventional laparoscopic or open surgery. Conclusion: Robot‐assisted laparoscopic surgery associated with RARP is feasible in patients with rectal cancer. The long‐term surgical outcomes remain to be further evaluated. [ABSTRACT FROM AUTHOR]