title: Robotic-assisted laparoscopic abdominoperineal resection for anal cancer: feasibility and technical considerations.
abstract: BACKGROUND
  Robotic-assisted laparoscopic surgery is an emerging technology that may prove advantageous for complex colorectal procedures involving the irradiated pelvis, such as abdominoperineal resection for recurrent anal cancer. The authors' initial experience is presented, with assessment of feasibility, safety, and oncologic principles.
  
  
  METHODS
  Over a 6 month period, five abdominoperineal resections were performed using the da Vinci® robot for recurrent anal cancer in patients initially treated with definitive chemoradiation therapy. Demographics, intraoperative parameters, pathology, and outcomes were assessed.
  
  
  RESULTS
  Five patients underwent surgery with a mean age of 58.8 years and body mass index of 24.9 kg m(-2) . The interval between chemoradiation and salvage APR was 14.2 ± 10.0 months. Operative time was 204 ± 39.1 min with robotic docking time 12.2 ± 2.8 min and console time 93.0 ± 24.9 min. The mean estimated blood loss was 150 cc and there were no intraoperative complications. The mean hospital length of stay was 5.4 days. Pathology analysis revealed that all surgical margins were adequate. There was one postoperative complication consisting of a seroma.
  
  
  CONCLUSIONS
  Robotic-assisted laparoscopic surgery for anal cancer was found to be a safe and feasible procedure. It facilitated enhanced visualization and dissection through deep irradiated pelvic structures.
authors.affiliation: Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Chirag B
authors.initials: CB
authors.lastname: Patel
authors.forename: Diego I
authors.initials: DI
authors.lastname: Ramos-Valadez
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D001005:Anus Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors