title: Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance.
abstract: OBJECTIVE
  The purpose of this study was to analyze the safety, feasibility, and efficacy of the da Vinci S HD robotic system in mesorectal excision for rectal adenocarcinoma, with the aim to identify areas of potential advantage for the robot in this procedure.
  
  
  METHODS
  This study was conducted as a retrospective review of a prospectively maintained database of 44 consecutive cases of robot-assisted mesorectal excision for rectal adenocarcinoma performed between August 2005 and February 2010. Patient demographics, perioperative outcomes, and complications were evaluated and compared with similar published reports and relevant literature.
  
  
  RESULTS
  There were 28 (63.6%) men and 16 (36.4%) women, with a mean age of 63 years. The majority of patients were either overweight or obese and 88.7% of lesions were in the mid or low rectum. We performed 36 low anterior resections (6 intersphincteric) and 8 abdominoperineal resections with a median blood loss of 150 mL (range, 50-1000), a median operative time of 347 minutes (range, 155-510), and a median length of stay of 5 days (range, 3-36). The median lymph node yield was 14 (range, 5-45) and the circumferential resection margin was negative in all patients. We had 1 distal margin positivity (2.7%), 2 anastomotic leaks (5.6%), 1 death (2.7%), and 2 conversions (4.5%) to the open approach. No robot-associated morbidity occurred in this series.
  
  
  CONCLUSIONS
  This series compares favorably with similar published reports with regard to the safety and feasibility of robotic assistance in total mesorectal excision for rectal cancer. The lower conversion rates reported for robotic rectal resection compared with laparoscopy require validation in large randomized trials.
authors.affiliation: Center for Robotic Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: Ashwin L
authors.initials: AL
authors.lastname: deSouza
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Marecik
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blumetti
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.forename: Andrea
authors.initials: A
authors.lastname: Zimmern
authors.forename: Herand
authors.initials: H
authors.lastname: Abcarian
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome