title: Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients.
abstract: BACKGROUND
  Intersphincteric resection (ISR) for low rectal cancer has been described as the ultimate sphincter-saving procedure. Laparoscopic ISR has been proved safe with early postoperative benefits. Recently, some colorectal surgeons have begun to perform robot-assisted ISR to harness the advantages of the da Vinci robotic system. The authors present their short-term results for a robotic technique of ISR.
  
  
  METHODS
  Data from 29 consecutive patients at a single institution with very low rectal cancer (<4 cm) from the anal verge who underwent robot-assisted ISR were prospectively collected between December 2007 and March 2010.
  
  
  RESULTS
  The study enrolled 23 men and 6 women with a median age of 61.5 years (range, 36-82 years). Their median body mass index (BMI) was 23.3 kg/m(2) (range, 17.9-32.5 kg/m(2)). The median distance of the tumor from the anal verge was 3 cm (range, 1-4 cm). The median operative time was 325 min (range, 235-435 min), with a console time of 130 min (range, 110-210 min). There were no conversions to open surgery. A protecting ileostomy was performed for all the patients. The median blood loss was less than 50 ml (range, < 50-1,000 ml). The median size of the tumor was 3 cm (range, 0-6.9 cm), and the median number of lymph nodes harvested was 16 (range, 1-44). The median distal margin was 0.8 cm (range, 0-4 cm), and one margin was positive. The circumferential margin was negative (>2 mm) for 27 patients. Therefore, complete resection (R0) was achieved for 26 (90%) of the 29 patients. The median hospital stay was 9 days (range, 5-15 days). Nine patients experienced complications, including three anastomotic leaks (10%). All the leaks were managed conservatively. No surgical mortalities occurred.
  
  
  CONCLUSIONS
  Robot-assisted intersphincteric resection for very low rectal cancer is feasible, and its short-term outcome is acceptable.
authors.affiliation: Korea University College of Medicine, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, SungBook-gu, Seoul 136-705, Korea. quormeng@gmail.com
authors.forename: Quor M
authors.initials: QM
authors.lastname: Leong
authors.forename: Dong N
authors.initials: DN
authors.lastname: Son
authors.forename: Jae S
authors.initials: JS
authors.lastname: Cho
authors.forename: Se J
authors.initials: SJ
authors.lastname: Baek
authors.forename: Jung M
authors.initials: JM
authors.lastname: Kwak
authors.forename: Azali H
authors.initials: AH
authors.lastname: Amar
authors.forename: Seon H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D001005:Anus Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome