title: Robotic cylindrical abdominoperineal resection with transabdominal levator transection.
abstract: OBJECTIVE
  The extralevator approach to abdominoperineal resection is an emerging surgical option for patients with low rectal cancer. This technique involves a wide excision of the levator muscles that could reduce the high incidence of circumferential margin positivity associated with conventional abdominoperineal resections. We present our technique of robotic cylindrical abdominoperineal resection where the daVinci robot is used to perform a controlled transection of the levator muscles transabdominally under direct visualization.
  
  
  METHODS
  Five patients with rectal adenocarcinoma within 5 cm of the anal verge underwent robot-assisted cylindrical abdominoperineal resection. Safety, feasibility, immediate postoperative outcomes, and pathological adequacy of the specimen were assessed.
  
  
  RESULTS
  The procedure was successfully completed in all 5 patients without any intraoperative complications, robot-associated morbidity, or conversion to the open approach. The mean operative time and length of hospital stay were 343 minutes and 5.8 days. An intact mesorectal envelope and negative circumferential margin was achieved in all cases. All specimens had a cylindrical shape.
  
  
  CONCLUSIONS
  Robotic assistance enables the transabdominal transection of the levator muscles in cylindrical abdominoperineal resection, with acceptable perioperative and pathological outcomes. Further studies are essential to objectively define the safety, efficacy, and long-term results of this new technique.
authors: Division of Colon and Rectal Surgery, University of Illinois at Chicago Medical Center, Chicago, Illinois 60612, USA.
authors: Slawomir J
authors: SJ
authors: Marecik
authors: Marek
authors: M
authors: Zawadzki
authors: Ashwin L
authors: AL
authors: Desouza
authors: John J
authors: JJ
authors: Park
authors: Herand
authors: H
authors: Abcarian
authors: Leela M
authors: LM
authors: Prasad
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D010502:Perineum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013997:Time Factors