title: Is hybrid robotic laparoscopic assistance the ideal approach for restorative rectal cancer dissection?
abstract: OBJECTIVE
  While the use of robotic assistance in the management of rectal cancer has gradually increased in popularity over the years, the optimal technique is still under debate. The authors' preferred technique is a robotic low anterior resection that requires a hybrid approach with laparoscopic hand-assisted mobilization of the left colon and robotic assistance for rectal dissection. The aim of this study was to determine the efficacy of this approach as it relates to intra-operative and short-term outcomes.
  
  
  METHODS
  Between August 2005 and July 2011, consecutive patients undergoing rectal dissection for cancer via the hybrid robotic technique were included in our study. Demographics, margin positivity, intra-operative and short-term outcomes were evaluated.
  
  
  RESULTS
  The preferred approach was performed in 77 patients with rectal adenocarcinoma. Of these, 68 underwent low anterior resection and nine had a coloanal pull-through procedure (mean age 60.1 years; mean body mass index 28.0 kg/m(2) ; mean operative time 327 min; conversion rate 3.9%). Three patients (3.9%) had positive resection margins (one circumferential, two distal). Five patients had an anastomotic leak (6.4%). No robot-specific complications were observed.
  
  
  CONCLUSIONS
  The hybrid approach involving hand-assisted left colon mobilization and robotic rectal dissection is a safe and feasible technique for minimally invasive low anterior resection. This approach can be considered an viable option for surgeons new to robotic rectal dissection.
authors.affiliation: Department of Colon and Rectal Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Zawadzki
authors.forename: V R
authors.initials: VR
authors.lastname: Velchuru
authors.forename: S A
authors.initials: SA
authors.lastname: Albalawi
authors.forename: J J
authors.initials: JJ
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Marecik
authors.forename: L M
authors.initials: LM
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: anterior resection; da Vinci robot; hybrid; rectal cancer