title: Four-arm single docking full robotic surgery for low rectal cancer: technique standardization.
abstract: The authors present the four-arm single docking full robotic surgery to treat low rectal cancer. The eight main operative steps are: 1- patient positioning; 2- trocars set-up and robot docking; 3- sigmoid colon, left colon and splenic flexure mobilization (lateral-to-medial approach); 4-Inferior mesenteric artery and vein ligation (medial-to-lateral approach); 5- total mesorectum excision and preservation of hypogastric and pelvic autonomic nerves (sacral dissection, lateral dissection, pelvic dissection); 6- division of the rectum using an endo roticulator stapler for the laparoscopic performance of a double-stapled coloanal anastomosis (type I tumor); 7- intersphincteric resection, extraction of the specimen through the anus and lateral-to-end hand sewn coloanal anastomosis (type II tumor); 8- cylindric abdominoperineal resection, with transabdominal section of the levator muscles (type IV tumor). The techniques employed were safe and have presented low rates of complication and no mortality.
authors.affiliation: Hospital Samaritano, Rio de Janeiro, RJ, Brazil.
authors.forename: José Reinan
authors.initials: JR
authors.lastname: Ramos
authors.affiliation: Florida Hospital Celebration Health, Orlando, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Parra-Davila
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods*