Robotic interface for transabdominal division of the levators and pelvic floor reconstruction in abdominoperineal resection: a case report and technical description.
BACKGROUND
Extralevator abdominoperineal resection (APR) in a prone jackknife position was developed to avoid a positive circumferential resection margin, and its application led to lower rates of local recurrence. The paper describes a technique of robotic extralevator APR with transabdominal levator division followed by pelvic floor reconstruction with bilayered composite mesh.


METHODS
A 42-year-old man with low rectal cancer required APR that was performed in a lithotomy position with transabdominal division of the levators. After the perineal phase, the robot was redocked and a bilayered composite mesh was sutured to the pelvic inlet using robotic needle drivers.


RESULTS
The specimen had a cylindrical shape, and there was no surgical waist or perforation. Histology revealed a ypT2N0 tumor without circumferential margin involvement.


CONCLUSIONS
The robotic interface can aid in APR by accurately transecting the levators from the top. Additionally, it allows suturing of mesh around the pelvic inlet to prevent perineal hernias. Copyright © 2014 John Wiley & Sons, Ltd.
Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea.
Sung U
SU
Bae
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Korea.
Avanish P
AP
Saklani
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Korea.
Hyuk
H
Hur
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Korea.
Byung S
BS
Min
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Korea.
Seung H
SH
Baik
Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Korea.
Nam K
NK
Kim
abdominoperineal resection; pelvic floor repair; robotics