ROBOTIC LOW ANTERIOR RESECTION WITH TRANSRECTAL EXTRACTION
Alex Ky, matthew Miyasaka*
Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
INTRODUCTION:
Natural orifice intracorporeal anastomosis and transrectal extraction of the specimen have been described. Same day discharges have also been described by a number of trailblazing surgeons. For those of us who have been around for a long time or just started, there is always hesitation to embrace new ways of surgical techniques especially if the complication can be major. We present our experience at our institution demonstrating the feasibility, safety, and utility of transrectal extraction with progressing earlier discharge of single surgeon experience.
TECHNIQUE:
Seven natural orifice intracorporeal anastomosis with transrectal extraction procedures with double stapled anastomosis were performed. All specimens were extracted through a wound protector transrectally.
METHOD:
Between 5/22-12/22, a total of seven low anterior resections with transrectal extraction were performed robotically. The average age was 68 (47-86yrs old) All of the patient was collected on operative time, BMI, indication for surgery, length of operations and length of stay,
RESULTS:
The indications were complicated diverticulitis, rectal cancer, and large polyps not amenable to EMR. The mean operative time was 182.2minutes for surgeon A 178 min (132-249 min). There were no intraoperative complications or conversions. An EEA double staple technique intracorporeal anastomosis was successful in all patients. Natural orifice transrectal extraction was successful in all (100%) patients. A small wound protector was used transrectally for extraction. The mean postoperative length of stay was 3 days (1.5-5). There was 1 complication of post op bleeding from the staple line from an unexpected postoperative elevated INR. The patient was returned to the OR the same day and the anastomosis clipped endoscopically by the surgeon There were no reoperations or mortalities.
CONCLUSIONS:
Robotic natural orifice intracorporeal anastomosis with transrectal extraction procedure and anastomosis was feasible and safe in this series. This technique can be successfully performed in a total intracorporeal manner without the need for an incision for extraction incision.
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