2025/03/28 by Chee Hoe Koo, María Sánchez‐Rodríguez, Vincent Assenat +3 · 1 voice
Medicine · #Colorectal Cancer Surgical Treatments #Anorectal Disease Treatments and Outcomes #Diverticular Disease and Complications
paper · pdf · doi:10.1093/bjs/znae308
openalex publication_date 2025/03/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
The current video is of a middle-aged male diagnosed with low rectal adenocarcinoma, with initial MRI staging of T3N1M0, and distal edge of tumour 1 cm above the upper border of the anal canal. Post chemoradiotherapy MRI revealed residual tumour and the patient proceeded to surgical resection. Our video describes the technique of a total robotic inter-sphincteric dissection with transanal transection and single stapled (TTSS) anastomosis, using a Da Vinci X robotic surgical platform. The robotic approach to proctectomy has many potential advantages, including having superior visualization and articulating instruments in the pelvis. These advantages allow for finer dissection compared to conventional laparoscopy, thereby making inter-sphincteric dissection possible. TTSS has also been proposed as a technique with many advantages compared to double-stapler technique. These include no intersecting staple lines, no multiple stapler firings for transection, an even transection line, and good distal margin control. The ongoing trials also demonstrate a reduced leak rate as compared to colo-anal hand-sewn anastomosis1–3. The current Video 1 demonstrates an approach to ultra low rectal cancer combining robotic ISD and TTSS. All procedures performed in studies involving humans were in accordance with ethical standards of the institutional research committee and the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all participants included in the study. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal. The authors have no funding to declare. The authors declare no conflict of interest. Supplementary material is available at BJS online. Data sharing not applicable to this article as no data sets were generated or analysed during the current study.