View
216
Download
2
Category
Tags:
Preview:
Citation preview
Robotic LAR with Transanal Extraction
Alessio PigazziCity of HopeDuarte, CA
A history of Lap TA extraction -Franklin procedure
First shown by Franklin in early 1990s for Recto/sigmoid resection.
Advantages:• Cosmetically pleasing• Lower hernia rate• Lower wound infection• Better anastomosis?
Disadvantages• Technically demanding• Oncologically safe?
Franklin’s transanal extraction
Anastomosis
Indications
Can be done for• Benign disease• Selected cancers
Avoid large tumors
What about rectal cancer?
Types of Rectal Transanal ResectionLife within 8 cm of the outside world
Low AnteriorResectionColorectal AA
InterSphincteric Coloanal AA
40 Intersphincteric resection vs 37 CAA 1990-2000 Same frequency, urgency, fragmentation Wexner incontinence score higher in ISR
• 10.8 ISR vs 6.9 CAA
Higher use of antidiarrheals in ISR
Double stapled AA
13 patients• 11 transanal extraction • 2 Transvaginal extractions• Complications :2 patients (15%)• Anastomotic leak: 1• Bleeding anastomosis:1• No report of incontinence
Surg Endosc, 2010
Robotic low anterior resection with TA extraction
Potential to have• Superior cosmetic results• Lower wound infection rates• Lowe hernia rate• Better continence data than coloanal
anastomosis
Robotic transanal extraction with double purse string aa.
City of Hope experience Double Purse String AA.
4 patients (3F;1M) Age: 58 Mean distance tumor anal verge: 8
cm Ileostomy:2 Complications: None Mean Wexner score: 3.5 (2-6)
Conclusions
Resection with transanal extraction ideal minimally invasive procedure• Combines Open, LAP, Endoscopic skills
Robotic technology makes the procedure more applicable to low anterior resection
Preliminary data encouraging-more studies are needed
Recommended