Robotic-assisted abdominoperineal resection: technique, feasibility, and short-term outcomes

Aim: The use of robotic-assisted laparoscopy seems fully adapted to pelvic surgery. However, few studies focus on robotic-assisted abdominoperineal resection (RAAPR). The aim of this study was to assess the feasibility, short-term postoperative outcomes, and pathological results of RAAPR. In addition, we provide a detailed description of the operative procedure and a brief review of the current literature.Methods: Between January 2013 and April 2018, we performed a total of 428 robotic surgeries, including 294 colorectal resections (68.7%). Data were prospectively collected and included demographics, intraoperative findings, postoperative outcomes, and pathological data. For this study, we included the first 20 consecutive RAAPRs performed with the four-arm da Vinci Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA).Results: Twenty patients (nine men) with a mean age of 68 years and a mean BMI of 24.5 ± 5.0 kg/m2 underwent RAAPR for low rectal adenocarcinoma (80%) or squamous cell carcinoma of the anal canal. Sixteen (80%) patients underwent preoperative pelvic radiotherapy and eight (40%) had a history of previous abdominal surgery. Mean operative duration was 218 ± 52 min. There was no conversion to open surgery. Mortality, reoperation, and morbidity rate were 5%, 25%, and 60%, respectively. Three (15%) patients presented perineal complications. Mean length of hospital stay was 20 days. Three (15%) patients had pT4 tumor. Mesorectal excision was considered complete in 90%. On average, 16.5 ± 7.2 lymph nodes were retrieved.Conclusion: RAAPR is feasible, with acceptable pathologic and short-term outcomes. The current literature does not demonstrate significant differences between robotic and laparoscopic APR. Indeed, we cannot justify its use in routine on the basis on the available evidence