Robotic Rectal Resection for Rectal Cancer: State of the Art

*Francesca De Stefano, Gianfrancesco Intini, Giulia Costantini, Carlo Gennaro, Ali Chahrour and Igor Monsellato*

## **Abstract**

Surgical resection with total mesorectal excision (TME) represents a crucial milestone in the treatment of rectal cancer. Conventional open procedures have been gradually replaced by minimally invasive techniques. To date, laparoscopic and robotic resection associated with neoadjuvant chemo-radiotherapy, represent the gold standard for rectal malignancies. Robotic surgery, when performed by an experienced surgeon, can offer advantages in case of difficult anatomical conditions, such as in male patients with a narrow pelvis. Higher costs remain a matter of debate in the diffusion of robotic platforms in general surgery. However, encouraging surgical outcomes and a shorter learning curve for the surgeon counterbalance the associated expense. Different surgical approaches are available for rectal cancer, according to the extension of the tumor and its location. The cornerstone of the different approaches is represented by TME, both transabdominally and transanally. Adequate TME, associated with neoadjuvant therapy, is pivotal in the success of the oncological treatment, in terms of curative results and reduced recurrence. Current different approaches are low anterior resection, abdominoperineal resection, and intersphincteric resection. They can all be performed with the robotic system and their surgical steps are described in this chapter.

**Keywords:** rectal cancer, robotic surgery, total mesorectal excision, low anterior resection, abdomino-perineal resection, intersphincteric resection
