Page 32 - Read Online

Page 10 of 15 Kumar et al. Mini-invasive Surg 2018;2:19 I http://dx.doi.org/10.20517/2574-1225.2018.26

Pubic symphysis
Vas deferens divided Dissection anterior to SV till Denonvillier's fascia is cut

Seminal vesicle
Left ureter

Rectum

Figure 7. Laparoscopic anterior resection with seminal vesicle excision

Rectum

Vas deferens

Seminal vesicle

Figure 8. Specimen of laparoscopic anterior resection with seminal vesicle excision

surgery are paramount for successful laparoscopic extended resections. Nagasaki et al. confirmed the role of
[25]
laparoscopic extended resections for locally recurrent rectal cancer to achieve R0 resection.

The reports on robotic extended resections are scarce. One of the largest series of robotic extended resections
was published by Shin et al. . The study included eight prostate or seminal vesicle excisions, three partial
[74]
cystectomies, and five partial vaginal wall excisions along with other multi visceral resections. There were
urinary leakage in one patient and five patients developed urinary retention. R0 resection was achieved in
all patients. The 5-year cumulative local recurrence rate was 3.6%. The 5-year actuarial disease-free rate was
54.6% and an OS rate was 80%. The authors confirmed that the robotic extended resection is safe and feasible
with good perioperative outcomes, a low risk for conversion, a high rate of R0 resection, and acceptable long-
term oncological outcomes.

ABDOMINOSACRAL RESECTION
Abdominosacral resection is required when locally advanced/recurrent rectal cancer involves presacral
fascia and sacrum. Williams et al. reported an R0 resection following laparoscopic abdominosacral
[75]