Dr. Igor Monsellato has completed his Ph.D at the age of 33 years at Sapienza University of Rome, Italy. He gained a fellowship on Robotic Surgery at San Giovanni – Addolorata Hospital, Rome, Italy. He is reviewer and has published more than 10 papers in reputed journals.
Part of the book: Colorectal Cancer
Since the 1990s, laparoscopic technique has become a standard approach for several surgical procedures in the field of colorectal surgery. Laparoscopic approach to splenic flexure and transverse colon cancer, however, is still a matter of debate and considered challenging for both anatomical and technical aspects. The relationship with the spleen and the absence of a consensus on the extent of surgery for splenic flexure cancer are two of several aspects that make splenic flexure surgery mostly debated. Robotic technique has overcome some pitfalls of laparoscopy, thanks to its stability of vision, tremor filtering, and fine movements of the robotic arms that can help in better identifying and managing both vascular structures and side organs, thus avoiding splenic and pancreatic injuries. In addition, robotic system can allow a better fashioning of the intracorporeal anastomosis, and the advent of fluorescence is useful to guide dissection and to evaluate the vascularization of the colon. Herein we discuss a standardized approach for robotic splenic flexure resection and transverse colon.
Part of the book: Surgical Robotics
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.
Part of the book: Recent Understanding of Colorectal Cancer Treatment