V66 - Robotic Low Anterior Resection with Bilateral Pelvic Node Dissection and Paraaortic Node Dissection

CME Eligible

Purpose/Background: Robotic-assisted techniques have revolutionized rectal cancer surgery by enhancing precision, visualization, and ergonomics in the confined pelvic cavity. While robotic low anterior resection (LAR) is well established, combining it with bilateral pelvic and para-aortic lymph node dissection in a single procedure remains rare. This report presents a complex case illustrating the feasibility and oncologic value of an extended robotic approach for advanced rectal adenocarcinoma.

Methods/Interventions: A 68-year-old female with Stage III (T3N2M0) rectal adenocarcinoma, previously treated with neoadjuvant chemoradiotherapy and systemic chemotherapy (Bevacizumab with Capecitabine), underwent a robotic-assisted laparoscopic ultra-low anterior resection with total intersphincteric resection, coloanal anastomosis, bilateral pelvic lymph node dissection, and para-aortic lymph node dissection.

The Da Vinci Xi robotic system was utilized to achieve precise dissection within the deep pelvis and retroperitoneal space. The enhanced three-dimensional visualization and articulating instruments facilitated sharp mesorectal excision, meticulous nerve preservation, and controlled para-aortic lymphadenectomy up to the level of the renal vessels. A diverting loop ileostomy was fashioned for distal anastomotic protection.

Results/Outcomes: The operation was completed without intraoperative complications and with minimal blood loss. Postoperative recovery was smooth, and bowel continuity was restored after satisfactory healing. Final histopathologic evaluation confirmed negative margins and adequate lymph node yield. Para-aortic nodes were free of metastasis. The patient remains clinically stable and disease-free on follow-up.

Conclusion/Discussion: This case underscores the technical feasibility and safety of an extended robotic approach encompassing both pelvic and para-aortic lymph node dissection in rectal cancer. The robotic platform allowed precise oncologic resection in difficult anatomical zones with reduced morbidity and excellent functional outcomes. Such integration of advanced robotic maneuvers expands the surgical frontier for complex colorectal malignancies, supporting its use in selected cases requiring comprehensive nodal clearance.

Robotic Low Anterior Resection with Bilateral Pelvic and Para-Aortic Lymph Node Dissection for Locally Advanced Rectal Adenocarcinoma