Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Aug 10;35(4):298-305.
doi: 10.1055/s-0042-1743583. eCollection 2022 Jul.

The Mesentery in Robot-Assisted Total Mesorectal Excision

Rogier M P H Crolla  1 , J Calvin Coffey  2 , Esther J C Consten  3
Affiliations
Review

The Mesentery in Robot-Assisted Total Mesorectal Excision

Rogier M P H Crolla et al. Clin Colon Rectal Surg. .

Abstract

In recent decades, surgery for rectal cancer has evolved from an operation normally performed under poor vision with a lot of blood loss, relatively high morbidity, and mortality to a safer operation. Currently, minimally invasive rectal procedures are performed with limited blood loss, reduced morbidity, and minimal mortality. The main cause is better knowledge of anatomy and adhering to the principle of operating along embryological planes. Surgery has become surgery of compartments, more so than that of organs. So, rectal cancer surgery has evolved to mesorectal cancer surgery as propagated by Heald and others. The focus on the mesentery of the rectum has led to renewed attention to the anatomy of the fascia surrounding the rectum. Better magnification during laparoscopy and improved optimal three-dimensional (3D) vision during robot-assisted surgery have contributed to the refinement of total mesorectal excision (TME). In this chapter, we describe how to perform a robot-assisted TME with particular attention to the mesentery. Specific points of focus and problem solving are discussed.

Keywords: mesentery; robot-assisted total mesorectal excision; surgical technique.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Rogier Crolla and Esther Consten are both proctors for Intuitive.

Figures

Fig. 1
Fig. 1
( A ) Schematic demonstrating trocar positioning using SI/X robotic platforms. ( B ) Schematic demonstrating trocar positioning using Xi platform.
Fig. 2
Fig. 2
Schematic illustration of nerves around the root of the IMA (Courtesy Yang et al 9 ).
Fig. 3
Fig. 3
Intraoperative photograph demonstrating central lymphadenectomy around the root of IMA.
Fig. 4
Fig. 4
Intraoperative photograph demonstrating the O-sign.
Fig. 5
Fig. 5
Intraoperative photograph demonstrating the A-sign.
See this image and copyright information in PMC

References

    1. Culligan K, Walsh S, Dunne C. The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg. 2014;260(06):1048–1056. - PubMed
    1. Coffey J C, O'Leary D P. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol. 2016;1(03):238–247. - PubMed
    1. Chapuis P, Bokey L, Fahrer M, Sinclair G, Bogduk N.Mobilization of the rectum: anatomic concepts and the bookshelf revisited Dis Colon Rectum 200245011–8., discussion 8–9 - PubMed
    1. Heald R J. The 'Holy Plane' of rectal surgery. J R Soc Med. 1988;81(09):503–508. - PMC - PubMed
    1. Heald R J, Moran B J. Embryology and anatomy of the rectum. Semin Surg Oncol. 1998;15(02):66–71. - PubMed