FULL-ROBOTIC ABDOMINOPERINEAL RESECTION AND SIMULTANEOUS LIVER METASTASES ENUCLEO-RESECTION WITH THE DA VINCI XI

Background: The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiquadrant surgery. We present a case of robot-assisted abdominoperineal resection (Miles) and enucleoresection of multiple liver metastasis with the use of the da Vinci Xi surgical system. Methodology: A 61-years old man with low rectal adenocarcinoma and CT scan and MRI finding of multiple liver metastases, underwent chemoradiotherapy with evidence of liver disease regression. The patient was then referred to our center where a combined procedure of abdominoperineal resection and contextual liver metastases resection (I, II, III and VII hepatic segments) with the Da Vinci Xi platform was performed. Both procedures were performed with the same four robotic trocars. Results: The procedure was successfully completed in 405 min by a full-robotic approach. Initially, the patient was placed in 15° Trendelemburg position, to complete the left colon mobilization and section, and the total mesorectal excision with the assistant's trocar positioned on the right upper quadrant. The patient's position was changed in 15° anti-Trendelemburg position, and the robotic boom was rotated 180° in order to carry out an US-guided liver metastasis enucleation with TilePro technology. In this phase the assistant's trocar was placed on left pararectal line, in the site previously marked for the permanent stoma. The specimens were removed through the perineal incision. No external instruments collisions or surgical complications occurred. The post-operative course was uneventful. Conclusion: Robotic rectal resections can be safely combined with hepatic resections in selected cases. Our experience confirms the positive role of the da Vinci Xi in facilitating minimally invasive multiquadrant combined surgery.