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Robotic APR

Robotic APR: The latest and the best treatment for Low Rectal Cancer

The most prevalent cancer in the world is colorectal cancer (CRC). With more than 1.4 million new cancer cases each year, it is the second most prevalent disease among women and the third most common cancer among men. More than half of CRC cases occur in wealthy nations, showing a geographic variance in incidence rates. Incidence rates in India are modest, at 7.2 per 100,000 for men and 5.1 per 100,000 for women. The absolute number of CRC patients is high in a nation with a population of more than a billion people. India has one of the lowest rates of CRC survival after five years, at less than 40%.

What is Rectal Cancer

Cancer that starts in the rectum is called rectal cancer. The large intestine’s final few inches are known as the rectum. Your colon’s final section marks the beginning of this passageway, which stops when it reaches the short, confined passageway leading to the anus. Colorectal cancer, also known as rectal cancer and colon cancer, is a term that is frequently used interchangeably. While rectal and colon tumours share many characteristics, their approaches to treatment differ greatly.

This is primarily due to how closely the rectum is located to other organs and structures. Rectal cancer removal surgery may be challenging due to the restricted area within the pelvis. Rectal cancer survival rates have significantly increased as a result of recent advancements in treatment. Abdominoperineal Resection (APR) is the surgery offered for low rectal cancers.

What is APR Surgery

During an abdominoperineal resection (APR), the sigmoid colon, rectum, and anus are surgically excised. Rectal cancer that is very low in the rectum is most frequently treated with this treatment. The back canal and the bowel-controlling muscles will both be removed. The remaining portion cannot be repaired and the bowel reconnected. Thus a permanent colostomy is required. One needs to wear a bag over the colostomy. Faeces from your body will travel through this. A stoma is the name for the portion of the intestines that is brought out as a conduit through the abdomen. APR surgery is done after one has finished chemotherapy and/or radiation treatments for most of the rectal cancers

Technological Advances in the management of Low Rectal Cancer

Abdominoperineal resection (APR) procedures have been much less common over the past ten years, largely as a result of technical developments, the requirement for narrower distal margins, and the development of excellent stapling devices.

Despite this, APR is still the best course of action for older patients with poor baseline functional and respiratory capacity who have rectal cancer that involves the sphincter complex or that cannot be excised with adequate distal resection margins. After chemoradiotherapy, APR continues to be the go-to treatment for anal canal squamous cell carcinoma that is persistent or recurrent.

What is Minimally Invasive Rectal Surgery

The standard procedure for rectal cancer surgery today is minimally invasive rectal surgery (MIRS). Although a laparoscopic technique is used in this, new paradigms for APR have been created with the advent of robotic systems. Some of the drawbacks of traditional laparoscopic rectal surgery are solved by a robotic-assisted technique.

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What is Robotic Surgery for rectal cancer

Robotic surgery is a type of minimally invasive surgery that is made available to remove rectal cancer. Surgery uses small incisions, similar to other minimally invasive procedures, which can lower the risk of complications compared to open surgery or large incision procedures. Robotic surgery, however, is a more modern procedure that involves very expensive and sophisticated equipment. The surgeon uses a high-definition three-dimensional camera, miniature equip ment, and very small incisions in the abdomen to do  surgery using the robotic system.

In certain cases, skin incisions are not even necessary. The surgeon will then control those instruments to carry out the procedure from a nearby console. Imagine the robotic system as a supercomputer that translates the actions of the surgeon into real-time, allowing for more precision. The surgeon utilizes the master controls at the surgeon console to operate the instruments during the surgery when it is robotically assisted. The instruments inside your body are controlled by a computer that interprets the actions of the surgeon to those of the tools. The surgical system reacts to commands from the surgeon, who controls the robot the entire time.


What are the advantages of Robotic Surgery over laparoscopic method for Rectal cancer

The da Vinci surgical robotic system provides a clear surgical advantage over conventional laparoscopic tools thanks to its improved instrument stability, tridimensional vision, and dexterity with more degrees of wristed motion. This benefit is particularly noticeable in the deep pelvis, where the restricted working area and visibility make distal rectal dissection quite difficult. Additionally, this solid surgical platform allows for precise and fine dissection in this area under the surgeon’s full control. There are other systems too but da Vinci system is the most popular till now.

What are the benefits of Robotic Rectal Surgery

Rectal cancer treatment using robots provides a number of different benefits. Robotic-assisted surgery is the best option for treating distal rectal malignancies due to the obvious advantages of the enlargement and visualization as well as the enhanced dexterity in confined spaces like the true pelvis. Short-term results, according to recent literature, are equivalent to laparoscopic surgery.

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A few disadvantages of Robotic Rectal Surgery

The cost and greater operating time are probably the biggest obstacles to more widespread adoption of robotic surgery. However, as surgeons are becoming more efficient, robotic surgery for certain organs offer many advantages. APR for rectal cancer is one such organ. The surgeon is offered a 3D vision, superb magnification in very limited space and instrument movements which are so precise that the surrounding structures like prostate, seminal vesicles and nerves controlling micturition and ejaculation are preserved better than conventional or laparoscopic surgery. This results in much better outcomes and a fairly uneventful recovery after surgery. The chances of tumor coming back are also reduced due to this precise surgery.


Thus, rectal cancer lying low requiring APR surgery can be managed by Robotic Surgery with lot of benefits. Since this location is in a very small area surrounded by many vital structures, use of robotic surgery helps in being very precise due to a 3D view and good magnification. Whenever possible, Robotic APR surgery is fast becoming the surgery of choice

Dr. Rajeev Kapoor is a colorectal surgeon based in Mohali, who performs robotic APR surgery for low Rectal cancers. He is a highly experienced. Contact +91-9876-507-444 to schedule a consultation.