Robotic intracorporeal single‐stapled anastomosis (<scp>R</scp>i<scp>SSA</scp>) and natural orifice specimen extraction (<scp>NOSE</scp>) in total mesorectal excision for rectal cancer—A video vignette

Abstract

Total mesorectal excision (TME) is the mainstay of rectal cancer treatment. Various anastomotic techniques are in use today, including hand-sewn methods, double-stapling technique, and single-stapling technique, performed either intra- or extracorporeally. The double-stapling technique is the most widely adopted in minimally invasive surgeries, involving two crossing staple lines (one from the linear stapler and one from the circular stapler), which some studies suggest may increase the risk of anastomotic complications including leakage [1, 2]. To address this concern, various single-stapling techniques have been developed. By using just one staple line, single-stapling techniques may potentially lower the risk of complications that may arise from the overlapping staple lines typical of double-stapling techniques [3]. Single-stapled anastomosis can be performed through either a transanal approach (as in transanal total mesorectal excision [TaTME] or transanal transection and single-stapling [TTSS]) or an intracorporeal approach using laparoscopy or a robotic platform. Taking full advantage of the improved dexterity that robotic surgery offers, the robotic intracorporeal single-stapled anastomosis (RiSSA) technique offers an innovative approach that is more easily performed than a laparoscopic approach. Additionally, in selected cases, this technique can be combined with natural orifice specimen extraction (NOSE). In the attached video we demonstrate how we perform RiSSA and NOSE in a robotic TME for rectal cancer (Video 1). Shih-Feng Huang: Writing – original draft. Chih-Chien Wu: Writing – review and editing; supervision; conceptualization; methodology. None. None to declare. The procedure described and demonstrated was conducted in compliance with both national ethical standards and the ethical guidelines set by the Institutional Review Board of Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, R.O.C. The data that support the findings of this study are available from the corresponding author upon reasonable request.