Robotic low ligation in rectal cancer: How we do it

Abstract

IntroductionHigh versus low ligation of the inferior mesenteric artery is a controversial issue in the literature. However, low ligation is revealed to be technically demanding, particularly in minimal invasive surgery. Here we provide technical tips to facilitate safe inferior mesenteric artery skeletonization and low ligation at the level of the superior rectal artery. MethodologyThe robotic approach to vascular ligation possesses many advantages over the laparoscopic approach; however, due to the lack of haptic feedback, technical skills are necessary to achieve low ligation and vascular skeletonization. Conclusion Ligation of the inferior mesenteric artery is easier than low ligation. However, if procedures are followed, then low ligation can be easy.

Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: A narrative review and outcomes study from an expert tertiary center

“…However, in the case of radiological positive lymph node around the IMA or ultra low anterior resection we prefer high ligation. 29 Orsay et al 30 evaluated blood supply to the rectal anastomosis and compared the incidence of stenosis between ligation and preservation of the IMA, showing no relationship between them.…”