Optimizing sexual and urinary outcomes in robotic TME

Abstract

Sexual and urinary dysfunctions are well-known complications of rectal cancer surgery and are the factors that most influence both the physical and psychological health of patients, as well as impacting quality of life for themselves and their partners. Robotic surgery was developed to overcome the limitations of laparoscopic instrumentation and has peculiarities that could facilitate nerve-sparing rectal surgery when compared to traditional open and laparoscopic surgery. Despite this, the studies published thus far show conflicting results. There is currently no statistical evidence of superiority of robotic surgery over conventional laparoscopy for performing nerve-sparing TME for rectal cancer. Nonetheless, the use of a robotic platform is in constant expansion. This book chapter aims to give a comprehensive view of the anatomy of the hypogastric plexus as well as the autonomic regulation of sexual and urinary functions. The technical aspects and limitations related to the current robotic platforms (e.g., lack of force and tactile feedback) are discussed and practical suggestions on how to avoid the most common mistakes outlined. The surgical phases and key points for nerve-sparing surgery and surgically related lesions are also explained and analyzed in detail. In conclusion, the objectives of this chapter are to give surgeons a comprehensive knowledge of robotic nerve-sparing rectal cancer surgery and help achieve proficiency with a shorter learning curve.