Robotic Pelvic Exenteration

There has been significant growth in the use of robotic surgery for rectal cancer worldwide. Emerging data appears to support the feasibility of robotic surgery for T4 rectal cancers with comparable short-term oncologic outcomes. The advantages of robotic surgery over conventional laparoscopic surgery include better pelvic visualization by 3-D-adjustable cameras and more degrees of freedom with wrist-articulated instrumentation, thus achieving more precise dissections. These benefits may compensate for some of the limitations of conventional laparoscopic surgery, especially during complex pelvic dissection. In carefully selected cases, the robotic approach may expand our ability to offer minimally invasive surgery to this subset of locally advanced rectal cancer patients. In this chapter, we clarify a step-by-step approach of robotic pelvic exenteration for T4 rectal cancers.