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. 2019 Oct 25;5(1):156.
doi: 10.1186/s40792-019-0719-1.

Robot-assisted Laparoscopic Surgery After Placing a Self-Expanding Metallic Stent for Malignant Rectal Obstruction: A Case Report

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Free PMC article

Robot-assisted Laparoscopic Surgery After Placing a Self-Expanding Metallic Stent for Malignant Rectal Obstruction: A Case Report

Hiroshi Takeyama et al. Surg Case Rep. .
Free PMC article

Abstract

Background: Approximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so.

Case presentation: An 80-year-old man with incomplete paralysis of the lower limbs as well as bladder-rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO.

Conclusions: RALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.

Keywords: Malignant colorectal obstruction; Malignant rectal obstruction; Obstruction; Rectal cancer; Robot-assisted laparoscopic surgery; Self-expandable metallic stent; Self-expanding metallic stent.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Abdominal multi-detector computed tomography scan. Rectal tumor (white arrow) and distended bowel on the oral side can be seen
Fig. 2
Fig. 2
a Colonoscopy showing bowel obstruction with a malignant rectal tumor. b Self-expanding metallic stent placement through the malignant rectal obstruction using endoscopy. c Fluoroscopy showing a 2.8-cm constricted area due to tumor (black double-headed arrow) which of the upper end located at the anal side of the promontory (white long arrow)
Fig. 3
Fig. 3
a Abdominal multi-detector computed tomography (CT) scan showing decompression of distended bowel and patency of self-expanding metallic stent (white arrow). b A contrast-enhanced CT image showing the existence of a tumor near the right ureter, with possible invasion (yellow arrow)
Fig. 4
Fig. 4
Intraoperative findings. a Laparoscopic view showing tumor fixation to right pelvic wall. b, c Articulated flexible robotic instruments helped create a stable surgical view, and the tumor could be approached from ideal directions, securing definitive negative margin avoiding injury to the right ureter (white arrow). d After the resection of the tumor from right side pelvic wall without injury to the right ureter (white arrow)
Fig. 5
Fig. 5
a Image of the surgical specimen showing a circumferential rectal tumor with placement of self-expanding metallic stent. b Histopathological image showing the absence of intestinal edema on the oral side (× 40, H&E stain)

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