Rectal Resection Surgery

Learn about rectal resection surgery and understand your options

There’s more than hope when you know the facts

At the end of your large intestine, the rectum and anal canal receive and store waste until it is released through the anus. Conditions affecting the rectum, including cancer, are common. In 2019, it’s expected that doctors will diagnose more than 44,000 new cases of rectal cancer in the U.S.¹ Other rectal conditions include, but are not limited to, rectal prolapse (when the rectum drops from its normal position and slips out through the anus), bulging blood vessels (hemorrhoids), inflammation that can become chronic, infected abscesses, and benign or precancerous polyps and tumors.

Understanding your options Rectal conditions can range from causing minor discomfort to being life-threatening. There are several options for managing noncancerous rectal conditions, including medications, changes to your diet and lifestyle, and localized removal of small areas of abnormal tissue.2-6 If these options fail to relieve symptoms, your doctor may suggest surgery. If you have been diagnosed with rectal cancer your doctor may recommend chemotherapy, targeted therapy, immunotherapy, radiation therapy, surgery to remove the rectum and nearby lymph nodes, or a combination of these options depending on the type of cancer and how far it has advanced.7 One type of surgery in which surgeons can remove the diseased section of the rectum, along with nearby lymph nodes, is a procedure called a low anterior resection. After the surgeon has removed the diseased section of your rectum, he or she may then reattach the two healthy parts of the intestine, performing what is known as an anastomosis.  The surgeon can perform a low anterior resection through open surgery or a minimally invasive approach. Traditional open surgery requires the surgeon to make an incision in your abdomen large enough to see the rectum and perform the procedure using hand-held tools. There are two minimally invasive approaches for lower anterior resection: laparoscopic or robotic-assisted surgery, possibly with da Vinci® technology. Both minimally invasive surgical options require a few small incisions that doctors use to insert surgical equipment and a camera for viewing. In laparoscopic surgery, doctors use special long-handled tools to perform surgery while viewing magnified images from the laparoscope (camera) on a video screen.

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How da Vinci works

Surgeons using da Vinci technology may be able to remove part or all of your rectum through a few small incisions (cuts). During surgery, your surgeon sits at a console next to you and operates using tiny, wristed instruments. The da Vinci system translates every hand movement your surgeon makes in real time to bend and rotate the instruments with precision.

A camera provides a high-definition, 3D magnified view inside your body. Your surgeon may use Firefly® fluorescence imaging, which offers visualization beyond the human eye by activating injected dye to light up and clearly show the blood flow to the colon. This may help your surgeon during the procedure.

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It’s important to remember that Intuitive does not provide medical advice. After discussing all options with your doctor, only you and your doctor can determine whether surgery with da Vinci is appropriate for your situation. You should always ask your surgeon about his or her training, experience, and patient outcomes.

More about da Vinci

Why surgery with da Vinci?

A review of published studies suggests that potential benefits of low anterior resection surgery with da Vinci technology include:

• Patients may stay in the hospital for a shorter amount of time than patients who had open^8-10 and the same amount of time, or possibly less, than patients who had laparoscopic^11-18 surgery.
• Patients may have a similar rate of complications compared to patients who had open surgery^9,10 and lower, though sometimes similar, rates of complications compared to patients who had laparoscopic surgery.^12,13,15-17
• Compared to patients who had open^8,10 and laparoscopic¹⁴ surgery, patients who had surgery with da Vinci had similar rates of positive cancer margins (cancer found at the edge of removed tissue). 
• Seven of eight studies suggested surgeons may be less likely to switch to open surgery when performing surgery with da Vinci, compared to laparoscopic surgery.^11-15,17,18 The eighth study suggests a similar rate.¹⁶

All surgery involves risk. You can read more about associated risks of low anterior resection here.

Questions you can ask your doctor

• What medical and surgical options are available for me?
• Which is best for my situation?
• What are the differences between open, laparoscopic, and robotic-assisted surgery?
• If you suggest I have rectal surgery, how can I prepare for it?
• Can you tell me about your training, experience, and patient outcomes with da Vinci?

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Resources for learning more

Colorectal surgery brochure Take away information about colorectal surgery with da Vinci technology in our brochure designed for patients and their families. About your options

Colorectal surgery with da Vinci  Robotic-assisted surgery with da Vinci technology is used in many different types of procedures by colorectal surgeons. About the specialty

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1. Key Statistics for Colorectal Cancer. American Cancer Society. Web. 23 January 2019

2. Polyps of the Colon and Rectum. American Society of Colon and Rectal Surgeons. Web. 24 January 2019 

3. Hemorrhoids. American Society of Colon and Rectal Surgeons. Web. 24 January 2019 

4. Abscess and Fistula. American Society of Colon and Rectal Surgeons. Web. 24 January 2019 

5. Crohn’s Disease. American Society of Colon and Rectal Surgeons. Web. 24 January 2019 

6. Ulcerative Colitis. American Society of Colon and Rectal Surgeons. Web. 24 January 2019 

7. Treating Colorectal Cancer. American Cancer Society. Web. 24 January 2019 

8. Midura, E. F., et al. (2015). "The effect of surgical approach on short-term oncologic outcomes in rectal cancer surgery." Surgery 158(2): 453-459.

9. Liao, G., et al. (2016). "Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence." Sci Rep 6: 26981.

10. Somashekhar, S. P., et al. (2015). "Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer-Indian Study." Indian J Surg 77(Suppl 3): 788-794.

11. Lee, S. H., et al. (2015). "Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis." Ann Surg Treat Res 89(4): 190-201.

12. Lin, S., et al. (2011). "Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer." World Journal of Gastroenterology 17(47): 5214-5220.

13. Memon, S., et al. (2012). "Robotic versus laparoscopic proctectomy for rectal cancer: a metaanalysis." Ann Surg Oncol 19(7): 2095-2101.

14. Sun, Y., et al. (2016). "Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis." World J Surg Oncol 14(1): 61.

15. Sun, Z., et al. (2015). “Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer.” Ann Surg. 263(6):1152-8.

16. Trastulli, S., et al. (2012). "Robotic resection compared with laparoscopic rectal resection for cancer: Systematic review and meta-analysis of short-term outcome." Colorectal Disease 14(4): e134-e156.

17. Xiong, B., et al. (2014). "Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis." J Surg Res 188(2): 404-414.

18. Yang, Y., et al. (2012). "Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis." Ann Surg Oncol 19(12): 3727-3736.

Disclosures and Important Safety Information

Surgical Risks

Risks associated with bowel resection and other colorectal procedures (removal of all/part of the intestine) include leaking and/or narrowing at the spot where two sections of bowel were reconnected, colorectal or anal dysfunction (cannot empty bowel, frequent bowel movements, leakage or constipation).

Important Safety Information

Patients should talk to their doctor to decide if da Vinci® surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision. 

Serious complications may occur in any surgery, including da Vinci surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety. 

Individuals' outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.

da Vinci Xi® System Precaution Statement

The demonstration of safety and effectiveness for the specific procedure(s) discussed in this material was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.

Medical Advice and Locating a Doctor

Patients should talk to their doctor to decide if da Vinci surgery is right for them. Other options may be available and appropriate. Only a doctor can determine whether da Vinci surgery is appropriate for a patient’s situation. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Surgeons experienced with the da Vinci system can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci system but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.

Published Evidence

In order to provide benefit and risk information, Intuitive Surgical reviews the highest available level of evidence on procedures named above. Intuitive Surgical strives to provide a complete, fair and balanced view of the clinical literature. However, our materials should not be seen as a substitute for a comprehensive literature review for inclusion of all potential outcomes. We encourage patients and physicians to review the original publications and all available literature in order to make an informed decision. Clinical studies are typically available at pubmed.gov.

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