Introduction

There have been serious developments in the treatment of rectal cancer in the last century. In this process, both neoadjuvant use of radiotherapy and chemotherapeutics played an important role in addition to the definition of total mesorectal excision. In the last 20 years, although minimally invasive surgery has become widespread in the surgical treatment of benign and malignant diseases of the colon and rectum, controversies continue about the use of laparoscopic surgery in rectum cancer. There are studies showing that robotic surgery is superior to conventional laparoscopy in the surgery of rectum cancer with the developing technology. Robotic surgery has some advantages: The robotic arms can manipulate the pelvis more easily, the operation can be performed with three-dimensional images, the surgeon sits and does not reflect possible tremors to the surgery. It has some disadvantages: It can not be performed in every center and it has a high cost. Another development is the methods defined for the removal of the resected specimen. At this point, the specimen is removed via transanal or transvaginal route, that is, without making a new incision in the abdomen. It is reported that this method, called NOSE, provides benefits to the patient in terms of postoperative pain and wound healing.^1,2

In the colonoscopy of a 60-year-old female patient, a polyp with a size of 1.5 cm was detected in the middle rectum, and polypectomy was performed. After histopathological examination showed the presence of adenocarcinoma, an magnetic resonance imaging was performed and no additional pathology was detected in the uterus, except for a myoma uteri with a size of 6.5 cm. The patient was discussed in the multidisciplinary council and the surgical decision was made. After obtaining the consent form, she was taken to surgery. The ports were placed in accordance with the Da Vinci Xi robotic system in a standard way and the hysterectomy procedure following docking was completed robotically by the obstetrics team and the specimen was taken out of the vagina. The low anterior resection procedure was completed robotically by placing a tampon in the vagina. The tampon was removed from the vagina and the rectum specimen was taken out of the abdomen from the vagina. Following the control of the anastomosis with indocyanine green, an ileostomy was opened in the right lower quadrant and the surgery was terminated. Histopathological examination of the specimen was reported as T1N1.

As a result, although it has a disadvantage in terms of cost, the robotic method and the NOSE method in appropriate patients are the preferred method for the patient and the surgeon.

https://www.doi.org/10.4274/tjcd.galenos.2020.2020-10-9.video3

Informed Consent: After obtaining the consent form, she was taken to surgery.

Peer-review: Externally and internally peer reviewed.

Authorship Contributions

Concept: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K., Design: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K., Data Collection or Processing: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K., Analysis or Interpretation: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K., Literature Search: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K., Writing: N.K., Ö.F.Ö., E.Ü., İ.K., M.T.D., G.K.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.