Robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach

Robotic surgery is increasingly being applied for rectal cancer and its feasibility and safety have been reported. However, problems associated with advanced robotic surgery such as pelvic exenteration include lengthy operation time and difficulty in controlling unexpected bleeding. A 47-year-old woman had undergone laparoscopic left hemicolectomy for descending colon cancer three years previously (pT3N0M0 pStageII). And had undergone bilateral oophorectomy for ovarian metastases one year previously. Follow-up CT detected a peritoneal metastasis in the pelvic space. After seven courses of systemic chemotherapy, she received robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach. The postoperative course was uneventful. There is no evidence of recurrent disease 8 months after surgery. In conclusion, robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach is a safe and feasible minimally invasive approach for the treatment of advanced rectal malignancies