Robotic rectal resection for cancer: A prospective cohort study to analyze surgical, clinical and oncological outcomes Amilcare Parisi, Jacopo Desiderio,

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Robotic rectal resection for cancer: A prospective cohort study to analyze surgical, clinical and oncological outcomes Amilcare Parisi, Jacopo Desiderio, Stefano Trastulli, Roberto Cirocchi, Francesco Ricci, Federico Farinacci, Antongiulio Mangia, Carlo Boselli, Giuseppe Noya, Angelo Filippini, Vito D'Andrea, Alberto Santoro International Journal of Surgery Volume 12, Issue 12, Pages 1456-1461 (December 2014) DOI: 10.1016/j.ijsu.2014.11.012 Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 1 Port position: R1, R2, R3 robotic arms; AS assistant; C camera. International Journal of Surgery 2014 12, 1456-1461DOI: (10.1016/j.ijsu.2014.11.012) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 2 Posterior dissection in the plane between the fascia propria of the rectum and the presacral fascia performed until the level of the levators thus ensuring a total mesorectal excision. International Journal of Surgery 2014 12, 1456-1461DOI: (10.1016/j.ijsu.2014.11.012) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 3 Anterior dissection: mesorectum is wholly dissected from the seminal vesicles in men or from the posterior wall of the vagina in women. The rectum enveloped within the fascia propria is completely removed in TME. If a PME is performed, the fascia propria recti is sectioned at a distance of 5 cm below the cancer. International Journal of Surgery 2014 12, 1456-1461DOI: (10.1016/j.ijsu.2014.11.012) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 4 Overall operative time analysis. The blue line indicates the operative time achieved in all procedures, showing a significant time decrease (P = 0.001) between the first and the second half of patients. The red line is a logarithmic curve in order to simplify the graphical view of the temporal course. The line shows the surgeon moved from a value above 450 min to a value below the threshold of 300 min at the end of the observation period of the study, as result of the learning period. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) International Journal of Surgery 2014 12, 1456-1461DOI: (10.1016/j.ijsu.2014.11.012) Copyright © 2014 Surgical Associates Ltd Terms and Conditions