Single-reposition robotic surgery for synchronous cecal and rectal cancer: a technical case report

Synchronous colorectal cancers located in anatomically distant segments of the colon present a particular challenge for minimally invasive surgery. Although robotic platforms may facilitate complex multiquadrant procedures, simultaneous right-sided colonic and pelvic resections may require changes in robotic positioning and additional access for specimen extraction. We report the case of a 77-year-old woman with synchronous cecal and rectal adenocarcinomas. Preoperative staging demonstrated a cT2N0 cecal tumor and a cT3N2 rectal tumor without distant metastases. The patient received short-course five-fraction radiotherapy and underwent surgery four days after completion of radiotherapy. A single-stage robot-assisted right hemicolectomy with intracorporeal ileocolic anastomosis and abdominoperineal resection was performed using a da Vinci X surgical system. Four 8-mm robotic ports and two 12-mm assistant ports were used. The robot was positioned on the patient’s right side for the right hemicolectomy and repositioned only once toward the patient’s left leg for the pelvic phase. Both specimens were extracted through the perineal incision, avoiding an additional abdominal extraction incision. Total operative time was 4 h 20 min, with an estimated blood loss of approximately 100 mL. Histopathology demonstrated G2 adenocarcinoma with lymphovascular invasion in both specimens. The final pathological stage was pT2N0 for the cecal tumor and ypT2N0 for the rectal tumor. Eight lymph nodes were retrieved from the cecal specimen and 11 from the rectal specimen. The patient passed flatus and had stool output through the stoma on postoperative day 3. This case demonstrates the technical feasibility of combining two anatomically distant colorectal resections during a single robotic operation with only one robotic repositioning and without an additional abdominal extraction incision.