• Colorectal surgery
• Faecal incontinence
• Neuromonitoring
• Sexual dysfunction
• Total mesorectal excision
• Urinary dysfunction

• Humans
• Rectum/surgery
• Rectum/innervation
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Pelvis/innervation
• Pelvis/surgery
• Intraoperative Neurophysiological Monitoring/methods
• Female
• Male
• Sensitivity and Specificity
• Autonomic Pathways
• Anal Canal/innervation
• Anal Canal/surgery
• Monitoring, Intraoperative/methods
• Middle Aged
• Rectal Diseases/surgery

• abdominoperineal resection
• colorectal cancer
• ejaculatory dysfunction
• erectile dysfunction
• low anterior resection
• sexual dysfunction

• Male
• Humans
• Quality of Life
• Rectal Neoplasms/surgery
• Rectal Neoplasms/complications
• Penile Erection
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/prevention & control
• Ejaculation
• Erectile Dysfunction/etiology
• Erectile Dysfunction/prevention & control
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control

• R01 DK130991 NIDDK NIH HHS
• 1R01DK130991 NIDDK NIH HHS
• National Institute of Diabetes and Digestive and Kidney Diseases

• Laparoscopic colorectal surgery
• Rectal cancer
• Robotic colorectal surgery
• Total mesorectal excision
• Urinary retention

• TaTME
• autonomic nerve system
• circumferential resection margin
• rectal cancer
• urinary function

Laparoscopic rectal surgery has moved from being experimental to getting established as a mainstream procedure. We aimed at analysing how rectal cancer surgery has evolved at our institute.

A retrospective review of 1000 consecutive patients who underwent laparoscopic anterior resection for rectal adenocarcinoma over a period of 15 years (January 2005 to December 2019) was performed. Technical modifications were made with splenic flexure mobilisation, intersphincteric dissection and anastomotic technique. The data collected included type of surgery, duration of surgery, conversion to open, anastomotic leak, defunctioning stoma and duration of hospital stay. The first 500 and the next 500 cases were compared.

The study patients were predominantly males comprising 68% (n = 680). The mean age of the patients was 58.3 years (range: 28–92 years). Majority of the procedures performed were high anterior resection (n = 402) and low anterior resection (LAR) (n = 341) followed by ultra-LAR (ULAR) (n = 208) and ULAR + colo-anal anastomosis (n = 49). A total of 42 patients who were planned for laparoscopic surgery needed conversion to open procedure. Forty-one patients (4.1%) had an anastomotic leak. The mean duration of stay was 5.3 + 2.8 days. The rate of conversion to open procedure had reduced from 5.4% to 3.0%. The rate of defunctioning stoma had reduced by >50% in the recent group. The anastomotic leak rate had reduced from 5.0% to 3.2%. The average duration of stay had reduced from 5.8 days to 4.9 days.

This is one of the largest single-centre experiences of laparoscopic anterior resection. We have shown the progressive benefits of an evolving approach to laparoscopic anterior resection.

• Anterior resection
• colo-anal anastomosis
• rectal cancer
• ultra-low anterior resection

By improved surgical technique such as total mesorectal excision (TME), multimodal treatment and advances in imaging survival and an increased rate of sphincter preservation have been achieved in rectal cancer surgery. Minimal-invasive approaches such as laparoscopic, robotic and transanal-TME (ta-TME) enhance recovery after surgery. Nevertheless, disorders of bowel, anorectal and urogenital function are still common and need attention.

This review aims at exploring the causes of dysfunction after anterior resection (AR) and the accordingly preventive strategies. Furthermore, the indication for low AR in the light of functional outcome is discussed. The last therapeutic strategies to deal with bowel, anorectal, and urogenital disorders are depicted.

Functional disorders after rectal cancer surgery are frequent and underestimated. More evidence is needed to define an indication for non-operative management or local excision as alternatives to AR. The decision for restorative resection should be made in consideration of the relevant risk factors for dysfunction. In the case of restoration, a side-to-end anastomosis should be the preferred anastomotic technique. Further high-evidence clinical studies are required to clarify the benefit of intraoperative neuromonitoring. While the function of ta-TME seems not to be superior to laparoscopy, case-control studies suggest the benefits of robotic TME mainly in terms of preservation of the urogenital function. Low AR syndrome is treated by stool regulation, pelvic floor therapy, and transanal irrigation. There is good evidence for sacral nerve modulation for incontinence after low AR.

• Functional outcome
• Health related quality of life
• Pelvic floor
• Rectal cancer
• Total mesorectal excision

• Anal Canal
• Digestive System Surgical Procedures
• Humans
• Laparoscopy
• Proctectomy
• Rectal Neoplasms/surgery
• Rectum/surgery
• Treatment Outcome

• University of Basel

• Colorectal
• Infrared
• Intracorporeal
• Robotic
• Simulation
• Skills assessment

Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect.

This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year.

Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months.

After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months.

• Functional outcome
• laparoscopy
• rectal cancer
• sexual dysfunction
• total mesorectal excision
• urinary dysfunction

• Proctectomy
• Rectal cancer
• Sexual dysfunction

• laparoscopy
• oncologic outcomes
• proctectomy
• rectal cancer
• techniques

• Carcinological proctectomy
• Radiation therapy
• Sexual sequelae
• Urinary sequelae

• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Female
• Female Urogenital Diseases/diagnosis
• Female Urogenital Diseases/etiology
• Female Urogenital Diseases/therapy
• Humans
• Male
• Male Urogenital Diseases/diagnosis
• Male Urogenital Diseases/etiology
• Male Urogenital Diseases/therapy
• Perioperative Care/methods
• Postoperative Complications/diagnosis
• Postoperative Complications/therapy
• Rectal Neoplasms/surgery
• Rectum/innervation
• Rectum/surgery

• Rectal cancer
• Robotic surgery
• Sexual function
• Urogenital function
• Urological function

To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.

A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.

Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.

There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

• Rectal neoplasms
• Robotic surgical procedures
• Colorectal surgery
• Sexual dysfunction
• Physiological
• Urinary bladder
• Neurogenic
• Humans

• pelvic autonomic nerve preservation
• sexual dysfunction
• total mesorectal excision
• urinary dysfunction

• denonvilliers’ fascia
• rectal cancer
• sexual dysfunction
• total mesorectal excision
• urinary dysfunction

• Adolescent
• Adult
• Aged
• Colectomy/methods
• Fasciotomy/methods
• Follow-Up Studies
• Humans
• Intraoperative Period
• Laparoscopy/methods
• Male
• Middle Aged
• Postoperative Complications/prevention & control
• Quality of Life
• Rectal Neoplasms/surgery
• Retrospective Studies
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/physiopathology
• Sexual Dysfunction, Physiological/prevention & control
• Sexuality
• Urination
• Urination Disorders/etiology
• Urination Disorders/physiopathology
• Urination Disorders/prevention & control
• Young Adult

• Total mesorectal excision
• low anterior resection syndrome
• rectal cancer
• urogenital dysfunction

• erectile dysfunction
• general surgery
• laparoscopy
• rectal neoplasms
• robotics, treatment outcome

• Erectile Dysfunction/etiology
• Humans
• Laparoscopy/adverse effects
• Male
• Minimally Invasive Surgical Procedures/adverse effects
• Minimally Invasive Surgical Procedures/methods
• Neoplasm Recurrence, Local
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Treatment Outcome

• Rectal cancer
• erectile function
• intra-operative nerve stimulation
• pelvic autonomic nerves
• urinary function

• cancer
• females
• psychosocial
• quality of life
• sexual function

• Laparoscopy
• Minimally invasive surgery
• Oncological outcomes
• Rectal cancer
• Short term benefits

• Diffusion of Innovation
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/mortality
• Laparoscopy/trends
• Postoperative Complications
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Risk Factors
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/mortality
• Robotic Surgical Procedures/trends
• Time Factors
• Treatment Outcome

• Laparoscopic surgery
• rectal cancer
• treatment outcome

• anal sphincter
• autonomic nerves
• electric stimulation
• electromyography
• intraoperative monitoring
• laparoscopy