Robotic lateral pelvic lymph node dissection using the Hugo™ RAS system: A video vignette

Lateral pelvic lymph node dissection (LPLND) is an essential component of treatment of rectal adenocarcinoma with lateral pelvic lymph node metastasis, in select cases. Rectal cancers infrequently metastasize to lateral pelvic nodes, with an incidence of 7.4% in patients with sub-centimetric lateral pelvic nodes, according to the JCOG0212 trial [1]. The commonly performed total mesorectal excision (TME) is inadequate for patients with involved lateral pelvic nodes. Currently, the indication of LPLND is when lateral nodes 7 mm or greater in short axis on primary MRI persist at 4 mm or greater on restaging MRI, as per Ogura et al., who have shown significant reduction in local recurrence when TME is combined with LPLND [2]. In this Video 1, we demonstrate the step-by-step surgical technique of LPLND (Figure 1) performed for rectal adenocarcinoma using Hugo™ RAS Robot by Medtronics, the first reported case performed using this robotic platform. Akhil Palod: Writing – review and editing; validation; investigation. Naveena A. N. Kumar: Conceptualization; data curation; formal analysis; visualization; writing – original draft; methodology; investigation; supervision; project administration; writing – review and editing; validation; resources. Nawaz Usman: Investigation; supervision; validation; resources; writing – review and editing. Ananthakrishnan Balakrishnan: Conceptualization; data curation; visualization; writing – original draft; writing – review and editing; software. Preethi S. Shetty: Writing – review and editing; validation; investigation. The authors have nothing to report. The authors declare no conflict of interest. The current video correspondence was in conformance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. In view of the retrospective nature of the current video correspondence, formal consent and approval of the institutional research committee was not required. The data that support the findings of this study are available from the corresponding author upon reasonable request.