Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Abstract Background Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because circular stapler cannot be inserted into rectum through anus. Thus, an alternative procedure required for colorectal anastomosis. Case presentation A 78-year-old woman presented bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned anterior resection transanal hand-sewn anastomosis, but this would have been too due fibrosis caused by Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems declined stoma. Therefore, we anvil stump fixed it robotically purse-string suture followed insertion of shaft from sigmoidal side. In way, side-to-end was accomplished laparoscopically. distance anus 5 cm. discharged no anastomotic leakage. Robotic assistance proved extremely useful Conclusion Performing robotic stenosis.