Robotic Surgery in Rectal Cancer

Abstract

Rectal cancer is an important cause of morbidity and mortality worldwide. The most effective and curative treatment is surgery, and the standard procedure is total mesorectal excision, initially performed by open surgery and posteriorly by minimally invasive techniques. Robotic surgery is an emerging technology that is expected to overcome the limitations of the laparoscopic approach. It has several advantages, including a stable camera platform with high definition three-dimensional image, flexible instruments with seven degrees of freedom, a third arm for fixed retraction, fine motion scaling, excellent dexterity, ambidextrous capability, elimination of physiological tremors and better ergonomics, that facilitate a steady and precise tissue dissection. The main technical disadvantages are the loss of tactile sensation and tensile feedback and the complex installation process. The aim of the present study is to review the importance and benefits of robotic surgery in rectal cancer, particularly in comparison with the laparoscopic approach. Intraoperative estimated blood loss, short and long-term outcomes as well as pathological outcomes were similar between robotic and laparoscopic surgery. The operative time is usually longer in robotic surgery and the high costs are still its major drawback. Robotic surgery for rectal cancer demonstrated lower conversion rate to open surgery and benefits in urinary and sexual functions and has been established as a safe and feasible technique.

Robotic surgery in patients with colorectal cancer: Techniques and benefits - Integrative review

“…In the Robotic vs Laparoscopic Resection for Rectal Cancer (ROLARR) randomized clinical trial, the robotic approach was compared with the laparoscopic approach in rectal cancer, revealing similar conversion rates and the higher costs associated with robotic surgery. 23 At the same time, initial studies corroborate this perspective, estimating that robotic surgery can be up to 2.4 times more expensive than conventional laparoscopy. 24,25 In addition, it is worth noting the longer operative time associated with robot-assisted surgery, usually due to the additional installation required of this complex robotic system, the long learning curve, which involves training the healthcare team on simulators, the absence of tactile feedback, with the potential to result in tissue injuries due to excessive application of force, and the limited range of movement of the robotic arm, although the surgeon's experience can compensate for this…”