Comparison between robotic‐assisted and laparoscopic sphincter‐preserving operations for ultra‐low rectal cancer

Abstract

Aim Sphincter‐preserving operations for ultra‐low rectal cancer include low anterior and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is used. We aimed to evaluate whether robotic‐assisted surgery is technically superior to laparoscopic surgery for ultra‐low rectal cancer. We compared the frequency of low anterior resection in cases of sphincter‐preserving operations. Method We investigated 183 patients who underwent sphincter‐preserving robotic‐assisted or laparoscopic surgery for ultra‐low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic‐assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic‐assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was done significantly more frequently in robotic‐assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (P = 0.04). Multivariate analyses showed that tumor distance from the anal verge (P < 0.01) and robotic‐assisted surgery (P = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusion Compared with laparoscopic surgery, robotic‐assisted surgery significantly increased the frequency of low anterior resection in sphincter‐preserving operations for ultra‐low rectal cancer. Robotic‐assisted surgery has technical superiority over laparoscopic surgery for ultra‐low rectal cancer treatment.

Propensity score‐matched analysis of the short‐term outcomes of robotic versus laparoscopic surgery for rectal cancer

“…To date, some studies that incorporated propensity score matching have reported on the short-term outcomes of RARS [24][25][26] ; however, few have focused on anal preservation. In a single-institution, retrospective study, Kojima et al 27 showed that, compared with LARS, RARS achieved a significantly greater rate of low anterior resection with sphincter preservation in patients with ultralow rectal cancer. In our series, the distal edges of many of the tumors in the RARS group were near the anal verge and the sphincter was preserved in these patients.…”

Impact of shear stress on sacral pressure injury from table rotation during laparoscopic colorectal surgery performed in the lithotomy position

“…The lithotomy position is recognized as a high-risk position for surgery-related PI 6 , 7 . In recent years, laparoscopic and robot-assisted colorectal surgeries have become common 8 – 10 . Laparoscopic or robot-assisted surgery performed in the lithotomy position requires the utilization of positioning devices and rotation of the operating table.…”

Nomogram for predicting the surgical difficulty of laparoscopic total mesorectal excision and exploring the technical advantages of robotic surgery

“…Despite some controversy about the universal bene ts of R-TME, the ROLARR trial suggested that R-TME may offer potential advantages for technically challenging patients [9]. In addition, several studies have also reported that R-TME allows surgeons to feel comfortable and achieve better results when performing technically demanding operations, such as those with a narrow pelvis or low-level tumor [10][11][12]. However, considering the additional nancial burden and time overhead of robotic surgery, it is important to screen patients who could bene t from robotic surgery.…”