Full Robotic Left Colon and Rectal Cancer Resection: Technique and Early Outcome

Abstract

Full robotic colorectal surgery is a safe and effective technique that exploits the advantages of the Da Vinci robot during the whole intervention, without the need to make use of hybrid operations. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

“…For example, in robot-assisted rectal cancer surgery, there is no standardised technique and the decision has to be made whether to perform it as a hybrid operation or totally robot assisted. 171 As noted above, this decision will be influenced by the model of robot the hospital has acquired. However, there are also other factors that influence the decision.…”

“…However, there are also other factors that influence the decision. Performing a hybrid operation removes the need to redock the robot, which can add to the duration of the operation, 171 and thus the decision may be influenced by concerns about time. This ties in with concerns about the patient condition; if patient factors mean that the operation is likely to be difficult and require considerable time, a hybrid operation is more likely.…”

“…Experience seems to be an important contextual factor that influences surgeons' decisions about how to perform an operation. For example, it has been suggested that, for surgeons experienced in laparoscopic surgery, a hybrid approach is preferable, as their increased experience will mean that they feel more comfortable carrying out the first phase of the operation that way, 171,172 while a totally robot-assisted procedure may be preferable for surgeons who have less experience of laparoscopic surgery, despite the need to redock. 173 Another decision relates to the positioning of the ports through which the instruments are inserted, and some authors described not wanting to follow the layouts suggested by other surgeons experienced in RAS because they wanted to adapt the positioning they used for laparoscopic operations, again presumably wanting to build on their existing experience.…”

“…144,175 Others pointed to the time required to reposition and redock the robot during multiquadrant operations. 171,176 Yet others pointed to a longer operative time, perceived as being due to collisions of the robotic arms, itself a consequence of lack of experience with proper positioning of the robotic ports. 169 It has also been argued that longer operation duration is related to the lack of tactile information, leading surgeons to move more slowly because they have to rely on visual information only.…”

Surgical Treatment for Colorectal Cancer

“…The clear advantages of robot are increased dexterity of instruments, precision, 3-dimensional visuals, a steady camera, and intuitive movements that may help obtain better oncologic and overall surgical outcomes. 63,64 It has been well documented that robotic surgery has passed it infancy for some subspecialties (e.g., urology and gynecology). The data have shown the equality and sometimes superiority of robotic surgery versus conventional laparoscopic surgery.…”