How Has the Robot Contributed to Colon Cancer Surgery?

Işık, Özgen; Görgün, Emre

doi:10.1055/s-0035-1564436

Cited by 19 publications

(27 citation statements)

References 38 publications

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“…Beyond this, it has historically been challenging to truly calculate potential long-term cost savings for a given procedure. In colorectal surgery for example, the potential reduction in stoma rates for robotic low rectal resections could have a huge consequence for the health economics associated with the procedure, although this benefit is currently not proven [63]. Equally, reduced length of ICU admission or overall stay has cost effects [64].…”

Section: Long-term Outcomesmentioning

confidence: 99%

Robotic-assisted gastrectomy for gastric cancer: a European perspective

2019

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Gastrectomy is the mainstay treatment for gastric cancer. To reduce the associated patient burden, minimally invasive gastrectomy was introduced in almost 30 years ago. The increase in the availability of surgical robotic systems led to the first robotic-assisted gastrectomy to be performed in 2002 in Japan. Robotic gastrectomy however, particularly in Europe, has not yet gained significant traction. Most reports to date are from Asia, predominantly containing observational studies. These cohorts are commonly different in the tumour stage, location (particularly with regards to gastroesophageal junctional tumours) and patient BMI compared to those encountered in Europe. To date, no randomised clinical trials have been performed comparing robotic gastrectomy to either laparoscopic or open equivalent. Cohort studies show that robotic gastrectomy is equal oncological outcomes in terms of survival and lymph node yield. Operative times in the robotic group are consistently longer compared to laparoscopic or open gastrectomy, although evidence is emerging that resectional surgical time is equal. The only reproducibly significant difference in favour of robot-assisted gastrectomy is a reduction in intraoperative blood loss and some studies show a reduction in the risk of pancreatic fistula formation.

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Section: Long-term Outcomesmentioning

confidence: 99%

Robotic-assisted gastrectomy for gastric cancer: a European perspective

2019

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“…[2][3][4] Meanwhile, the robot-ic system provides magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and an opportunity to perform remote surgery. 5 In terms of the advantage to approach narrow pelvic cavity, robotic surgery has been used prominently in the urologic and gynecologic fields. In recent, robotic rectal surgery including a robot-assisted laparoscopic approach or totally robotic surgery is increasing and regarded as an effective and surgeon-convenient treatment option that is suggested to overcome the limitations of laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Jeon

Park

Baik

2019

J Minim Invasive Surg

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Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.

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“…The earliest case series of robotic TME (RTME) was published in 2006 by Pigazzi et al, 47 and since then several other studies have demonstrated the efficacy and safety of RTME and compared RTME. 29,35,37,[48][49][50][51][52][53][54][55][56][57][58][59][60][61] RTME was associated with lower conversion rates, and reduced rate of erectile dysfunction (ED) than laparoscopic TME in some studies. 49,60,62,63 Furthermore, of those who developed postoperative ED, patients in the robotic groups appeared to have a more rapid improvement of symptoms when assessed at 3 and 6 months.…”

Section: Total Mesorectal Excisionmentioning

confidence: 99%

“…(laparoscopic splenic flexure mobilization), single docking (mobilizing the second and third robotic arms for different parts of the surgery), double docking (docking once for splenic flexure mobilization, then redocking for the rest of the procedure), and recently a "single-position flip arm technique" that allows for splenic flexure mobilization and low anterior resection with only one docking position. [35][36][37] Although good outcome data are not as abundant as for robotic right colectomy, several studies have compared robotic versus laparoscopic left colectomy. [26][27][28][29][30]38 As seen with robotic right colectomy, robotic left colectomy had similar perioperative and oncologic outcomes with increased operative times.…”

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confidence: 99%

Future of Minimally Invasive Colorectal Surgery

Whealon

Vinci

Pigazzi

2016

Clinics in Colon and Rectal Surgery

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Minimally invasive surgery has been adapted to a wide variety of colorectal procedures. The first laparoscopic right colectomy was published by Jacobs et al in 1991 1 ; shortly after which Fowler performed the first laparoscopic left colectomy. Since these initial reports, several large studies found that the oncologic outcomes of laparoscopic colectomy were equivalent to open surgery and that patients undergoing laparoscopic colectomy tended to have improved shortterm outcomes such as decreased blood loss, shorter length of stay, faster return of bowel function, fewer wound complications, and improved postoperative pain. 2-9 Despite the growing body of evidence supporting the use of laparoscopic colectomy for colon cancer, the adoption of the technique was relatively slow with the utilization of laparoscopic colectomy only reaching 41.6% in 2010. [10][11][12] Despite its advantages over open surgery, there are some limitations to minimally invasive surgery. Loss of binocular vision, paradoxical motion of the instruments, amplified movements, parallel instrumentation, poor ergonomics, 13,14 increased motion needed to accomplish a given task, 15 and loss of proprioception are all common limitations. To overcome some of these shortfalls, the use of hand-assisted laparoscopy was introduced. 16,17 Although studies have shown similar oncologic outcomes, the short-term outcome benefits of laparoscopy were lost with the hand-assisted technique. 18,19 Furthermore, the incisional hernia rate for hand-assisted laparoscopic surgery has reported to be between 6 and 10.6%, 20,21 although this may be contingent on port site placement. 22 The da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA) was developed to overcome the limitations of traditional laparoscopic surgery. This system provided several potential advantages over traditional laparoscopic surgery including a stable camera platform, three-dimensional (3D) imaging, improved ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. The first two robotic-assisted colectomies described in the literature were performed in 2001 by Weber et al. 23 Several studies have compared the outcomes of laparoscopic versus robotic colectomy 24-33 and overall, robotic-assisted right colectomy had similar perioperative and oncologic outcomes at the expense of longer operation times, and increased surgical costs. Some studies suggest there may be some advantage to robotic right colectomy with regards to decreased estimated blood loss 25,26,30,31 and faster return of bowel function. [30][31][32] Although no significant benefit of robotic surgery has been seen, some authors feel that a robotic right colectomy is a good procedure for surgeons to tackle the learning curve of robotic surgery before undertaking more complex operations such as a low anterior resection, 24 while others liken the use of robotic surgery for right colectomy to taking a Ferrari to the grocery store to do the weekly shopping. 34 Left colect...

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How Has the Robot Contributed to Colon Cancer Surgery?

Cited by 19 publications

References 38 publications

Robotic-assisted gastrectomy for gastric cancer: a European perspective

Robotic-assisted gastrectomy for gastric cancer: a European perspective

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Future of Minimally Invasive Colorectal Surgery

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