Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases

Abstract

Robotic-assisted laparoscopic surgery attempts to facilitate rectal surgery in the narrow space of the pelvis. The aim of this study is to compare the outcomes of robotic versus laparoscopic surgery for rectal cancer. Monocentric retrospective study including 300 patients who underwent robotic (n = 178) or laparoscopic (n = 122) resection between Jan 2009 and Dec 2017 for high, mid and low rectal cancer. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, except for sex and ASA status. There were no statistical differences between groups in the conversion rate to open surgery. Surgical morbidity and oncological quality did not differ in either group, except for the anastomosis leakage rate and the affected distal resection margin. There were no differences in overall survival rate between the laparoscopic and robotic group. Robotic surgery could provide some advantages over conventional laparoscopic surgery, such as threedimensional views, articulated instruments, lower fatigue, lower conversion rate to open surgery, shorter hospital stays and lower urinary and sexual dysfunctions. On the other hand, robotic surgery usually implies longer operation times and higher costs. As shown in the ROLARR trial, no statistical differences in conversion rate were found between the groups in our study. When performed by experienced surgeons, robotic surgery for rectal cancer could be a safe and feasible option with no significant differences in terms of oncological outcomes in comparison to laparoscopic surgery.

A retrospective audit of robotic versus laparoscopic anterior resection for diverticular disease in a single surgeon’s experience

“…However, longer operating times in robotic surgery due to set up, docking, and increased costs has limited its widespread adoption. 7 Moreover, additional training is required for staff to operate the machinery, and there is a learning curve for surgeons learning this new platform. However, recent studies have demonstrated significant reductions in length of stay, conversion to open surgery rate, and hospital costs for surgeons performing a high volume of robotic surgery.…”

“…5 Robotic surgery has been developed to offer advantages over laparoscopic techniques, particularly in anatomically limited spaces such as a narrow pelvis. [6][7][8] It provides better three-dimensional depth of field, seven degrees of wrist-like motion allowing increased and more natural range of motion, tremor-filtering articulating instruments, a stable camera platform, results in better ergonomics and less surgeon fatigue. 7 Furthermore, the robotic approach is useful in allowing more precise optical definition and dissection in arduous pelvic dissection, especially in complicated diverticulitis.…”

“…[6][7][8] It provides better three-dimensional depth of field, seven degrees of wrist-like motion allowing increased and more natural range of motion, tremor-filtering articulating instruments, a stable camera platform, results in better ergonomics and less surgeon fatigue. 7 Furthermore, the robotic approach is useful in allowing more precise optical definition and dissection in arduous pelvic dissection, especially in complicated diverticulitis. 9 In colorectal cancer surgery, laparoscopic techniques have proven to be non-inferior to open techniques oncologically.…”

“…With the recent uptake of robotic surgery, studies have supported its safety and efficacy compared to laparoscopic surgery. 7 However, published comparisons of minimally invasive approaches in diverticular disease are limited. As such, our study aims to compare the outcomes of elective robotic and laparoscopic anterior resection for diverticular disease by a single experienced colorectal surgeon well-versed in both techniques.…”

A study on spinal level, length, and branch type of the inferior mesenteric artery and the position relationship between the inferior mesenteric artery, left colic artery, and inferior mesenteric vein

“…In accordance with the results above, the three mean distances were 72.96 ± 9.75 mm, 41.60 ± 6.73 mm, and 99.58 ± 13.07 mm, respectively. Although the SMA root, aorta abdominalis branch, and the level of sacral promontory can be used as location markers for IMA roots, the SMA root and aorta abdominalis branch are located behind the peritoneum, requiring a deeper dissociative Toldt space [25]. The level of the sacral promontory serves as a marker of the entrance to the pelvis and is more easily determined.…”