Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience

Abstract

The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.

Minimally Invasive Colorectal Surgery Techniques

“…The precise number of instances required to achieve technical competency has not been determined by published publications with a strong degree of agreement. A practitioner should successfully conduct at least 20 laparoscopic resections of benign colon lesions before being certified to remove colon cancer, according to data derived from COST research, the American Society of Cataract and Refractive Surgery, and the Society of American Gastrointestinal and Endoscopic Surgeons [31]. The remarkable short-term results of top surgeons in the COREAN experiment, who were in the top third for surgical experience in their individual cancer centers, clearly show that more procedures are linked to better outcomes [32].…”

“…M et al [31] 2021 Italy In order to address several problematic abilities of traditional laparoscopic surgery, robotic surgery has been established.…”