Robotic rectal surgery: State of the art

Abstract

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

Results of transanal mesorectumectomy in patients with rectal cancer

“…Основными причинами для кон-версии при мобилизации «сверху вниз» по данным исследования COLOR II являлись узкий таз, ожире-ние, ограниченная подвижность опухоли в тазу [6]. Роботическая техника при выполнении ТМЭ за счет известных преимуществ над несгибающимися лапа-роскопическими инструментами позволяет снизить час тоту конверсий у пациентов с ожирением, узким и длинным тазом, с опухолью в нижнеампулярном отделе [16]. Однако как для лапароскопической, так и для роботической операции сложным этапом явля-ется пересечение кишки после ее мобилизации.…”

Robotic surgery for rectal cancer

“…Postoperative hospital stay was also similar between robotic and conventional laparoscopic surgery according to meta‐analyses. However, some studies reported a shorter stay after robotic surgery, and others had the opposite finding .…”

“…Postoperative complications are important for discussing the safety of robotic surgery. Meta‐analyses showed that there was no significant difference in the frequency of overall complications between robotic and conventional laparoscopic surgery . For example, anastomotic leakage, the most frequent complication, occurred in 2.4%–11.2% of cases that underwent conventional laparoscopic rectal surgery and in 1.8%–13.5% that underwent robotic surgery .…”

“…Several meta‐analyses showed that robotic surgery was generally associated with longer operative times , whereas others concluded that there was no significant difference between robotic and laparoscopic surgery . These controversial conclusions appear to stem from various differences among institutions in terms of surgical procedures (e.g.…”

“…For example, anastomotic leakage, the most frequent complication, occurred in 2.4%–11.2% of cases that underwent conventional laparoscopic rectal surgery and in 1.8%–13.5% that underwent robotic surgery . There is no evidence of the superiority of robotic rectal surgery over laparoscopy in terms of the incidence of other postoperative complications .…”