Robotic surgery for rectal cancer

Abstract

Laparoscopic surgery has gained acceptance as a less invasive approach in the treatment of colon cancer. However, laparoscopic surgery for rectal cancer, particularly cancer of the lower rectum, is still challenging because of limited accessibility. Robotic surgery overcomes the limitations of laparoscopy associated with anatomy and offers certain advantages, including 3-D imaging, dexterity and ambidextrous capability, lack of tremors, motion scaling, and a short learning curve. Robotic rectal surgery has been reported to reduce conversion rates, particularly in low anterior resection, but it is associated with longer operative times than the conventional laparoscopic approach. Postoperative morbidities are similar between the robotic and conventional laparoscopic approaches, and oncological outcomes such as the quality of the mesorectum and the status of resection margins are also equivalent. The possible superiority of robotic surgery in terms of the preservation of autonomic function has yet to be established in research based on larger numbers of patients. Although robotic rectal surgery is safe, feasible, and appears to overcome some of the technical limitations associated with conventional laparoscopic surgery, the advantages provided by this technical innovation are currently limited. To justify its expensive cost, robotic surgery is more suitable for select patients, such as obese patients, men, those with cancer of the lower rectum, and those receiving preoperative chemoradiotherapy.

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

“…The use of da Vinci robot has spread rapidly in colorectal cancer surgery even if its alleged reported advantages over the direct manual laparoscopic approach, including lower conversion rate, shorter p-gcurve and improved functional outcomes (1,3,(6)(7)(8)18], have not been fully confirmed by the recently published randomized clinical trial, and meta-analyses [9][10][11][12]. The results of these studies indicate that selected patients, such as obese, men, those with cancer of the lower rectum, and patients operated after receiving preoperative chemoradiotherapy, are those for whom there is high-level evidence of superiority of RAS over direct manual laparoscopic surgery [25][26][27][28][29][30]. However, the downside of the RAS technique, which remains a critical issue preventing its widespread uptake, relates to its high capital, amortization, recurrent costs and longer operating time.…”

Robotic surgical procedure for diffuse cavernous hemangioma of the rectum: A case report

“…Robotic surgery overcomes the limitations of laparoscopic surgery and offers certain advantages, including 3-D imaging, no tremors, motion scaling, dexterity, ambidextrous capabilities, and a short learning curve. 7 These advantages contribute to preserving voiding and sexual functions and to minimizing bleeding in low anterior resection. However, the robotic procedure requires a F I G U R E 2 A, CT findings revealed thickening of the mucosal wall from the sigmoid colon to the rectum, as well as many small calcifications due to phleboliths around the diffuse cavernous hemangioma.…”

Robotic total mesorectal excision: state of the art

“…The system has recently incorporated the EndoWrist® technology, which improves dexterity and eliminates physiological tremor reducing the challenge of laparoscopic intra-corporeal suturing [51] . These technical advantages are expected to allow a better mesorectal dissection, preserving the integrity of the fascia and decreasing the odds of autonomic nerve injury resulting in sexual dysfunction, anterior resection syndrome, or urinary retention [38] .…”

“…The da Vinci® system provided a fourth arm and an independent console where the surgeon has a three-dimensional view of the field. Specifically designed devices with Endowrist® technology allow for 7º of freedom, 180º articulation and 540º rotation [38] .…”