Robotic Versus Laparoscopic Colorectal Surgery

Abstract

Background:Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.Study Design:A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group.Results:Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate.Conclusions:The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.

Reviewing the Comparison of Robotic Colectomy with the Laparoscopic Ones of All the Procedures based on Determined Parameters

“…17 The RRC entails more expenses than LRC, although the difference is still not statistically important. 17 On the contrary, the second meta-analysis which had the larger statistical sample was conducted by Trinh et al 4 and yielded the following outcomes. No significant difference was spotted regarding the harvested lymph nodes, the bowl function, the Flow Chart 1: Literature research days to soft diet, the LOS, the hospital readmission, and the postoperative complications.…”

“…No significant difference was spotted regarding the harvested lymph nodes, the bowl function, the Flow Chart 1: Literature research days to soft diet, the LOS, the hospital readmission, and the postoperative complications. 4 Based on this metaanalysis, the robotic approach showed longer operating times, less EBL, and a higher rate of conversion to an open procedure compared with that of LS. 4 Xu et al 7 considered…”

“…4 Based on this metaanalysis, the robotic approach showed longer operating times, less EBL, and a higher rate of conversion to an open procedure compared with that of LS. 4 Xu et al 7 considered…”

“…17 We included three meta-analyses in our research. 4,7,17 Cumulatively, these three studies include 30 comparative studies, in which 1,322 patients underwent RRC and 4,185 were treated with LRC. The first one was recently conducted from the Surgery Department of Sapienza University and compared the indications, surgical and oncologic outcomes, and costs of RRC with the LRC ones.…”

“…[9][10][11][12][13][14][15] However, robotic surgery (RS) has been recently introduced as a new contemporary alternative because of its obvious advantages, including the three-dimensional view, the ability to use multidegree-of-freedom forceps, the elimination of physiological tremors, and the stable camera control, in order to broaden the horizons of MIS. [3][4][5][16][17][18][19] Initially, it was expected that RS would dominate the field of MIS related to colorectal surgery because of its obvious structural advantages and due to the limited space in the pelvis for the laparoscopic instruments and the restricted potential of movements even for an experienced surgeon to perform rectal dissection. 3 However, it seems that there is no clear-cut answer in the literature determining the beneficial use of RS over LS in the field of colorectal cancer.…”