Robotic versus Laparoscopic Proctectomy for Rectal Cancer: A Meta-analysis

Memon, Sameer; Heriot, Alexander G.; Murphy, Declan; Bressel, Mathias; Lynch, A. C.

doi:10.1245/s10434-012-2270-1

Cited by 199 publications

(125 citation statements)

References 24 publications

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“…[10][11][12][13][14][15][16][17] In general, authors have found robotic surgery to be feasible and safe, referring to it as submit your manuscript | www.dovepress.com…”

Section: Introductionmentioning

confidence: 99%

“…A consistent conclusion in the majority of papers is that robotic colorectal surgery tends to be associated with a higher cost and a longer operative time. [13][14][15][16][17] However, the quality of these studies and consequently the conclusions drawn should be subjected to greater scrutiny. Most of these publications have been either case series or retrospective comparative studies.…”

mentioning

confidence: 99%

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The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

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Abstract:The Xi is the latest da Vinci surgical system approved for use in colorectal surgery. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures -from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis. While commonly criticized for its cost and prolonged operative time, robotic colorectal surgery holds the potential for enhanced ergonomics, superior precision, and a reduction in the learning curve involved in training an expert surgeon. This review appraises the existing literature on robotic colorectal surgery while elaborating how the improved capabilities of the Xi serve to usher in a new era of minimally invasive colorectal surgery.

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“…[10][11][12][13][14][15][16][17] In general, authors have found robotic surgery to be feasible and safe, referring to it as submit your manuscript | www.dovepress.com…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

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“…Indeed, the literature has shown evidence of its merits for rectal resections in the male pelvis as well as mid-and low-rectal tumors. [11][12][13] Whether any of these benefits will outweigh the cost of robotic assisted surgery will be addressed in the RObotic versus LAparoscopic Resection for Rectal cancer (ROLARR) study.…”

Section: Technical Improvementsmentioning

confidence: 99%

Current Concepts in Rectal Cancer

Fleshman

Smallwood

2015

Clinics in Colon and Rectal Surgery

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Since the first recorded surgical resection for rectal cancer in 1826 by Jacques Lisfranc, 1 the management of rectal cancer has evolved remarkably with dramatic improvements in local recurrence and mortality. Surgical resection is the only proven curative treatment of rectal cancer and the important advances in care have involved improvements in surgical techniques. Most of these improvements during this time period resulted from a better understanding of the anatomy and pathology of rectal cancer. It is important to be familiar with these important advances in rectal cancer treatment to fully understand the current methods of treatment.Historical Overview: From Miles' Abdominoperineal Resection to Today's Sphincter-Preserving Techniques Rectal Resections before MilesGiovanni Morgagni in the early 18th century was the first to propose rectal resection as a treatment for cancer. 1 However, it took over a century before the first successful rectal resection was performed. Over the years, there have been constant changes in the approach used by surgeons to perform a rectal resection.Rectal resections were first performed using a perineal approach as described in 1826 by Jacques LisFranc. 1,2 He operated in the era before anesthesia and proper antiseptic techniques. Since inadvertent entry into the peritoneal cavity could prove lethal, he chose the perineal approach to evert the rectum and perform a limited resection below the peritoneal reflection. A limited amount of rectum was resected with this approach and no attempt was made to purposely include the mesorectum and draining lymph nodes. 2 Success at that time was based upon whether the patient survived to leave the hospital, and so the risk of local recurrence had very little influence. With the advent of anesthesia and aseptic techniques, operations could now be performed that would provide for a more radical resection. Paul Kraske developed a technique similar to Kocher's technique, where he would incise and detach the left side of the coccyx and sacrum to provide more exposure. This exposure allowed him to resect the rectal cancer with ½ inch margins on either side of the rectum. The proximal bowel would then be pulled down and sutured to the anal sphincter complex. However, this "sacral anus" was difficult for the patient to manage. 1,3 Carl Guessenbauer performed the first transabdominal rectal resection and with closure and colostomy in 1879. This procedure would be later popularized by Henri Hartmann for the purpose of treating diverticulitis. 4 Vincent Czerny is credited with performing the first combined abdominal and perineal approach. This combined approach was never intended but was performed only after an unsuccessful attempt at resection through the perineal approach. 1 In Vogel's review of 1,500 cases performed by 12 of the most prominent 19th century surgeons including Billroth, Kocher, Kraske, and Czerny there was a 21% operative mortality rate with a high (80%) recurrence rate. 3 Surgery certainly had progressed beyond LisFranc's perineal res...

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“…For rectal resection there is evidence that robotics reduces conversion to open surgery, with no differences in operative time, morbidity, hospital stay and oncologic results [17,18]. Enhanced 3D visualization and more precise manoeuvres of the robot allow nerves preservation during the total mesorectal excision, producing a better recovery of sexual and urinary functions [19].…”

mentioning

confidence: 99%

Robotics in General Surgery: Update and Future Perspectives

Bravo¹,

Mc²,

Js³

et al. 2015

Adv Robot Autom

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Medicine is going through a technological revolution that produces a paradigm shift and makes us think in new ways of treating and diagnosing our patients [1]. Minimally invasive surgery development and routine application in multiple procedures has been the main evolution in the last 50 years, bringing great benefits to patients, surgeons, hospitals and even insurance companies.In laparoscopic surgery the surgeon keeps control by handling patient's tissues inside an insufflated cavity with an external fulcrum point for instrumentation. It changes drastically in robotic surgery, with the surgeon taking place in a virtual environment outside the operative field, with a distant and indirect control. SAGES defines robotic surgery as a surgical procedure that adds a computer technology enhancement interface to the interaction between the surgeon and his patient during a surgical operation and assumes some degree of control heretofore completely reserved for the surgeon.Surgical robots have been envisioned to overcome the limitations and extend the capabilities of human surgeons, allowing them to perform precise and reproducible tasks [2]. Its performance is rooted in the strengths and weaknesses of laparoscopic surgery, being able to avoid the fulcrum effect, overcome the limited range of movements and depth perception, and dismiss the surgeon physiological tremor, while keeping its minimally invasive nature [3].Robotic surgery or computer-assisted surgery is an interactive system fast and intuitive that allows the computer to disappear from the surgeon's mind, who senses as real the environment generated by the system. Through virtual reality, the surgeon defines the manoeuvres that the robot performs in the patient. The consolemanipulator device can be placed in the same operating room, or in a different place, or eventually in another city or country [4,5].Robotic or remote tele-presence surgery is based in two fundamental concepts: virtual reality and cybernetics. Virtual reality achieves 3D immersion effects, navigation, interaction and simulation in real time, making real what the surgeon sees and touches. Cybernetics makes possible the movement digitalisation, promoting the development of mechanical articulated parts programmed with motion degrees, cameras, sensors, information saving and data processing.So far tele-presence surgery uses slave robots that are not programmed to do any movement without surgeon's command, and therefore are completely dependent on his judgement, knowledge and skills. It has a structure that resembles the anatomy of human arms and articulations, capable of imitating movements such as those from shoulders, elbows, wrists and fingers, but exceeding its natural range of motion and increasing the degree of freedom. Da Vinci System® by Intuitive Surgical Inc, the most commonly used device, consists of a surgeon's console, a slave robot with four interactive arms, instruments, a graphic interface and a camera. This design allows the surgeon to operate from a seated position with ergonom...

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Robotic versus Laparoscopic Proctectomy for Rectal Cancer: A Meta-analysis

Abstract: Robot-assisted surgery decreased the conversion rate compared to conventional laparoscopic surgery. Other clinical outcomes and oncologic outcomes were equivalent. The benefits of robotic rectal cancer surgery may differ between population groups.

Cited by 199 publications

References 24 publications

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Current Concepts in Rectal Cancer

Robotics in General Surgery: Update and Future Perspectives

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