The art of robotic colonic resection: a review of progress in the past 5 years

Abstract

Surgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

Robotic versus laparoscopic colorectal surgery in elderly patients in terms of recovery time: a monocentric experience

“…In this recent study, Keller et al showed that laparoscopic surgery for colorectal cancer in the elderly, in addition to the clinical benefits, reduces overall costs in comparison to open surgery [ 15 ]. Robotic surgery was born to overcome the limits of laparoscopy (2-D vision, reduced ergonomics in confined spaces, tremor effect and unnatural hand–eye coordination) and was successfully applied to urology, general and pediatric surgery, gynaecology, and other surgical fields [ 11 , 12 , 17 , 28 , 29 ]. Robotic surgery has some advantages, such as shorter learning curve, 3-D views, increased wrist flexibility, better ergonomic benefits, reduction of hand tremor and surgeon workloads [ 8 , 11 , 12 , 16 , 17 , 30 ].…”

“…Robotic surgery was born to overcome the limits of laparoscopy (2-D vision, reduced ergonomics in confined spaces, tremor effect and unnatural hand–eye coordination) and was successfully applied to urology, general and pediatric surgery, gynaecology, and other surgical fields [ 11 , 12 , 17 , 28 , 29 ]. Robotic surgery has some advantages, such as shorter learning curve, 3-D views, increased wrist flexibility, better ergonomic benefits, reduction of hand tremor and surgeon workloads [ 8 , 11 , 12 , 16 , 17 , 30 ]. Comparison between robotic and laparoscopic surgery is considered a “hot topic”.…”

“…Comparison between robotic and laparoscopic surgery is considered a “hot topic”. Several studies suggested that robotic surgery is safe, feasible with same perioperative and oncological outcomes as laparoscopic surgery [ 17 , 31 – 35 ]. A meta-analysis showed that both techniques had similar results, even if the benefits of robotic surgery for colorectal disease remain controversial [ 31 ].…”

“…A case-matched of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) comparing 12,790 patients showed a better LOS (length of stay) in robotic colorectal surgery versus laparoscopic colorectal surgery but with a high operative cost [ 49 ]. There are other studies that report a reduction in hospitalization after robotic colorectal surgery, but no one targets elderly patients [ 17 , 43 , 44 , 49 – 53 ].…”

“…The robotic technique was developed as the evolution of conventional laparoscopy [ 1 , 7 , 11 ]. Robotic surgery provides several advantages such as three-dimensional (3D) high-definition vision, greater freedom and control on operating instruments, flexible wrists, and filtration of hand tremor to improve maneuverability and operative comfort [ 8 , 11 , 12 , 16 , 17 ]. The robotic technique for colorectal surgery was introduced in 2002 by Weber [ 18 ].…”