The Use of Enhanced Technologies in Robotic Surgery and Its Impact on Outcomes in Rectal Cancer: A Systematic Review

Abstract

The main advantage of the robotic approach is the surgical precision that the technology offers. It is particularly useful in rectal cancer as this is a technically challenging procedure. The technological advantage of the robot leads to better postoperative outcomes. Apart from the 3D vision and endowrist instrumentation in comparison to laparoscopy, the options of using fluorescence imaging, endowrist stapler, and table motion have revolutionised the way of performing an anterior resection. Thus, the true benefit of these advances will be the quality of the surgery, which leads to better postoperative outcomes. This article focuses on the current status of applications of new modalities and technology development in robotic rectal surgery. A systematic literature search was performed using PubMed, MEDLINE, and cochrane database. The studies included were considered based on the following (1) articles written in English, (2) full text is available, (3) whether the topic is related to the use of novel technologies during robotic rectal surgery, and (4) sample: adult patients and malignant rectal disease. The primary end point was to analyse the current use of technological advances in robotic rectal surgery. Only a few studies are currently available on the use of these different technologies in robotic colorectal surgery. Many of these reports describe promising results, although with short-term outcomes. The use of technologies in robotic colorectal surgery is safe and feasible and can be used together to improve short-term outcomes. Intraoperative fluorescence angiography has demonstrated to reduce the rate of anastomotic leak, whereas the robotic stapler and the table motion simplify anatomic resection.

Robotic oncologic colorectal surgery with a new robotic platform (CMR Versius): hope or hype? A preliminary experience from a full-robotic case-series

“…Median hospital stay was 6.5 (5-7) days. The histopathological report showed a complete R0 resection in every patient with a median lymph node yield of 13 (12)(13)(14)(15) lymph nodes. The mesorectal excision was considered complete by the pathologist (according to the College of American Pathologists).…”

“…In robotic surgery, technology is crucial and the gain in procedural costs can be justified when the platform is fully exploited for all the surgical steps from dissection until reconstruction [12][13][14].…”

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

“…Advances in oncology research[ 9 ] have resulted in increasing roles for the latest technologies in surgery. Enhanced video/camera systems[ 10 ], robotic technology[ 11 ], powered staplers[ 12 ], and specialized operating platforms for natural orifice transluminal endoscopic surgery[ 13 ] are just a few examples of surgical innovations in colorectal surgery introduced in the last decades. In this setting, laser fluorescence using indocyanine green (ICG) dye is a promising and widespread real-time technology because of its easy accessibility, accuracy and cost-effectiveness.…”

Precision surgery

“…Precision in surgery should refer to the ability to carefully perform a surgical operation according to well-established surgical techniques and following precise anatomical roadmaps. In minimally invasive operations, the use of a surgical robot can enhance precision [7]. Navigation and augmented reality offer additional opportunity for precision in surgery [8].…”