A review on robotic surgery in rectal cancer

Abstract

Robotic surgery has the upper hand when compared to the laparoscopic approach in terms of superior visualisation, flexibility in movement, steadiness and accessibility to confined anatomical spaces.Nevertheless, limitations still exist with regards to cost, reduced tactile sensation, time-consuming setup and a significant learning curve to achieve. Although studies have shown better or at least comparable outcomes between the robotic and laparoscopic approach, the limitations mentioned result in poor penetrance among centres and surgeons. Advancements in robotic surgery technology and attaining the acquired skillset will translate into better clinical outcomes for patients.

Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data

“…In the past decade, robotic surgery has been utilized successfully in various surgeries due to its advantages of three‐dimensional vision, increased dexterity of movement, and decreased fatigue . A meta‐analysis of eight studies, mostly non‐RCTs, evaluated the safety and efficacy of robotic total mesorectal excision in rectal cancer patients and concluded that robotic surgery was associated with a lower conversion rate (OR 0.23), fewer positive circumferential resection margins (OR 0.44), and a lower incidence of erectile dysfunction (OR 0.09) than laparoscopic surgery .…”

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

“…Laparoscopic TME (LTME) has apparent advantages and considered a preferred mode of surgery due to less tissue trauma[ 5 - 11 ]. Due to precision in dissection, stable base unit and better visualization in difficult areas like lower pelvis, the robotic TME (RTME) is also considered a possible alternative to LTME[ 12 , 13 ]. RTME may potentially offer same advantages which LTME offers as reported in some studies.…”

Robotic total mesorectal excision: state of the art

“…Contrasting results have been reported regarding the impact of the previous proficiency on laparoscopy on the duration of the period [45,46] . Most of the publications evaluated the expertise with variables as "operative time", "bleeding" or "conversion" which may not be the most critical outcomes [47] . There is a wide agreement on the fact that operative times are longer during a learning curve, but a recent study on robotic rectal resection showed no relationship between extended operative time and morbidity [48] .…”

“…Current robotic platforms display a 3D image, enhancing the visualization of the anatomical structures by improving the surgeon's depth perception and image quality. Compared to conventional laparoscopy, robotic surgery also allows to control a stable camera [47] . The system has recently incorporated the EndoWrist® technology, which improves dexterity and eliminates physiological tremor reducing the challenge of laparoscopic intra-corporeal suturing [51] .…”

“…Direct costs can be divided into fixed costs (to buy and maintain the robotic system), and variable costs (consumable instruments). The cost of a robotic platform is $1-$2.3 million [47] . Cost-analysis studies determined that robotic is more expensive than open and laparoscopic surgeries [57,58] .…”