Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

Abstract

Background: Robotic technology aims to obviate some of the limitations of conventional laparoscopic surgery, yet the role of robotics in colorectal surgery is still largely undefined and varies with respect to its application in abdominal versus pelvic surgery. Methods: With this review, we aimed to highlight current developments in colorectal robotic surgery. We systematically searched the following databases: PubMed, EMBASE, and Cochrane Library. We critically reviewed the available literature on the use of robotic technology in colon and rectal surgery. Results: Robotic colorectal surgery is oncologically safe and has short-term outcomes comparable to conventional laparoscopy, with potential benefits in rectal surgery. It has a shorter learning curve but increased operative times and costs. It offers potential advantages in the resection of rectal cancer, due to lower conversion rates. There is also a trend toward better outcomes in anastomotic leak rates, circumferential margin positivity, and perseveration of autonomic function. Conclusion: Laparoscopy remains technically challenging and conversion rates are still high. Therefore, most cases of colorectal surgery are still performed open. Robotic surgery aims to overcome the limits of the laparoscopic technique. This new technology has many advantages in terms of articulating instruments, advanced three-dimensional optics, surgeon ergonomics, and improved accessibility to narrow spaces, such as the pelvis. However, further studies are needed to assess long-term results and benefits.The first report on laparoscopic right colectomy was published by Jacobs et al. 1 ; shortly following that Fowler performed the first laparoscopic left colectomy. Since these initial reports, several large studies found that the oncologic outcomes of laparoscopic colectomy were equivalent to open surgery. Despite the growing evidence supporting the use of laparoscopic colectomy for colon cancer, the adoption of this technique was relatively slow due to some limitations: loss of stereoscopic vision and depth perception, paradoxical motion of the instruments, amplified movements, parallel instrumentation, and suboptimal ergonomics. To overcome these shortfalls, the use of hand-assisted laparoscopy was introduced as a bridge between open and laparoscopic surgery. 2,3 Robotic colectomy was first reported in 2002 and since that time adoption of robotic surgery has steadily increased, as evidenced by the number of publications in both medical and lay press. The da Vinci robotic system, the only currently available robotic system in the market approved by the FDA for colorectal surgery, provides several advantages over traditional laparoscopic surgery including a stable camera platform, threedimensional (3D) imaging, improved ergonomics, tremor elimination, ambidextrous capability, motion scaling, and

Robotic liver resection for hepatocellular carcinoma: a focus on anatomic resection

“…Robotic technology has increasingly infiltrated the field of abdominal surgery, encompassing urological, gynecological, and upper and lower gastrointestinal procedures [1,2] . However, the use of robotic systems is still limited in hepatobiliary and pancreatic surgery, probably because of the technical difficulty and insufficient instruments appropriate for this field.…”

Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot?

“…For colon cancer, the principle of mesocolic excision has been proposed as a superior surgical technique [1,8], but is assumed to be technically demanding and require a skillful and meticulous dissection of central vasculature [46]. In particular, this applies to minimally invasive CME, which, according to the available literature, is feasible but sometimes reported to have high complication rates [10,47] and should only be applied by experienced surgeons [3]. Robotic surgery has gained popularity as a minimally invasive technique with increased degrees of freedom, more precise manipulation, better visualization, and tremor compensation.…”

Robotic total mesorectal excision: state of the art

“…Further research is needed to evaluate the quality of life; including sexual, stool, and urinary functions, using utility measures like the disabilityadjusted life-year and the quality-adjusted life-year, to accurately compare the outcomes of the different surgical alternatives. For the latest 20 years, da Vinci® System has dominated robotic surgery, the lack of adversaries led to rising costs and maybe slowed the evolution of the technology [42] . In the near future, with the introduction of new robotic platforms, this situation is expected to change dramatically.…”

“…Senhance® Surgical Robotic System and the REVO-I® Robot Platform are the two other systems commercially available nowadays. Competitive industry players like Medtronic and Verb surgical (powered by GOOGLE® and Johnson & Johnson®) platforms are expected soon [42] .…”