Evaluation of the robotic approach concerning pitfalls in rectal surgery

Baukloh, Julia-Kristin; Reeh, Matthias; Spinoglio, Giuseppe; Corratti, A.; Bartolini, Ilenia; Mirasolo, Vita M; Priora, Fabio; Izbicki, Jakob R.; Fleitas, Manuel Gómez; Ruiz, Marcos Gómez; Perez, Daniel

doi:10.1016/j.ejso.2016.12.014

Cited by 17 publications

(23 citation statements)

References 40 publications

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“…A recent systematic review showed that laparoscopic surgery for rectal cancer in obese patients is technically challenging because of the longer operative times, higher risk of postoperative complications, and higher rates of conversion to OS compared with non‐obese patients . Recent retrospective case‐control studies that compared obese versus non‐obese patients (body mass index of ≥30 vs <30 kg/m 2 , respectively) undergoing robotic colorectal surgery consistently showed no difference in the conversion rate, rate of CRM, intraoperative or postoperative complications, or length of hospital stay . Shiomi et al .…”

Section: Short‐term Outcomesmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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Interest in minimally invasive surgery has increased in recent decades. Robotic‐assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual‐console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.

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Section: Short‐term Outcomesmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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“…A total of 3698 articles were identified on initial search of the bibliographic databases. After removal of duplicates and full-text screening, 12 articles 16,17,[24][25][26][27][28][29][30][31][32][33] subsequently met the inclusion and exclusion criteria and were included in the meta-analysis ( Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Obese patients and robotic colorectal surgery: systematic review and meta-analysis

et al. 2020

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Background: Obesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta-analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non-obese patients. Methods: MEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta-analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m 2 or above) undergoing robotic colorectal cancer resections were compared with non-obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery). Results: A total of 131 full-text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non-obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non-obese patients (weighted mean difference −21⋅99 (95 per cent c.i. −31⋅52 to −12⋅46) min; P < 0⋅001). Obese patients had a higher rate of conversion to laparotomy than non-obese patients (odds ratio 1⋅99, 95 per cent c.i. 1⋅54 to 2⋅56; P < 0⋅001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non-obese patients. Conclusion: Robotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non-obese patients. Further studies should focus on better stratification of the obese population with colorectal disease as candidates for robotic procedures.

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“…A striking coefficient is the patient-specific individual anatomy and tumor manifestation: A narrow male pelvis, obesity, and bulky and low tumors can substantially hamper LS [8,9,16,28]. Hence, RS was proposed and has already demonstrated ability to address the problem of anatomical limitations in low anterior resection.…”

Section: Resultsmentioning

confidence: 99%

“…shown to provide equal perioperative and oncological outcome even in patients presenting with complicated anatomical situations such as narrow male pelvis or obesity [22][23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Lower Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures

et al. 2018

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Introduction: For a long time, the comprehensive application of minimally invasive techniques in lower gastrointestinal (GI) surgery was substantially impaired by inherent anatomical and technical complexities. Recently, several new techniques such as robotic operating platforms and transanal total mesorectal excision (taTME) have revolutionized the minimally invasive approach. This review aims to depict the current state of the art and evaluates the advantages and drawbacks in regard to perioperative outcome and quality of oncological resection. Methods: A systematic literature search was performed using the search terms ‘colorectal cancer', ‘rectal cancer', ‘minimally invasive surgery', ‘laparoscopic surgery', and ‘robotic' to identify relevant studies reporting on robotic surgery (RS) either alone or in comparison to laparoscopic surgery (LS). Publications on taTME were analyzed separately. Results: 69 studies reporting on RS with a total of 20,872 patients, and 17 articles on taTME including 881 patients, were identified. Conclusion: Both RS and taTME can facilitate a minimally invasive approach for lower GI surgery in an increasing number of patients. Furthermore, combining both techniques might become an auspicious approach in selected patients; further prospective and randomized trials are needed to verify its benefits over conventional laTME.

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Evaluation of the robotic approach concerning pitfalls in rectal surgery

Cited by 17 publications

References 40 publications

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Obese patients and robotic colorectal surgery: systematic review and meta-analysis

Lower Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures

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