Laparoscopic versus Robotic-assisted Rectal Surgery: A Comparison of Postoperative Outcomes

Abstract

Rectal surgery continues to be an area of advancement for minimally invasive techniques. However, there is controversy regarding whether a robotic approach imparts any advantages over established laparoscopic procedures. The aim of this study was to analyze and compare outcomes of laparoscopic and robotic rectal resection operations. A single-institution retrospective review was performed identifying 83 consecutive patients undergoing low rectal resection requiring proximal diversion between 2009 and 2013. The cohort was comprised of 38 laparoscopic and 45 robotic cases. Data were analyzed for postoperative outcomes as well as 30-day morbidity and mortality. Male gender frequency, body mass index, and American Society of Anesthesiologists class were higher in the robotic group (71%, 28.6 kg/m2, and 2.6, respectively) compared with the laparoscopic group (42%, 23.7 kg/m2, and 2.2, respectively; P < 0.01). Length of stay was significantly longer for patients undergoing laparoscopic (7.5 days) compared with robotic procedures (5.7 days, P < 0.01). This difference was even greater when comparing patients who underwent a hybrid laparoscopic-assisted open total mesorectal excision (TME) with robotic TME (8.2 vs 5.7 days, respectively, P < 0.01). Conversion rate was 7.9 per cent for the laparoscopic group and zero per cent for the robotic ( P = 0.09). There were no mortalities in either group. A pure laparoscopic or robotic rectal surgery may be associated with a shorter hospital stay compared with a laparoscopic-assisted approach.

Retrorectal Tumors: A Comprehensive Literature Review

“…To date, to the best of our knowledge, only seven robotic cases have been described [39–41], and only in two cases the robotic technique was applied to malignant tumors (one malignant neurofibroma, one GIST). Based on previous studies on robotic resection of rectal tumors [80, 81], and the absence of recurrence or operative death in the robotic cases listed in our review [40, 41], we can hypothesize a similar outcome for patients who underwent robotic and laparoscopic retrorectal tumors resection. However, larger robotic retrorectal case‐series are needed in order to draw a definitive conclusion.…”

Operative and oncological outcomes after robotic rectal resection compared with laparoscopy: a systematic review and meta‐analysis

“…The initial search identified 1777 studies. Review of titles and/or abstracts reduced this to 101 papers which were assessed for eligibility, with 50 papers included in the final analysis 7,11–59 (Appendix S2 PRISMA flow chart). Thirty‐one studies were retrospective cohort studies, with three randomized trials, 13 case‐matched studies and three prospective cohort studies.…”

“…The small number of randomized studies comparing robotic and laparoscopic rectal surgery renders data susceptible to selection bias. One might expect surgeons to choose easier cases for a newer technique; however baseline characteristics in these studies appeared equal aside from three studies with more males in the robotic arm, 21,39,41 one study with more males in the laparoscopic arm 29 ; two studies 21,41 with significantly higher BMIs in the robotic arm; and four studies 11,20,30,51 with lower average tumour heights in the robotic arm, mostly suggesting the robotic platform was favoured for more difficult cases (see Appendix S3).…”