Laparoscopic and Robotic Total Mesorectal Excision in the Treatment of Rectal Cancer. Brief Review and Personal Remarks

Abstract

The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.

Robotic nipple-sparing mastectomy for the treatment of breast cancer: Feasibility and safety study

“…Robotic surgery is today considered a valid option for radical prostatectomy, radical cystectomy, colorectal surgery and hysterectomy, with the majority of cases being dedicated to oncologic procedures [1–3]. Despite the lack of a natural cavity needed for endoscopic viewing, applications of robotic surgery have also recently emerged for superficial organs such as in the fields of thyroidectomy [4], oropharyngeal surgery [5], and plastic and reconstructive surgery [6,7].…”

301. Total mesorectal excision for the treatment of rectal cancer

“…It is very important to avoid administering homologous blood to the patient with rectal cancer who underwent curative surgery, because of the increased risk of post-operative complications (14). Mean operative time was 212 minutes (range 120 to 535 minutes) (15)(16)(17)(18). The mean blood-loss volumes during surgery for rectal cancer patients was 451 mL (range 30 to 1,200 mL) (15,16,19).…”

The Surgical Robot: Applications and Advantages in General Surgery

“…It is under difficult circumstances of a narrow male pelvis, or a female pelvis that has been previously subjected to radiation therapy, where the fibrosis and desmoplastic reaction from a neoplastic process require the surgeon's maximum level of proficiency for the sake of a safe, efficient oncologic resection. The robotic technology enables the surgeon to achieve excellent results where laparoscopic surgery has failed to deliver in the past [24,25]. Interestingly, it has been determined that the learning curve for robotic low anterior resection (including total mesorectal excision) is similar and not longer than the learning curve for the laparoscopic technique, which argues against the idea that it would be more difficult to learn to perform such a demanding and challenging procedure with the robot as opposed to doing it laparoscopically.…”