Male urogenital function after robot-assisted and laparoscopic total mesorectal excision for rectal cancer: a prospective cohort study

Abstract

Background Urogenital dysfunction is recognized as a serious complication affecting patient quality of life after rectal cancer surgery to treat rectal cancer; however, the studies focus on the urogenital function after robot-assisted rectal cancer surgery compared to laparoscopic surgery are limited. Methods Male patients undergoing robotic total mesorectal excision (R-TME) or laparoscopic total mesorectal excision (L-TME) were prospectively enrolled. The International Prostate Symptom Score (IPSS) and the five-item version of the International Index of Erectile Function (IIEF-5) scale were used to compare the urogenital function of the two groups preoperatively and 3, 6, and 12 months postoperatively. Results Eighty-nine patients who planned to undergo R-TME and L-TME were prospectively enrolled; 77 patients of these patients (86.5%) completed all questionnaires at all time points and were thus included in the final analysis. Of the included patients, 38 underwent R-TME and 39 underwent L-TME. There was no significant difference in age, BMI, American Society of Anesthesiologists (ASA) score, tumor location, neoadjuvant therapy, operation method, postoperative pathological results and adjuvant therapy between the two groups. Preoperative urogenital function was similar in both groups; however, the IPSS was significantly lower in R-TME patients than that in T-TME patients at 6 months and 12 months [(7.82 ± 2.25 vs. 9.95 ± 3.01, P = 0.006; 7.62 ± 2.5 vs. 9.12 ± 2.64, P = 0.012)]. IIEF-5 scores decreased 3 months after R-TME and L-TME surgery (14.87 ± 3.27 vs. 13.92 ± 3.62, p = 0.231) and then gradually increased; at 12 months, IIEF-5 scores were comparable to those at baseline in both groups. IIEF-5 scores were higher in R-TME patients than those in L-TME patients at 6 months (18.55 ± 3.45 vs. 16.75 ± 3.26, P = 0.021), but there was no significant difference between the two groups at 12 months (21.22 ± 3.06 vs. 19.95 ± 3.03, P = 0.071). Conclusions The robotic approach for TME was associated with more rapid restoration of male urogenital function than the laparoscopic approach.

Robotic colorectal surgery initial results after 183 cases

“…Owing to the precise dissection and to the significant magnification, the blood loss in our study was 165.45±82.85 mL. Many robotic surgeons reported the same results for blood loss not exceeding 200 mL (12). Several studies indicate that the blood loss is significantly lower for robotic surgery compared to conventional and laparoscopic, due to the better visualization of structures, the pneumodissection that facilitates work in embryonic planes, and the wrist motion of instruments that allows gentle dissection of structures and vessels (13,14).…”

Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

“…Performing TME in the lower rectum is challenging owing to pelvic limitations, which can result in nerve injury. However, the magnified high-definition 3D view provided by robotic technology, along with the flexible and stable robotic arm, can help prevent permanent nerve injury during surgery[ 36 ]. In our study, we did not observe statistically significant differences in LARS and Wexner scores between patients in the R-NOSES I-F and RLRC groups ( P > 0.05).…”

The consequences of laparoscopic fascial space priority approach to lateral lymph node dissection on urinary and sexual functionality.

“…Residual urine volume by ultrasonography was also measured as an important indicator at pre-operation and 10 days, 1 month, 6 months after the procedure. Sexual function was assessed by means of the international index of erectile function (IIEF) [15][16][17] questionnaire in male patients.…”