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

Abstract

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.

Robots in Cancer Surgery: A Boon or Bane

“…Similar results were also reported in a comparative study using open, laparoscopic, and robotic approaches for right-sided colon cancer [56]. A meta-analysis study further showed longer RALS operating time due to docking and undocking of a robotic cart which has been rectified in da Vinci Xi system [57]. These studies suggest that despite comparable oncologic outcomes by the robotic approach, large and prospective randomized controlled trials are absolutely required to draw a definite conclusion.…”

Role of minimally invasive surgery for rectal cancer

“…The steps are further facilitated by the magnification of the laparoscope. However, laparoscopic rectal surgery is a labor-intensive procedure with a significant learning curve that is estimated to be around 40-90 cases[ 23 ]. The critical portion of the TME as such requires a high level of expertise.…”

“…The instruments are touted as having seven ranges of motion and behave more like a normal human wrist. Many studies found the learning curve to be quicker at around 15-44 cases[ 23 ]. Furthermore, the robot offers an ergonomic advantage as the surgeon sits down for most of the procedure.…”

Experience With Transitioning From Laparoscopic to Robotic Right Colectomy

“…1 Since the first descriptions of robotic-assisted colectomy in 2001, 2 the number of robotic colorectal procedures performed worldwide has rapidly increased. 3 The introduction of new technologies in surgery is not free of risks and poses questions concerning surgeon training and how to ensure patient safety.…”