The role of robotic assisted laparoscopy for oesophagogastric oncological resection; an appraisal of the literature

Abstract

The introduction of surgical robotics to the field of surgical oncology brings with it an expectation not only of improved vision, instrumentation, and precision but also as a result, a potential for improved oncological outcomes. The current interest in the field of oesophagogastric oncology is explored in this review together with the benefits, real and potential, that robotic assistance offers surgical cancer resection as well as some of the limiting factors which may be hampering its uptake into current surgical practice. A systematic review of all the published literature up until April 2010 was examined across the field of esophageal and gastric cancer resection. A quantitative assessment of the oncological, operative, and functional outcomes was determined from each procedure. The level of evidence behind the results was determined using the Oxford Centre for Evidence-based Medicine Levels of Evidence; Therapy and Prevention. Three hundred and five cases from 19 independent studies were included for review. Nine studies explored the outcomes from robotic-assisted esophagectomy and eight, the robotic-assisted gastrectomy. Two articles included small case series of both procedures. The level of evidence was predominantly based on case series or expert opinion (Level 4 or 5) with only three unmatched or poorly matched comparative trials (Level 4) with no randomized trials evident. Improved operative outcomes and hospital stays were demonstrated with a reduction of 2 days when the robotic-assisted gastrectomy technique was employed compared with the open. No improvement in oncological outcomes could be identified with the use of the robot for either oesophageal or gastric cancer resection; however, in terms of short-term oncological outcomes, these were at least equivalent to the open approach for oesophageal cancer and early stage gastric cancer. Robotic-assisted laparoscopic surgery is a feasible technique to use to perform a safe and oncologically sound resection for oesophageal and early gastric cancer. Operative benefits appear to be encouragingly similar to the laparoscopic approach with some demonstration of improvement over the open technique despite a prolonged operative time. However, the level of evidence is suboptimal and more randomized controlled trials and long-term survival studies within a framework of measured and comparable outcomes is required.

A novel flexible hyper-redundant surgical robot: prototype evaluation using a single incision flexible access pelvic application as a clinical exemplar

“…However, major drawbacks remain in terms of large operating theatre footprint and somewhat prohibitively high cost. Positioning the robot, particularly for some multiple-staged and/or multi-quadrant operations such as esophagectomy and colectomy, significantly slows the operation through the need to dock, un-dock and redock the robot [19,20]. This particular problem has been recognised by Intuitive surgical, and an automated docking feature has been integrated into the new da Vinci Xi TM model launched this year, to overcome this.…”

Total (Transthoracic and Transabdominal) Robotic Radical Three-Stage Esophagectomy—Initial Indian Experience

“…From a systematic review, which included nine articles (130 cases) related to robot-assisted esophagectomy, it was concluded that robot-assisted esophagectomy was a feasible and safe technique [22]. In terms of shortterm oncological outcomes, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy was at least equivalent to the open transthoracic approach for esophageal cancer [22,23].…”

Robotic surgery for esophageal cancer: Merits and demerits

“…Several published review articles have focused on robotic esophagectomy 8, 45, 46, 47. All of them acknowledge the technical superiority of robotic surgery (ie a three‐dimensional view with up to 10‐fold magnification, articulated instruments with seven degrees of movement, natural hand‐eye coordination axis, and tremor filter).…”