The role of robotics in colorectal surgery

Abstract

Studies of laparoscopic approaches in colorectal surgery support the use of such methods. Compared with the open approach, laparoscopy reduces rates of postoperative complications and decreases length of stay, while providing equivalent oncologic outcomes. Nevertheless, much of colorectal surgery is still being performed by the open approach. This may be partly due to the technical challenges in performing laparoscopy, particularly when working in narrow spaces such as the pelvis. Moreover, some of the current literature has questioned the oncologic outcomes after laparoscopic surgery for rectal cancer. Robotic surgery has been heralded as the minimally invasive tool that can overcome these challenges. It has the advantages that it provides a three dimensional image, uses wristed instruments, and has a computer interface that allows for fluid and accurate movements. Overall, current evidence suggests that robotics is safe and feasible in colorectal surgery, and that short term and long term outcomes are comparable to those seen for laparoscopic approaches. Studies on the costs of robotic surgery show conflicting results, and this is arguably one of the biggest disadvantages of its use. Because robotic surgery is a relatively new technology, few large high quality studies are available. Most of the published studies in this area consist of retrospective reviews, case matched studies, and national database reviews. Large randomized prospective studies are needed to further support its use.

Robotic rectal surgery has advantages over laparoscopic surgery in selected patients and centres

“…The fact that the best centres can achieve better outcomes than ROLARR appears to be conceded by Rockall and Jayne, and we believe that while this may not provide immediate evidence of an uncontrolled rollout of robotics it does show what can be achieved even now, and therefore offers a meaningful basis for extrapolating health economic forecasts. We agree that ongoing collection of data from the best centres and pooling these data to show evolving benefits would provide observational study experience analogous to a Phase IV pharmaceutical trial, either supporting greater rollout of robotic technology at that stage or, at the very least, a rerun of a larger randomized comparative study [23] between robotic and laparoscopic surgery with a more level playing field of surgeon expertise. We are sure robotic technology has not yet reached its full potential with regard to either technology or skill levels, and are also certain that wider usage will lead to a rapid reduction of acquisition and running costs even with significantly more advanced technology.…”

Transanal TME: new standard or fad?

“…Thus, transanal and robotic approaches aim at almost the same targets in rectal cancer surgery and there is an argument over which approach is better, robotic TME or taTME for patients with rectal cancer having challenging features 54,55) . Robotic surgery also has several drawbacks such as high cost, longer operative time, and lack of tactile sensa-tion 53,56,57) . Interestingly, there are regional differences in the selection of surgical treatments for rectal cancer, for example, robotic surgery is popular in the US while taTME is popular in other western countries 58) .…”

Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: A meta‐analysis based on seven randomized controlled trials

“…This technique has several potential advantages over LRCS, including an immersive three‐dimensional view of the surgical field, better dexterity and ambidextrous capability, and a stable camera platform . Several benefits of robotic rectal cancer surgery (RRCS) have been indicated, such as a lower conversion rate to open surgery and a reduced length of hospital stay . However, this technique has a longer operative time compared with conventional laparoscopic surgery …”

“…3,4 Several benefits of robotic rectal cancer surgery (RRCS) have been indicated, such as a lower conversion rate to open surgery and a reduced length of hospital stay. 5 However, this technique has a longer operative time compared with conventional laparoscopic surgery. 6 Pathologic outcomes can be used to assess the quality of surgery.…”