Updates in robotic colorectal surgery

Augmented Reality: Moving Robotics Forward

“…The Robotic versus Laparoscopic Resection for Rectal Cancer (ROLARR) study, for example, the largest international randomized control trial yet undertaken to compare the safety, efficacy, and short-and long-term outcomes of a robotic colorectal procedure compared with conventional laparoscopy, found no statistically significant difference in conversion rates to open laparotomy, circumferential resection margins, mesorectal resection quality, postoperative complications within 30 days, and quality of life on month 6 after operation. 1,6 There is a body of evidence from cohort and case-controlled studies into the use of robotics in rectal cancer resection (including TME) that suggests benefits in terms of all-cause mortality, surgical site infection, intraoperative blood loss, time to oral diet, postoperative ileus and preservation of sphincter, and urinary and sexual function, especially in obese men. 1,6 However, in 2019, Liao et al published a meta-analysis of seven randomized controlled trials (RCTs) comparing robotic and laparoscopic surgery of the rectum and again found no statistically significant differences in similar outcomes covered by ROLARR, including circumferential and proximal resection margins (it actually found that distal resection margins were longer in robot-assisted procedures, although significant heterogeneity in the data was noted across studies).…”

“…1,6 There is a body of evidence from cohort and case-controlled studies into the use of robotics in rectal cancer resection (including TME) that suggests benefits in terms of all-cause mortality, surgical site infection, intraoperative blood loss, time to oral diet, postoperative ileus and preservation of sphincter, and urinary and sexual function, especially in obese men. 1,6 However, in 2019, Liao et al published a meta-analysis of seven randomized controlled trials (RCTs) comparing robotic and laparoscopic surgery of the rectum and again found no statistically significant differences in similar outcomes covered by ROLARR, including circumferential and proximal resection margins (it actually found that distal resection margins were longer in robot-assisted procedures, although significant heterogeneity in the data was noted across studies). 6,12 There has been plenty of commentary on the fact that outcomes in robot-assisted surgery improve with the skill and experience of the surgical team.…”

“…1,6 However, in 2019, Liao et al published a meta-analysis of seven randomized controlled trials (RCTs) comparing robotic and laparoscopic surgery of the rectum and again found no statistically significant differences in similar outcomes covered by ROLARR, including circumferential and proximal resection margins (it actually found that distal resection margins were longer in robot-assisted procedures, although significant heterogeneity in the data was noted across studies). 6,12 There has been plenty of commentary on the fact that outcomes in robot-assisted surgery improve with the skill and experience of the surgical team. AlAsari and Min pointed out that one of the main reasons that robotic procedures tend to take longer is because of the technical difficulty of docking the robot, but studies show that set up and operative times reduce significantly the more experienced and proficient the user is.…”

“…5 Robotic systems with their superior instrumentation, seven degrees of free movement, ergonomic comfort, and stable three-dimensional (3D) visualization have been heralded as the solution to the limitations of conventional laparoscopy. 6,7 In theory, the better precision, maneuverability, and visibility robotic systems provide should lead to advantages when operating in this anatomically challenging area, such as, facilitating the identification of neurovascular structures, dissection in confined spaces, and minimizing human error caused by hand slips and fatigue. 2,3 While there is undoubtedly evidence that its adoption is accelerating, it remains a long way behind laparoscopy and a long way behind rates of use in other surgical areas.…”

“…This compares to a growth of 0.7 to 28.8% of inguinal and 0.5 to 22.4% of ventral hernia repairs, and of 3.1 to 26.7% of proctectomy procedures in the same time period. 8 Although robotic techniques are known to have particular advantages for total mesorectal excision (TME) in the treatment of rectal cancer, 6 the Michigan study found that use of robotics in all complex cancer resections only increased from 2.1% of cases in 2012 to 3.9% of cases in 2018. This is in stark contrast to other specialties, such as urology, where 75% of radical prostatectomies in the United States involve the use of robots, 2 and gynecology, where a quarter of oncologists reported using roboticassisted surgery within 4 years of it being approved for use.…”