J Korean Med Sci.  2015 Jul;30(7):837-846. 10.3346/jkms.2015.30.7.837.

The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques

• Park S
• Kim NK

• KMID: 2164465
• DOI: http://doi.org/10.3346/jkms.2015.30.7.837

Abstract

The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci(R) Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment.

Keyword

Rectal Neoplasms; Robotic Surgery; Laparoscopic Surgery; Advantage; Disadvantage

MeSH Terms

Digestive System Surgical Procedures/*methods
Laparoscopy/*methods
Postoperative Complications/surgery
Rectal Neoplasms/*surgery
Robotic Surgical Procedures/economics/*methods
Robotics/methods
Treatment Outcome

Figure

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  Fig. 1 Placement of ports for totally robotic rectal surgery.

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  Fig. 2 Changes in IIEF score and IPSS before surgery and several months after surgery. IIEF, international index of erectile function; IPSS, international prostate symptom score; L/R-TME, laparoscopic/robot-assisted total mesorectal excision. Red circle, R-TME allowed for an earlier recovery. Kim (43); Fab (44).

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  Fig. 3 Preservation of autonomic nerve system related to genitourinary function (43).

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  Fig. 4 Multimodality treatment preserving anus: Neoadjuvant chemoradiation therapy and robotic rectal sleeve resection with colo-anal anastomosis (57).

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  Fig. 5 The difference between conventional abdominoperineal resection and extralevator abdominoperineal resection using robotic assistance.

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  Fig. 6 Changes of cost according to accumulation of cases in robotic surgery (67).

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