The role of robots in colorectal surgery and the difficulty of running reliable comparisons with conventional laparoscopy (original) (raw)
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2015
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. The aim of this study was to evaluate the feasibility and short-term outcomes of robotic surgery for colorectal cancer as initial cases, compared with conventional laparoscopic surgery. From July 2015 to October 2015, fifteen patients with left-sided colon and rectal cancer underwent robotic surgery, and we compare with 20 patients received conventional laparoscopic surgery selected from our database of 153 patients with colorectal cancer operated in the last five years. Both groups were balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), operative history, TNM staging, and tumor location using the propensity score matching me...
Minimally invasive surgery, 2018
Undoubtedly, robotic systems have largely penetrated the surgical field. For any new operative approach to become an accepted alternative to conventional methods, it must be proved safe and result in comparable outcomes. The purpose of this study is to compare the short-term operative as well as oncologic outcomes of robotic-assisted and laparoscopic rectal cancer resections. This is a prospective randomized clinical trial conducted on patients with rectal cancer undergoing either robotic-assisted or laparoscopic surgery from April 2015 till February 2017. Patients' demographics, operative parameters, and short-term clinical and oncological outcomes were analyzed. Fifty-seven patients underwent permuted block randomization. Of these patients, 28 were assigned to undergo robotic-assisted rectal surgery and 29 to laparoscopic rectal surgery. After exclusion of 12 patients following randomization, 45 patients were included in the analysis. No significant differences exist between b...
The International Journal of Medical Robotics and Computer Assisted Surgery, 2014
Introduction Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The aim of this study is to compare main outcomes of laparoscopic and robotic rectal resection. Methods In total, 143 consecutive patients treated for rectal cancer in our department with laparoscopic or robotic-assisted surgery from October 2010 to July 2013 were retrospectively analyzed. Results A total of 87 patients underwent laparoscopic rectal resection, and 56 patients were treated using a robotic approach. The conversion rate was 11.5% in the laparoscopic group and 3.5% in the robotics group (P = 0.09). The low rectal cancer conversion rate was significantly lower in the robotic group (1.8%) than in the laparoscopy group (9.2%) (P = 0.04). Mean operation time was 252 min in the laparoscopic group and 309 min in the robotic group (P = 0.023).
Robotic Versus Laparoscopic Colorectal Surgery
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2014
Background: Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.
International Journal of Colorectal Disease, 2011
Purpose There is growing enthusiasm for robotic-assisted laparoscopic operations across many surgical specialities, including colorectal surgery, often not supported by robust clinical or cost-effectiveness data. A proper assessment of this new technology is required, prior to widespread recommendation or implementation. Methods/design The ROLARR trial is a pan-world, prospective, randomised, controlled, unblinded, superiority trial of robotic-assisted versus standard laparoscopic surgery for the F.
Mini-invasive Surgery , 2020
Much effort has been spent evaluating the difference between robotic and laparoscopic surgery platforms for rectal cancer. There is a plethora of literature comparing outcomes for intraoperative events, postoperative complications, long term outcomes, cost, and learning curve. The data are conclusive regarding the higher cost of robotic surgery compared to laparoscopic surgery. This article is a comprehensive review of the available literature regarding intraoperative and postoperative outcomes. For practically all parameters evaluated, there are no significant differences between the two platforms. The ultimate decision on whether to perform robotic vs. laparoscopic surgery should be based on surgeon preference and familiarity with equipment, as well as local resources.
Robotic Versus Laparoscopic Colorectal Resection: Are We There Yet?
Cureus, 2021
Background: Laparoscopy-assisted surgery (LAS) for colorectal cancer (CRC) was first described in 1991 and robotic-assisted surgery (RAS) for CRC was first reported in 2002; robotic-assisted colorectal surgery (RACS) is becoming increasingly popular. However, data comparing its outcomes to other established techniques remain limited to small case series. Our primary goal was to review the mortality outcome difference between laparoscopic versus robotic elective colon resection at a small, community hospital. Study design: We conducted a retrospective review of 2089 patients at the South Atlantic division for cases who underwent robotic and laparoscopic colectomies at our division in 2014-2018. All cases were elective surgeries and analysis was performed within these two subgroups. Results: In this study, 306 patients underwent robotic colorectal surgery versus 1783 patients who underwent laparoscopic-assisted colorectal surgery. Readmission rate within 30 days of operation was significantly lower for laparoscopic-assisted colorectal resection (LACR) versus RACS (445.4% vs. 53.9%, p= 0.006). However, the length of hospital stay was significantly shorter for RACS with a median of three days (interquartile range {IQR}: 2-5) versus four days (IQR: 3-7) for LACR (p=0.0001). There were no significant differences between the two groups for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, or rate of conversion to an open procedure. Conclusion: Our study showed a similar outcome between LACR and RACS for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, and rate of conversion to an open procedure. Also, our study showed a readmission rate within 30 days of operation was significantly lower for LACR versus RACS. However, the length of hospital stay was significantly shorter for RACS with a median of three days when compared to LACR. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.
Robot-Assisted Versus Standard Laparoscopic Colorectal Surgery
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2014
Background and Objectives: Over the years, there has been a continual shift toward more minimally invasive surgical techniques, such as the use of laparoscopy in colorectal surgery. Recently, there has been increasing adoption of robotic technology. Our study aims to compare and contrast robot-assisted and laparoscopic approaches to colorectal operations. Methods: Forty patients undergoing laparoscopic or robotic colorectal surgery performed by 2 surgeons at an academic center, regardless of indication, were included in this retrospective review. Patients undergoing open approaches were excluded. Study outcomes included operative time, estimated blood loss, length of stay, complications, and conversion rate to an open procedure. Results: Twenty-five laparoscopic and fifteen robot-assisted colorectal surgeries were performed. The mean patient age was 61.1 Ϯ 10.7 years in the laparoscopic group compared with 61.1 Ϯ 8.5 years in the robotic group (P ϭ .997). Patients had a similar body mass index and history of abdominal surgery. Mean blood loss was 163.3 Ϯ 249.2 mL and 96.8 Ϯ 157.7 mL, respectively (P ϭ .385). Operative times were similar, with 190.8 Ϯ 84.3 minutes in the laparoscopic group versus 258.4 Ϯ 170.8 minutes in the robotic group (P ϭ .183), as were lengths of hospital stay: 9.6 Ϯ 7.3 and 6.5 Ϯ 3.8 days, respectively (P ϭ .091). In addition, there was no difference in the number of lymph nodes harvested between the laparoscopic group (14.0 Ϯ 6.5) and robotic group (12.3 Ϯ 4.2, P ϭ .683). Conclusions: In our early experience, the robotic approach to colorectal surgery can be considered both safe and efficacious. Furthermore, it also preserves oncologically sufficient outcomes when performed for cancer operations.
Cirugía Española (English Edition), 2011
Introduction: Robotic-assisted surgery is playing an increasingly important role in the last few years in the treatment of colorectal oncological disease. However, there are still no studies that objectively demonstrate the advantages of this type of surgery. We present a prospective randomised study in order to compare the short-term results between colorectal robotic surgery and laparoscopic surgery. Material and method: A total of 56 patients diagnosed with colorectal cancer between January 2008 and January 2009 were randomised and assigned to the robotic or laparoscopic group. Age, body mass index, tumour location, conversions in each group, complications during and after surgery, and histological characteristics of the specimens obtained, were all compared. Results: There were no significant differences between age (P=.055), body mass index (P=.12), or tumour location (P=.91). Only one patient in the robotic group required a transfusion and none in the laparoscopic group. The percentage of conversions was the same in both groups, however, the preparation times and operating times were significantly longer in patients intervened using the robotic device (P=.0001 and P=.017, respectively). There were no differences as regards the rate of complications or in the percentage of re-interventions (14.2% and 7.1%). The mean hospital stay of the patients was 9.3 (8.1) days in the robotic group and 9.2 (6.8) days in the laparoscopic (P=.79). The distal resection margin was greater in the specimen obtained using robotic surgery (P=.003) as well as the number of lymph nodes obtained in the specimen (P=.23). Conclusion: Robotic colorectal was performed safely and effectively, and with similar clinical results.