• anastomotic leak
• anterior resection
• postoperative complication
• rectal cancer
• risk factors

• health promotion
• non-communicable diseases
• rectal cancer
• risk factors
• robotic-assisted surgery

• Humans
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Operative Time
• Laparoscopy/adverse effects
• Length of Stay/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Blood Loss, Surgical/statistics & numerical data

• Circumferential resection margin
• Quality of TME
• Rectal cancer
• Robotic surgery
• Total mesorectal excision

• Humans
• Male
• Robotic Surgical Procedures
• Retrospective Studies
• Margins of Excision
• Overweight/complications
• Overweight/surgery
• Treatment Outcome
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Laparoscopy
• Multicenter Studies as Topic

• TME
• TME quality
• lymph nodes
• robotic TME
• robotic surgery
• total mesorectal excision

• Humans
• Robotic Surgical Procedures/methods
• Retrospective Studies
• Laparoscopy/methods
• Treatment Outcome
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Lymph Nodes/surgery
• Lymph Nodes/pathology

• GAUK 2120256 Grantová Agentura, Univerzita Karlova

• colorectal surgery
• rectal cancer
• rectal neoplasm
• robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Treatment Outcome
• Rectum/surgery
• Robotics
• Rectal Neoplasms/surgery
• Laparoscopy/methods
• Operative Time

• colorectal fistula
• colorectal leakage
• rectal cancer
• rectal surgery
• stoma

• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Humans
• Models, Statistical
• Prognosis
• Rare Diseases
• Rectal Neoplasms/complications
• Retrospective Studies
• Risk Factors
• Surgical Oncology

Surgery remains a mainstay of combined modality treatment at patients with rectal cancer; however, there is a growing interest in using laparoscopic techniques (LG); including robotic-assisted techniques (RG). Therefore, we have prepared a meta-analysis of the literature regarding the safety and efficacy of robotic versus laparoscopic approaches in patients undergoing curative surgery for rectal cancer. The results indicate a number of advantages of RG in terms of both safety and efficacy. Operative time in the RG group was shorter and associated with a statistically significantly lower conversion of the procedure to open surgery. RG technique provided a shorter duration of hospital stay and lowered urinary risk retention. No differences were found between these techniques regarding TNM stage; N stage or lymph nodes harvested. Survival to hospital discharge or 30-day overall survival rate was 99.6% in RG vs. 98.8% for LG.

Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to 10 November 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was 2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD = −0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs. LG group varied and amounted to 8.0 ± 5.3 vs. 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.

• conventional laparoscopic surgery
• meta-analysis
• outcome
• rectal cancer
• robotic-assisted laparoscopic
• systematic review

• LNR
• LODDS
• colorectal cancer
• lymph node classification

• implementation
• rectal cancer
• robotic surgery

The application of robotic surgery for rectal cancer is increasing steadily. The purpose of this meta-analysis is to compare pathologic outcomes among patients with rectal cancer who underwent open rectal surgery (ORS) versus robotic rectal surgery (RRS).

We systematically searched the literature of EMBASE, PubMed, the Cochrane Library of randomized controlled trials (RCTs) and nonrandomized controlled trials (nRCTs) comparing ORS with RRS.

Fourteen nRCTs, including 2711 patients met the predetermined inclusion criteria and were included in the meta-analysis. Circumferential resection margin (CRM) positivity (OR: 0.58, 95% CI, 0.29 to 1.16, P = 0.13), number of harvested lymph nodes (WMD: −0.31, 95% CI, −2.16 to 1.53, P = 0.74), complete total mesorectal excision (TME) rates (OR: 0.93, 95% CI, 0.48 to 1.78, P = 0.83) and the length of distal resection margins (DRM) (WMD: −0.01, 95% CI, −0.26 to 0.25, P = 0.96) did not differ significantly between the RRS and ORS groups.

Based on the current evidence, robotic resection for rectal cancer provided equivalent pathological outcomes to ORS in terms of CRM positivity, number of harvested lymph nodes and complete TME rates and DRM.

• Humans
• Prognosis
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures

To describe the surgical technique and examine the feasibility and outcomes following robotic pelvic exenteration and extended pelvic resection for rectal and/or urological malignancy.

We present a case series of seven patients with locally advanced or synchronous urological and/or rectal malignancy who underwent robotic total or posterior pelvic exenteration between 2012–2016.

In total, we included seven patients undergoing pelvic exenteration or extended pelvic resection. The mean operative time was 485±157 minutes and median length of stay was 9 days (6–34 days). There was only one Clavien–Dindo complication grade 3 which was a vesicourethral anastomotic leak requiring rigid cystoscopy and bilateral ureteric catheter insertion. Eighty-five percent of patients had clear colorectal margins with a median margin of 3.5 mm (0.7–8.0 mm) while all urological margins were clear. Six out of seven patients had complete (grade 3) total mesorectal excision. Three patients experienced recurrence at a median of 22 months (21–24 months) post-operatively. Of the three recurrences, one was systemic only whilst two were both local and systemic. One patient died from complications of dual rectal and prostate cancer 31 months after the surgery.

We report a large series examining robotic pelvic exenteration or extended pelvic resection and describe the surgical technique involved. The robotic approach to pelvic exenteration is highly feasible and demonstrates acceptable peri-operative and oncological outcomes. It has the potential to benefit patients undergoing this highly complex and morbid procedure.

• Colorectal cancer
• Minimally invasive surgical procedures
• Pelvic exenteration
• Prostate cancer
• Surgery

• Cost
• Functional outcome
• Laparoscopy
• Oncologic outcome
• Robotic
• TME

• MIS colorectal
• Robotic
• colorectal cancer
• colorectal research
• colorectal surgery
• laparoscopic
• meta-analysis
• rectal cancer
• robotic surgery
• systematic review
• total mesorectal excision

Despite the technical limitations of minimally invasive surgery, laparoscopic total mesorectal excision (LTME) for rectal cancer has short-term advantages over open surgery, but the pathological outcomes reported in randomized clinical trials are still in controversy. Minimally invasive robotic total mesorectal excision (RTME) has recently been gaining popularity as robotic surgical systems potentially provide greater benefits than LTME. Compared to LTME, RTME is associated with lower conversion rates and similar or better genitourinary functions, but its long-term oncological outcomes have not been established. Although the operating time of RTME is longer than that of LTME, RTME has a shorter learning curve, is more convenient for surgeons, and is better for sphincter-preserving operations than LTME. The robotic surgical system is a good technical tool for minimally invasive surgery for rectal cancer, especially in male patients with narrow deep pelvises. Robotic systems and robotic surgical techniques are still improving, and the contribution of RTME to the treatment of rectal cancer will continue to increase in the future.

• Rectal neoplasms
• Robotic surgical procedures
• Total mesorectal excision

• Circumferential resection margin
• Learning curve
• Rectal cancer
• Robotic surgery
• Total mesorectal excision

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Clinical Competence/standards
• Female
• Follow-Up Studies
• Humans
• Laparoscopy/education
• Laparoscopy/methods
• Learning Curve
• Male
• Margins of Excision
• Middle Aged
• Proctectomy/education
• Proctectomy/methods
• Prognosis
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/education
• Robotic Surgical Procedures/methods
• Surgeons/education

• Minimally invasive surgery
• Rectal cancer
• Robotic platform
• Robotic surgery
• Total mesorectal excision

• Low anterior resection
• Minimally invasive surgery
• Rectal cancer

• Anastomotic leak
• Rectal cancer
• Score

• Aged
• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/etiology
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Neoplasm Staging
• Nomograms
• Predictive Value of Tests
• Prospective Studies
• Quality of Life
• ROC Curve
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/surgery
• Risk Assessment/methods
• Risk Factors

• Laparoscopic surgery
• Robotic surgery
• Total mesorectum excision

• Humans
• Laparoscopy
• Publication Bias
• Rectum/surgery
• Regression Analysis
• Robotic Surgical Procedures
• Treatment Outcome

• Medical device
• Minimally invasive surgery
• Port placement
• Robotic surgery
• Visceral surgery

• Laparoscopy
• Rectal cancer
• Robotic surgery
• Transanal

To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).

Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).

One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.

RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

• Diverticular disease
• Colorectal resections
• Multi-incision laparoscopic surgery
• Colorectal cancer
• Single incision laparoscopic surgery

• Cost
• Rectal resection
• Robotic surgery

• Colorectal cancer
• Laparoscopic training
• Minimally invasive
• Robotic surgery
• Robotic training

• laparoscopy
• meta-analysis
• rectal cancer
• robotic
• total mesorectal excision

• Digestive System Surgical Procedures/adverse effects
• Humans
• Laparoscopy/adverse effects
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/adverse effects

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

• Robotic surgery
• Robotic rectal surgery
• DaVinci rectal surgery
• Robotic rectal cancer
• Robotics for rectal cancer
• Robotic rectal resection

• Automatic data processing
• Medical device
• Robotic surgical procedures
• Standardization
• Visceral surgery

• Colectomy/standards
• Female
• Follow-Up Studies
• Humans
• Laparoscopy/standards
• Male
• Proctoscopy
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/surgery
• Retrospective Studies
• Robotics/methods
• Time Factors

• Circumferential resection margin
• Colorectal surgery
• Hand-sewn ileocolic anastomoses
• Laparoscopic colorectal surgery
• Quality of total mesolectal excision
• Rectal cancer
• Robotic colorectal surgery

• Anastomosis, Surgical/methods
• Colorectal Surgery
• Digestive System Surgical Procedures/economics
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/standards
• Humans
• Laparoscopy
• Pelvis/anatomy & histology
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/economics
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/standards
• Suture Techniques

The aim of this meta-analysis was to comprehensively compare the safety and efficacy of robotic-assisted rectal cancer surgery (RRCS) and open rectal cancer surgery (ORCS). Electronic database (PubMed, EMBASE, Web of Knowledge, and the Cochrane Library) searches were conducted for all relevant studies that compared the short-term and long-term outcomes between RRCS and ORCS. Odds ratios (ORs), mean differences, and hazard ratios were calculated. Seven studies involving 1074 patients with rectal cancer were identified for this meta-analysis. Compared with ORCS, RRCS is associated with a lower estimated blood loss (mean difference [MD]: −139.98, 95% confidence interval [CI]: −159.11 to −120.86; P < 0.00001), shorter hospital stay length (MD: −2.10, 95% CI: −3.47 to −0.73; P = 0.003), lower intraoperative transfusion requirements (OR: 0.52, 95% CI: 0.28 to 0.99, P = 0.05), shorter time to flatus passage (MD: −0.97, 95% CI = −1.06 to −0.88, P < 0.00001), and shorter time to resume a normal diet (MD: −1.71.95% CI = −3.31 to −0.12, P = 0.04). There were no significant differences in surgery-related complications, oncologic clearance, disease-free survival, and overall survival between the two groups. However, RRCS was associated with a longer operative time. RRCS is safe and effective.

During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic surgery offers major benefits in oncological outcomes. Although initial reports are promising, more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery.

• Laparoscopy
• Rectal neoplasms
• Robotics
• Total mesorectal excision

• colorectal cancer
• local excision
• total mesorectal excision

• Cholecystectomy/methods
• Conversion to Open Surgery/statistics & numerical data
• Cost-Benefit Analysis
• Endoscopy/economics
• Endoscopy/methods
• Europe
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Pancreatectomy/methods
• Robotics/economics
• Robotics/methods
• Societies, Medical