Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2016; 8(11): 757-771
Published online Nov 15, 2016. doi: 10.4251/wjgo.v8.i11.757
Robotic rectal surgery: State of the art
Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giacomo Trallori, Beatrice Mallardi, Gabriele Lami, Giuseppe Macrì, Andrea Bonanomi, Siro Bagnoli, Giuliano Perigli, Fabio Cianchi
Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy
Giacomo Trallori, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
Beatrice Mallardi, Istituto per lo Studio e Prevenzione Oncologica, 50134 Florence, Italy
Gabriele Lami, Giuseppe Macrì, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
Andrea Bonanomi, Siro Bagnoli, Unit of Gastroenterology, AOU Careggi, 50134 Florence, Italy
Author contributions: All the authors contributed to the data collection.
Conflict-of-interest statement: Authors declare no conflict of interest for this article. Authors declare no instance of Plagiarism or Academic Misconduct.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabio Cianchi, MD, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy. fabio.cianchi@unifi.it
Telephone: +39-33-9307447
Received: March 10, 2016
Peer-review started: March 15, 2016
First decision: May 19, 2016
Revised: July 12, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 15, 2016
Abstract

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.

Keywords: Robotic surgery, Robotic rectal surgery, DaVinci rectal surgery, Robotic rectal cancer, Robotics for rectal cancer, Robotic rectal resection

Core tip: Laparoscopic rectal surgery has progressively expanded. However it has some technical limitations. The need to overcome these limitations leads to the development of robotic platforms. Although the positive feedback is by the surgeons, there is still no evidence in literature about the superiority of robotic rectal surgery when compared to traditional laparoscopy.