Robotic surgery vs conventional laparoscopy for the treatment of rectal cancer: Review of the literature

Abstract

Laparoscopic surgery has established itself as a safe and effective alternative to open surgery for the treatment of colorectal cancer. However, laparoscopic resection of rectal cancer, and in particular of the lower rectum, remains challenging in view of the limitations of operating in the confined pelvic space, limited movement of instruments with fixed tips, assistant-dependant two-dimensional view, easy camera fogging, and poor ergonomics. The introduction of robotic surgery and its application in particular to pelvic surgery, has potentially resolved many of these issues. To define the role of robotic surgery in total mesorectal excision for rectal cancer, a review of the current literature was performed using PubMed, Embase, Cochrane Library, and Google databases, identifying clinical trials comparing short-term outcomes of conventional laparoscopic total mesorectal excision with the robotic approach. Robotic surgery for rectal cancer is a safe alternative to conventional laparoscopy. However, randomised trials are needed to clearly establish its role.

Keywords: Rectal cancer, Total mesorectal excision, Laparoscopic surgery, Robotic surgery

Core tip: Robotic surgery for rectal cancer is a promising approach since it allows a better view of the pelvic cavity and enhanced freedom of instrument movements when compared to conventional laparoscopy. This would potentially translate into a better oncological dissection, and reduced risk of injury to neurovascular structures. This review of the literature shows that no definite conclusion of the potential benefits of robotic surgery can be drawn, and that larger prospective studies with long-term follow up are needed to establish the role of the procedure.