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2016 ; 8
(11
): 757-771
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Robotic rectal surgery: State of the art
#MMPMID27895814
Staderini F
; Foppa C
; Minuzzo A
; Badii B
; Qirici E
; Trallori G
; Mallardi B
; Lami G
; Macrì G
; Bonanomi A
; Bagnoli S
; Perigli G
; Cianchi F
World J Gastrointest Oncol
2016[Nov]; 8
(11
): 757-771
PMID27895814
show ga
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.