Robotic Colorectal Surgery for Colorectal Cancer: Evidence and technical Aspects

Robotic colorectal Surgery for colorectal Cancer: Evidence and technical Aspects
BACKGROUND:
Robotic total mesorectal excision (TME) for rectal cancer and complete mesocolic excision for right colon cancer has been proved in various studies. However, the results of prospective, randomized studies providing valuable evidence are now available. Compared to conventional surgery, the laparoscopic and Robotic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss
METHODS:
The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic and robotic procedure. With regard of the oncological dimension, the laparoscopic and robotic TME technique is not different compared to the open procedure. However, a standardized robotic step-by-step procedure may simplify the operation and can reduce operation time.
RESULTS:
In the robotic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier. After multiple workshops and extensive discussion with national and international experts, we developed a standardized robotic "10 step TME procedure." as well as “10 step CME procedure” for right colon cancer.
CONCLUSION:
Robotic TME and CME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer and colon cancer based on evidence mainly from nonrandomized studies. In nearly all published studies, the efficacy and technical feasibility of robotic surgery for colorectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized robotic TME and CME technique can be strongly recommended.