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Review
. 2021 Sep 8;11(9):900.
doi: 10.3390/jpm11090900.

Update on Robotic Total Mesorectal Excision for Rectal Cancer

Simona Giuratrabocchetta  1 , Giampaolo Formisano  1 , Adelona Salaj  1 , Enrico Opocher  2 , Luca Ferraro  1 , Francesco Toti  1 , Paolo Pietro Bianchi  1
Affiliations
Review

Update on Robotic Total Mesorectal Excision for Rectal Cancer

Simona Giuratrabocchetta et al. J Pers Med. .

Abstract

The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint.

Keywords: rectal cancer; robotic low anterior resection; robotic surgery; total mesorectal excision.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Operative room setup.
Figure 2
Figure 2
Patient positioning.
Figure 3
Figure 3
Trocar layout for a fully robotic TME.
Figure 4
Figure 4
Final view after Total Mesorectal Excision.
Figure 5
Figure 5
Splenic flexure takedown—bottom to up approach.
See this image and copyright information in PMC

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