Robotic Surgery in Rectal Cancer: Potential, Challenges, and Opportunities

Abstract

The current standard treatment for locally advanced rectal cancer is based on a multimodal comprehensive treatment combined with preoperative neoadjuvant chemoradiation and complete surgical resection of the entire mesorectal cancer. For ultra-low cases and cases with lateral lymph node metastasis, due to limitations in laparoscopic technology, the difficulties of operation and incidence of intraoperative complications are always difficult to overcome. Robotic surgery for the treatment of rectal cancer is an emerging technique that can overcome some of the technical drawbacks posed by conventional laparoscopic approaches, improving the scope and effect of radical operations. However, evidence from the literature regarding its oncological safety and clinical outcomes is still lacking. This brief review summarized the current status of robotic technology in rectal cancer therapy from the perspective of several mainstream surgical methods, including robotic total mesorectal excision (TME), robotic transanal TME, robotic lateral lymph node dissection, and artificial intelligence, focusing on the developmental direction of robotic approach in the field of minimally invasive surgery for rectal cancer in the future.

Keywords: Colorectal cancer; RLLND; RTME; RTaTME; Robotic surgery.

Fig. 1.

Neuroprotection in robotic TME surgery. A, B Protection of the inferior epigastric nerve during the group 253 lymph node dissection. C Protection of the inferior epigastric nerve during complete resection of the mesorectum. D Protection of the pelvic nerve during complete resection of the mesorectum.

Fig. 2

Laparoscopic transanal part of robotic TaTME surgery. A Find the boundary between the rectal mesorectum and the pelvic fascia from lateral direction. B Cut off the rectum caudate ligament from the rear. C Open the Denonvilliers’ fascia in the front and enter the abdominal cavity. D Cut off the lateral ligament.

Fig. 3.

Robotic system–assisted left pelvic exenteration. A Open the peritoneum on the outside of the ureter. B Expose the internal iliac artery and vein, and separate the urinary fascia plane composed of the pelvic plexus and ureter. C Continue to separate distally along the internal iliac artery, clean the lymph nodes, and identify the inferior bladder artery. D Display the lateral region after complete lymph node clearance.