Robotic Rectal Cancer Surgery

摘要

Major pitfalls of laparoscopic rectal surgery are the technical and anatomic complexity in the narrow pelvis where some maneuvers are difficult to perform with non-articulating instruments. Because of the potential advantages of robotic assistance in the pelvis, we started to assess the utility of the DaVinci system for total mesorectal excisions. We found that telerobotic surgery facilitates several aspects of the pelvic dissection in the confined pelvic space, and that the three-dimensional imaging gives excellent view of the pelvic anatomy. Early experiences with different robotic-assisted colorectal procedures such as colectomies (Rawlings et al., 2006; D'Annibale et al., 2004), rectopexy (Munz et al., 2004) and anterior resections (D'Annibale et al., 2004, Anvari et al., 2004) are described in recent literature including our previous early report of robotic-assisted TMEs (Pigazzi et al., 2006). These studies found no difference in specimen length, number of lymph nodes retrieved, estimated blood loss, recovery of bowel function or hospital stay between laparoscopic and robotic colorectal resections. Our data showing no positive circumferential or distal margins support these findings. Additionally our leak rate of 12.5% is comparable to a leak rate of 1319% seen in laparoscopic TME series (Morino et al., 2003; Leroy et al., 2004). Our operative times of 180-540 minutes also compare favorable to reported operative times (88-600 minutes) for laparoscopic rectal surgery (Morino et al., 2003; Leroy et al., 2004; Leung et al., 2004). However, increased operative times due to robotic and operating room set-up have been reported (D'Annibale et al., 2004, Anvari et al., 2004). The low conversion rate of 2.7% and high success rate of TMEs suggest that the advantage of the robot system may translate in better patient outcome. Nevertheless, there are some drawbacks to current robotic systems. The most significant disadvantage is the inability of the robotic arms to self-adjust around the bed to allow the surgeon to gain access to more than one quadrant of the abdominal cavity at any one time. Another criticism of current robotic systems includes a lack of adequate instruments for bowel surgery such as staplers and suction devices necessitating the use of additional laparoscopic ports.