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Surg Endosc (2012) 26:111 DOI 10.1007/s00464-011-1867-y
REVIEWS
Robot-assisted laparoscopic surgery of the colon and rectum
Stavros A. Antoniou George A. Antoniou
Oliver O. Koch Rudolf Pointner
Frank A. Granderath
Received: 12 January 2011 / Accepted: 31 May 2011 / Published online: 20 August 2011 Springer Science+Business Media, LLC 2011
AbstractIntroduction Laparoscopic techniques have induced a tremendous revolution in the eld of general surgery. Recent multicenter trials have demonstrated similar patient-oriented and oncologic outcomes for laparoscopic colon and rectal resections compared with their open counterparts. Meanwhile, robotic technology has gradually entered the eld of general surgery, allowing increased dexterity, improved operative view, and optimal ergo-nomics. The objective of this study was to review the current status of clinical robotic applications in colorectal surgery.
Methods A systematic review of the literature using the PubMed search engine was undertaken to identify relevant articles. The keywords used in all possible combinations were: surgical robotics, robotic surgery, computer-assisted surgery, colectomy, sigmoid resection, sigmoidectomy, and rectal resection.
Results Thirty-nine case series or comparative nonrandomized studies were identied. A specic interest for
robot-assisted rectal surgery during the past few years was recorded in the literature. The retrieved articles included 13 ileocecal resections, 220 right colectomies, 190 left colectomies/sigmoid resections, 440 anterior resections, 149 abdominoperineal/intersphincteric resections, and 11 total/ subtotal colectomies. The clinical application of the da Vinci robotic system in right and left/sigmoid colectomies yielded satisfactory results in terms of open conversion (1.1 and 3.8%, respectively) and operative morbidity (13.4 and15.1%, respectively). Robot-assisted anterior resection was accompanied by a considerably low conversion rate(0.4%), morbidity (9.7%), and adequate number of harvested lymph nodes (14.3, mean).
Conclusions Robotic applications in colorectal surgery are feasible with low conversion rates and favorable morbidity. Further studies are required to evaluate its oncologic and patient-oriented outcomes.
Keywords Laparoscopic Robotic Da Vinci Colon
Rectum Total mesorectal excision
Novel operative modalities introduced throughout the past decades have signicantly minimized surgical trauma and resulted in lower morbidity, diminished blood loss, decreased postoperative pain, and faster recovery for several procedures [14]. Laparoscopic techniques allow improved visualization of areas difcult to reach by means of open surgery, and thus more precise dissection of anatomic structures. Recent results of prospective, randomized, multicenter trials comparing laparoscopic and open colon and rectal resections have demonstrated...