Surgical Endoscopy

, Volume 22, Issue 7, pp 1601–1608 | Cite as

Robotic tumor-specific mesorectal excison of rectal cancer: short-term outcome of a pilot randomized trial

  • S. H. Baik
  • Y. T. Ko
  • C. M. Kang
  • W. J. LeeEmail author
  • N. K. Kim
  • S. K. Sohn
  • H. S. Chi
  • C. H. Cho



Laparoscopic colorectal resection has become popular. The recently developed da Vinci Surgical System promises to facilitate endoscopic surgery and overcome its disadvantages. This study therefore aimed to compare the short-term results between robotic tumor-specific mesorectal excision (R-TSME) using the da Vinci Surgical System and conventional laparoscopic tumor-specific mesorectal excision (L-TSME) in rectal cancer patients.


Between April 2006 and February 2007, 36 patients were randomly assigned to receive R-TSME or L-TSME. During the study, 18 patients underwent robotic low anterior resection using the da Vinci Surgical System, and 18 patients had conventional laparoscopic low anterior resection. Patient characteristics, perioperative clinical results, complications, and pathologic details were compared between the two groups.


The patient characteristics were not significantly different between the two groups. The mean operating time, hemoglobin change, and conversion rate were not significantly different between the groups. Complications were treated conservatively and did not require surgical intervention in the R-TSME group. The average length of stay was 6.9 ± 1.3 days in the R-TSME group and 8.7 ± 1.3 days in the L-TSME group (p < 0.001). The specimen quality of the R-TSME group was acceptable.


Tumor-specific mesorectal excision was performed safely and effectively using the da Vinci Surgical System and the perioperative outcomes were acceptable.


DaVinci Rectal cancer Robotic surgery 



This study was supported by a faculty research grant of the Yonsei University College of Medicine for 2006. (6-2006-0111).


  1. 1.
    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic resection). Surg Laparosc Endosc 1:144–150PubMedGoogle Scholar
  2. 2.
    Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467–1477PubMedGoogle Scholar
  3. 3.
    Cadiere GB, Himpens J, Vertruyen M, Bruyns J, Germay O, Leman G, Izizaw R (2001) Evaluation of telesurgical (robotic) NISSEN fundoplication. Surg Endosc 15:918–923PubMedCrossRefGoogle Scholar
  4. 4.
    Kim NK, Baik SH, Seong JS, Kim H, Roh JK, Lee KY, Sohn SK, Cho CH (2006) Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor specific mesorectal excision for fixed locally advanced rectal cancer. Ann Surg 244:1024–1030PubMedCrossRefGoogle Scholar
  5. 5.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMedCrossRefGoogle Scholar
  6. 6.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1251–1525CrossRefGoogle Scholar
  7. 7.
    Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694PubMedCrossRefGoogle Scholar
  8. 8.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784PubMedCrossRefGoogle Scholar
  9. 9.
    Vibert E, Denet C, Gayet B (2003) Major digestive surgery using a remote controlled robot: the next revolution. Arch Surg 138:1002–1006PubMedCrossRefGoogle Scholar
  10. 10.
    Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, Pirozzi F, Caiazzo P (2005) Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 19:117–119PubMedCrossRefGoogle Scholar
  11. 11.
    Woeste G, Bechstein WO, Wullstein C (2005) Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis 20:253–257PubMedCrossRefGoogle Scholar
  12. 12.
    D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal disease. Dis Colon Rectum 47:2162–2168PubMedCrossRefGoogle Scholar
  13. 13.
    Nagtegaal ID, Van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734PubMedCrossRefGoogle Scholar
  14. 14.
    Heald RJ (1979) A new approach to rectal cancer. Br J Hosp Med 22:277–281PubMedGoogle Scholar
  15. 15.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1987–1997. Arch Surg 133:894–899PubMedCrossRefGoogle Scholar
  16. 16.
    Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMedGoogle Scholar
  17. 17.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  18. 18.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery vs. open suegery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRefGoogle Scholar
  19. 19.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC Trial Group (2005) Short-term end points of conventional vs laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 365:1718–1726Google Scholar
  20. 20.
    Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telemonitoring: review of early clinical results. Surg Endosc 16:1389–1402PubMedCrossRefGoogle Scholar
  21. 21.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639PubMedCrossRefGoogle Scholar
  22. 22.
    Braumann C, Jacobi CA, Menenakos C, Borchert U, Rueckert JC, Mueller JM (2005) Computer-assisted laparoscopic colon resection with the da Vinci System: our first experiences. Dis Colon Rectum 48:1820–1827PubMedCrossRefGoogle Scholar
  23. 23.
    Darzi A (2001) Hand-assisted laparoscopic colorectal surgery. Semin Laparosc Surg 8:153–160PubMedCrossRefGoogle Scholar
  24. 24.
    Pandya S, Murray JJ, Coller JA, Rusin LC (1999) Laparoscopic colectomy: indications for conversion to laparotomy. Arch Surg 134:471–475PubMedCrossRefGoogle Scholar
  25. 25.
    Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342PubMedCrossRefGoogle Scholar
  26. 26.
    Targarona EM, Gracia E, Garriga J, Martinez-Bru C, Cortes M, Boluda R, Lerma L, Trias M (2002) Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response, and cost. Surg Endosc 16:234–239PubMedCrossRefGoogle Scholar
  27. 27.
    Schadde E, Smith D, Alkoraishi AS, Begos DG (2006) Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital: a prospective analysis of 104 consecutive cases. Surg Endosc 20:1077–1082PubMedCrossRefGoogle Scholar
  28. 28.
    Kim SH, Park IJ, Joh YG, Hahn KY (2006) Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients. Surg Endosc 20:1197–1202PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • S. H. Baik
    • 1
    • 2
  • Y. T. Ko
    • 1
    • 2
  • C. M. Kang
    • 1
    • 2
  • W. J. Lee
    • 1
    • 2
    Email author
  • N. K. Kim
    • 2
  • S. K. Sohn
    • 2
  • H. S. Chi
    • 2
  • C. H. Cho
    • 2
  1. 1.Robotic and Laparoscopic Surgery CenterSeverance HospitalSeoulKorea
  2. 2.Department of SurgeryYonsei University College of MedicineSeoulKorea

Personalised recommendations