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Robotic technology for colorectal surgery

Procedures, current applications, and future innovative challenges

Robotertechnologie in der kolorektalen Chirurgie

Verfahren, aktuelle Anwendung und künftige innovative Herausforderungen

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Abstract

Background

Colorectal cancer is the third most common cancer worldwide. Current treatment approaches are multidisciplinary, including neoadjuvant chemoradiotherapy for rectal cancer. Several studies have reported an improvement in surgical techniques and in new devices facilitating better pre- and intraoperative staging.

Objectives

Since its first application in 2002, robotic surgery has progressed steadily, offering good surgical results and better oncological outcomes. Currently, many studies and reviews have confirmed its safety and feasibility for colorectal cancer.

Materials and methods

Robotic technology simplifies surgical maneuvers thanks to the three-dimensional magnification and stable vision, convenient mobility of the robotic arms, endowrist instruments with seven degrees of freedom, ambidextrous capability, tremor filtering, and indocyanine green fluorescence imaging.

Results

Regarding the oncological outcome, the robotic technique is equivalent to the laparoscopic approach; however, a lower recurrence rate has been achieved with the robotic approach in extended lymphadenectomy as part of complete mesocolic excision for right colonic cancer and total mesorectal excision for low rectal tumors.

Conclusion

Colorectal robotic surgery has progressively improved worldwide. Its advantages are related not only to better oncological outcomes, but also to improvements in terms of detection, accurate diagnosis, and staging.

Zusammenfassung

Hintergrund

Kolorektale Karzinome sind die dritthäufigsten Karzinome weltweit. Gegenwärtiger Therapiestandard ist die multimodale Behandlung, einschließlich der neoadjuvanten Radiochemotherapie des Rektumkarzinoms. Eine Vielzahl von Studien befasst sich mit der Fortentwicklung der chirurgischen Technik und neuen Gerätschaften auch zur Verbesserung des prä- und intraoperativen Stagings.

Ziel der Arbeit

Die roboterassistierte Chirurgie hat sich seit dem ersten Einsatz in der kolorektalen Chirurgie im Jahr 2002 stetig weiterentwickelt und verbessert. Gegenwärtig haben bereits viele Studien die Sicherheit und Machbarkeit der roboterassistierten Behandlung des kolorektalen Karzinoms belegt.

Material und Methoden

Die Robotertechnologie vereinfacht die chirurgische Präparation aufgrund von 3‑D-Optik mit Vergrößerung auf stabiler Plattform, guter Beweglichkeit der Roboterarme, Endowrist-Instrumenten mit 7 Freiheitsgraden, Beidhändigkeit, Beseitigung von Tremor und Einsatz der Indozyaningrün(ICG)-Fluoreszenz.

Ergebnisse

Bezüglich des onkologischen Ergebnisses ist die Robotertechnologie der laparoskopischen Technik mindestens gleichwertig. Der Einsatz des Roboters vermag bei der erweiterten Lymphadenektomie im Rahmen der kompletten mesokolischen Exzision (CME) wegen eines rechtsseitigen Kolonkarzinoms und bei der totalen mesorektalen Exzision (TME) wegen eines tiefen Rektumkarzinoms die Rezidivrate zu senken.

Schlussfolgerung

Die kolorektale Roboterchirurgie findet weltweit zunehmende Verbreitung: die Vorteile liegen nicht nur im besseren onkologischen Ergebnis, sondern auch in der Verbesserung im Hinblick auf Erkennung, korrekter Diagnosestellung und Staging.

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Authors and Affiliations

  1. Proctor for robotic surgery at the Department General Surgery, AOU “Maggiore della Carità” Hospital, Corso Mazzini 18, 28100, Novara, Italy

    G. Spinoglio

  2. Department of General Surgery, “Maggiore della Carità” Hospital, Novara, Italy

    P. Bellora & M. Monni

Authors
  1. G. Spinoglio
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  2. P. Bellora
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  3. M. Monni
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Corresponding author

Correspondence to G. Spinoglio.

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Conflict of interest

G. Spinoglio MD is proctor for Intuitive Surgical Inc (Sunnyvale CA, USA) for colorectal robotic surgery. P. Bellora MD and M. Monni MD have not conflict of interest to declare.

I confirm that the accompanying manuscript does not include studies on humans or animals.

The supplement containing this article is not sponsored by industry.

Additional information

The German version of this article can be found under doi: 10.1007/s00104-016-0238-6.

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Spinoglio, G., Bellora, P. & Monni, M. Robotic technology for colorectal surgery. Chirurg 88 (Suppl 1), 29–33 (2017). https://doi.org/10.1007/s00104-016-0208-z

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