Skip to main content

Advertisement

SpringerLink
Log in

Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The role of robotic assistance in colorectal cancer surgery has not been established yet. We compared the results of robotic assisted with those of laparoscopic rectal resections done by two surgeons experienced in laparoscopic as well as in robotic rectal cancer surgery.

Methods

Two surgeons who were already experienced laparoscopic colorectal surgeons in 2005 started robotic surgery with the daVinci SI system in 2012. All their rectal cancer resections between 2005 and 2015 were retrieved from a prospectively recorded colorectal database of routinely collected patient data. Multi-organ resections were excluded. Patient data, diagnostic data, data on preceding operations and neoadjuvant treatment, perioperative and operative data, logistic data, and short-term outcomes were gathered. Multivariable analyses (multiple linear and logistic regression) were used to assess differences in several outcomes between the two resection methods while adjusting for all potential confounders we could identify. Results are presented as adjusted mean differences for continuous outcome variables or as adjusted odds ratios (OR) for dichotomous outcome variables.

Results

Three hundred and fifty-two patients with rectal cancers were identified: 168 robotic and 184 conventional laparoscopic cases, 178 operated by surgeon A and 174 operated by surgeon B. Adjusted mean operation time was 215 min in the robotic group which was 40 min (95% CI 24–56; p < 0.0005) longer than the 175 min in the laparoscopic group. Robotic treatment had significantly lesser numbers of conversions (OR 0.09 (0.03–0.32); p < 0.0005) and other complications (SSI and anastomic leakage excluded) (OR 0.32 (0.15–0.69); p = 0.004), adjusted for potential confounders.

Conclusions

Our study suggests that robotic surgery in the hands of experienced laparoscopic rectal cancer surgeons improves the conversion rate and complication rate drastically compared to conventional laparoscopic surgery, but operation time is longer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kim CW, Kim CH, Baik SH (2014) Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 18(4):816–830. https://doi.org/10.1007/s11605-014-2469-5 Epub 2014 Feb 5.

    Article  PubMed  Google Scholar 

  2. Xiong B, Ma L, Zhang C, Cheng Y (2014) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res May 188(2):404–414. https://doi.org/10.1016/j.jss.2014.01.027

    Article  Google Scholar 

  3. Hara M, Sng K, Yoo BE, Shin JW, Lee DW, Kim SH (2014) Robotic-assisted surgery for rectal adenocarcinoma: short-term and midterm outcomes from 200 consecutive cases at a single institution. Rectum 57(5):570–577. https://doi.org/10.1097/DCR.0000000000000088

    Article  Google Scholar 

  4. Ghezzi TL, Luca F, Valvo M, Corleta OC, Zuccaro M, Cenciarelli S, Biffi R (2014) Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 40(9):1072–1079. https://doi.org/10.1016/j.ejso.2014.02.235

    Article  CAS  PubMed  Google Scholar 

  5. Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg Jan 261(1):129–137. https://doi.org/10.1097/SLA.0000000000000613

    Article  Google Scholar 

  6. Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19(3):516–526. https://doi.org/10.1007/s11605-014-2697-8

    Article  PubMed  Google Scholar 

  7. Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a case-matched retrospective study. Medicine 94(11):e522. https://doi.org/10.1097/MD.0000000000000522

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim CW, Baik SH, Roh YH, Kang J, Hur H, Min BS, Lee KY, Kim NK (2015) Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis. Medicine 94(22):e823. https://doi.org/10.1097/MD.0000000000000823

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park JS, Kim NK, Kim SH, Lee KY, Lee KY, Shin JY, Kim CN, Choi GS, Korean Laparoscopic Colorectal Surgery Study Group (2015) Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg 102(12):1567–1573. https://doi.org/10.1002/bjs.9914 Epub 2015 Aug 27.

    Article  CAS  PubMed  Google Scholar 

  10. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J (2015) Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg 262(6):1040–1045. https://doi.org/10.1097/SLA.0000000000001017

    Article  PubMed  Google Scholar 

  11. Kim YS, Kim MJ, Park SC, Sohn DK, Kim DY, Chang HJ, Nam BH, Oh JH (2016) Robotic versus laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy: case-matched study of short-term outcomes. Cancer Res Treat 48(1):225–231. https://doi.org/10.4143/crt.2014.365

    Article  PubMed  Google Scholar 

  12. Sun Y, Xu H, Li Z, Han J, Song W, Wang J, Xu Z (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61. https://doi.org/10.1186/s12957-016-0816-6

    Article  PubMed  PubMed Central  Google Scholar 

  13. Allemann P, Duvoisin C, Di Mare L, Hübner M, Demartines N, Hahnloser D (2016) Robotic-assisted surgery improves the quality of total mesorectal excision for rectal cancer compared to laparoscopy: results of a case-controlled analysis. World J Surg 40(4):1010–1016. https://doi.org/10.1007/s00268-015-3303-2

    Article  PubMed  Google Scholar 

  14. Lim S, Kim JH, Baek SJ, Kim SH, Lee SH (2016) Comparison of perioperative and short-term outcomes between robotic and conventional laparoscopic surgery for colonic cancer: a systematic review and meta-analysis. Ann Surg Treat Res 90(6):328–339. https://doi.org/10.4174/astr.2016.90.6.328 Epub 2016 May 30.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhang X, Wei Z, Bie M, Peng X, Chen C (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30(12):5601–5614

    Article  Google Scholar 

  16. Hollis RH, Cannon JA, Singletary BA, Korb ML, Hawn MT, Heslin MJ (2016) Understanding the value of both laparoscopic and robotic approaches compared to the open approach in colorectal surgery. J Laparoendosc Adv Surg Tech A 26(11):850–856

    Article  Google Scholar 

  17. Ortiz-Oshiro E, Sánchez-Egido I, Moreno-Sierra J, Pérez CF, Díaz JS, Fernández-Represa J (2012) Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot 8(3):360–370. https://doi.org/10.1002/rcs.1426 Epub 2012 Mar 22.

    Article  PubMed  Google Scholar 

  18. Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19:3727–3736

    Article  Google Scholar 

  19. Scarpinata R, Aly EH (2013) Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum 56:253–262

    Article  Google Scholar 

  20. Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison–open, laparoscopic,and robotic surgery. Ann Surg 257:95–101

    Article  Google Scholar 

  21. Araujo SE, Seid VE, Klajner S (2014) Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes. World J Gastroenterol 20(39):14359–14370. https://doi.org/10.3748/wjg.v20.i39.14359

    Article  PubMed  PubMed Central  Google Scholar 

  22. Papanikolaou IG (2014) Robotic surgery for colorectal cancer: systematic review of the literature. Surg Laparosc Endosc Percutan Tech 24(6):478–483. https://doi.org/10.1097/SLE.0000000000000076

    Article  PubMed  Google Scholar 

  23. Moghadamyeghaneh Z, Phelan M, Smith BR, Stamos MJ (2015) Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer. Dis Colon Rectum 58(12):1123–1129. https://doi.org/10.1097/DCR.0000000000000475

    Article  PubMed  Google Scholar 

  24. Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30(4):1576–1584. https://doi.org/10.1007/s00464-015-4381-9 Epub 2015 Jul 14.

    Article  PubMed  Google Scholar 

  25. Wilder FG, Burnett A, Oliver J, Demyen MF, Chokshi RJ (2016) A review of the long-term oncologic outcomes of robotic surgery versus laparoscopic surgery for colorectal cancer. Indian J Surg 78(3):214–219. https://doi.org/10.1007/s12262-015-1375-8. Epub 2015 Oct 22

    Article  PubMed  Google Scholar 

  26. Feinberg AE, Elnahas A, Bashir S, Cleghorn MC, Quereshy FA (2016) Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity. Can J Surg 59(4):262–267. https://doi.org/10.1503/cjs.016615

    Article  PubMed  PubMed Central  Google Scholar 

  27. Patel SV, Van Koughnett JA, Howe B, Wexner SD (2015) Spin is common in studies assessing robotic colorectal surgery: an assessment of reporting and interpretation of study results. Dis Colon Rectum 58(9):878–884. https://doi.org/10.1097/DCR.0000000000000425

    Article  PubMed  Google Scholar 

  28. Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP (2014) Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 28(1):212–221. https://doi.org/10.1007/s00464-013-3163-5 Epub 2013 Aug 31.

    Article  PubMed  Google Scholar 

  29. Lorenzon L, Bini F, Balducci G, Ferri M, Salvi PF, Marinozzi F (2016) Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis 31(2):161–173. https://doi.org/10.1007/s00384-015-2394-4 Epub 2015 Sep 26.

    Article  PubMed  Google Scholar 

  30. Ezekian B, Sun Z, Adam MA, Kim J, Turner MC, Gilmore BF, Ong CT, Mantyh CR, Migaly J (2016) J robotic-assisted versus laparoscopic colectomy results in increased operative time without improved perioperative outcomes. Gastrointest Surg 20(8):1503–1510. https://doi.org/10.1007/s11605-016-3124-0

    Article  Google Scholar 

  31. Silva-Velazco J, Dietz DW, Stocchi L, Costedio M, Gorgun E, Kalady MF, Kessler H, Lavery IC, Remzi FH (2017) Considering value in rectal cancer surgery: an analysis of costs and outcomes based on the open, laparoscopic, and robotic approach for proctectomy. Ann Surg 265(5):960–968

    Article  Google Scholar 

  32. Miller PE, Dao H, Paluvoi N, Bailey M, Margolin D, Shah N, Vargas HD (2016) Comparison of 30-day postoperative outcomes after laparoscopic vs robotic colectomy. J Am Coll Surg 223(2):369–373. https://doi.org/10.1016/j.jamcollsurg.2016.03.041

    Article  PubMed  Google Scholar 

  33. Morelli L, Guadagni S, Lorenzoni V, Di Franco G, Cobuccio L, Palmeri M, Caprili G, D’Isidoro C, Moglia A, Ferrari V, Di Candio G, Mosca F, Turchetti G (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Colorectal Dis 31(9):1639–1648. https://doi.org/10.1007/s00384-016-2631-5 Epub 2016 Jul 31.

    Article  PubMed  Google Scholar 

  34. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. The ROLARR Randomized Clinical Trial JAMA 318(16):1569–1580. https://doi.org/10.1001/jama.2017.7219

    Article  PubMed  PubMed Central  Google Scholar 

  35. de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA, SURPASS Collaborative Group (2010) Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 363:1928–1937

    Article  Google Scholar 

  36. Crolla RM, van der Laan L, Veen EJ, Hendriks Y, van Schendel C, Kluytmans J (2012) Reduction of surgical site infections after implementation of a bundle of care. PLoS ONE 7(9):e44599. https://doi.org/10.1371/journal.pone.0044599 Epub 2012 Sep 4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Sobin LH, Wittekind CH (1997) International Union Against Cancer (UICC): TNM classification of malignant tumors, 5th edn. Wiley, Berlin

    Google Scholar 

  38. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  Google Scholar 

  39. Wexner SD, Cohen SM, Ulrich A, Reissman P (1995) Laparoscopic colorectal surgery—are we being honest with our patients? Dis Colon Rectum 38:723–727.

    Article  CAS  Google Scholar 

  40. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC Trial Group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  Google Scholar 

  41. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  Google Scholar 

  42. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM., de Lange-de Klerk ESM, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, For the COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  Google Scholar 

  43. Babaei M, Balavarca Y, Jansen L, Gondos A, Lemmens V, Sjövall A, Brge Johannesen T, Moreau M, Gabriel L, Gonçalves AF, Bento MJ, van de Velde T, Kempfer LR, Becker N, Ulrich A, Ulrich CM, Schrotz-King P, Brenner H (2016) Minimally invasive colorectal cancer surgery in Europe: implementation and outcomes. Medicine 95(22):e3812. https://doi.org/10.1097/MD.0000000000003812

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  46. Chan AC, Poon JT, Fan JK, Lo SH, Law WL (2008) Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc 22(12):2625–2630. https://doi.org/10.1007/s00464-008-9813-3 Epub 2008 Feb 23.

    Article  PubMed  Google Scholar 

  47. Ptok H, Kube R, Schmidt U, Köckerling F, Gastinger I, Lippert H, “Colon/Rectum Carcinoma (Primary Tumor)” Study Group (2009) Conversion from laparoscopic to open colonic cancer resection - associated factors and their influence on long-term oncological outcome. Eur J Surg Oncol 35(12):1273–1279. https://doi.org/10.1016/j.ejso.2009.06.006 Epub 2009 Jul 16.

    Article  CAS  PubMed  Google Scholar 

  48. White I, Greenberg R, Itah R, Inbar R, Schneebaum S, Avital S (2011) Impact of conversion on short and long-term outcome in laparoscopic resection of curable colorectal cancer. JSLS 15(2):182–187. https://doi.org/10.4293/108680811X13071180406439

    Article  PubMed  PubMed Central  Google Scholar 

  49. Scheidbach H, Garlipp B, Oberländer H, Adolf D, Köckerling F, Lippert H (2011 Dec) Conversion in laparoscopic colorectal cancer surgery: impact on short- and long-term outcome. J Laparoendosc Adv Surg Tech A 21(10):923–927. https://doi.org/10.1089/lap.2011.0298 Epub 2011 Oct 19.

    Article  PubMed  Google Scholar 

  50. Rottoli M, Stocchi L, Geisler DP, Kiran RP (2012) Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes. Surg Endosc 26(7):1971–1976. https://doi.org/10.1007/s00464-011-2137-8. Epub 2012 Jan 12

    Article  PubMed  Google Scholar 

  51. Clancy C, O’Leary DP, Burke JP, Redmond HP, Coffey JC, Kerin MJ, Myers E (2015) A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis 17(6):482–490. https://doi.org/10.1111/codi.12875

    Article  CAS  PubMed  Google Scholar 

  52. Masoomi H, Moghadamyeghaneh Z, Mills S, Carmichael JC, Pigazzi A, Stamos MJ (2015) Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 39(5):1240–1247. https://doi.org/10.1007/s00268-015-2958-z

    Article  PubMed  Google Scholar 

  53. Ha GW, Lee MR, Kim JH (2016 Sep) Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis. Am J Surg 212(3):527–536. https://doi.org/10.1016/j.amjsurg.2016.02.019 Epub 2016 May 10.

    Article  PubMed  Google Scholar 

  54. Jensen KK, Krarup PM, Scheike T, Jorgensen LN, Mynster T (2016) Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study. Surg Endosc 30(10):4469–4479. https://doi.org/10.1007/s00464-016-4779-z Epub 2016 Feb 19.

    Article  PubMed  Google Scholar 

  55. Smolarek S, Shalaby M, Paolo Angelucci G, Missori G, Capuano I, Franceschilli L, Quaresima S, Di Lorenzo N, Sileri P. (2016) Small-bowel obstruction secondary to adhesions after open or laparoscopic colorectal surgery. JSLS 20(4):e2016.00073. https://doi.org/10.4293/JSLS.2016.00073

    Article  PubMed  PubMed Central  Google Scholar 

  56. Jensen KK, Andersen P, Erichsen R, Scheike T, Iversen LH, Krarup PM (2016) Decreased risk of surgery for small bowel obstruction after laparoscopic colon cancer surgery compared with open surgery: a nationwide cohort study. Surg Endosc 30(12):5572–5582 Epub 2016 Apr 29.

    Article  Google Scholar 

  57. Pecorelli N, Greco M, Amodeo S, Braga M (2017) Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 31(1):85–99. https://doi.org/10.1007/s00464-016-4995-6. Epub 2016 Jun 10

    Article  PubMed  Google Scholar 

  58. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. (2004) Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 47(10):1680–1685

    Article  Google Scholar 

  59. Allaix ME, Degiuli M, Arezzo A, Arolfo S, Morino M (2013) Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer? Surg Endosc 27(12):4596–4607. https://doi.org/10.1007/s00464-013-3072-7. Epub 2013 Jul 12

    Article  PubMed  Google Scholar 

  60. Yerokun BA, Adam MA2, Sun Z, Kim J, Sprinkle S, Migaly J, Mantyh CR (2016) Does conversion in laparoscopic colectomy portend an inferior oncologic outcome? Results from 104,400 patients. J Gastrointest Surg 20(5):1042–1048. https://doi.org/10.1007/s11605-016-3073-7. Epub 2016 Jan 14

    Article  PubMed  PubMed Central  Google Scholar 

  61. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774. https://doi.org/10.1016/S1470-2045(14)70205-0 Epub 2014 May 15.

    Article  PubMed  Google Scholar 

  62. Yang C, Wexner SD, Safar B, Jobanputra S, Jin H, Li VK, Nogueras JJ, Weiss EG, Sands DR. (2009) Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc 23(11):2454–2458. https://doi.org/10.1007/s00464-009-0414-6. Epub 2009 Mar 25

    Article  PubMed  Google Scholar 

  63. Ozben V, Cengiz TB, Atasoy D, Bayraktar O, Aghayeva A, Erguner I, Baca B, Hamzaoglu I, Karahasanoglu T (2016) Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems. Surg Laparosc Endosc Percutan Tech 26(5):417–423

    Article  Google Scholar 

  64. ten Broek RP1, Bakkum EA, Laarhoven CJ, van Goor H (2016) Epidemiology and prevention of postsurgical adhesions revisited. Ann Surg 263(1):12–19. https://doi.org/10.1097/SLA.0000000000001286

    Article  PubMed  Google Scholar 

  65. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493. https://doi.org/10.1245/s10434-012-2262-1. Epub 2012 Mar 21

    Article  PubMed  Google Scholar 

  66. Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, Sonzogni A, Biffi R (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257(4):672–678. https://doi.org/10.1097/SLA.0b013e318269d03b

    Article  PubMed  Google Scholar 

  67. D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27(6):1887–1895. https://doi.org/10.1007/s00464-012-2731-4 Epub 2013 Jan 5.

    Article  PubMed  Google Scholar 

  68. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Yun SH (2014) Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg 38(7):1834–1842. https://doi.org/10.1007/s00268-013-2419-5

    Article  PubMed  Google Scholar 

  69. Broholm M, Pommergaard HC, Gögenür I (2015) Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 17(5):375–381. https://doi.org/10.1111/codi.12872

    Article  CAS  PubMed  Google Scholar 

  70. Panteleimonitis S, Ahmed J, Ramachandra M, Farooq M, Harper M, Parvaiz A (2017) Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study. Int J Colorectal Dis 32(2):241–248. https://doi.org/10.1007/s00384-016-2682-7 Epub 2016 Oct 21.

    Article  PubMed  Google Scholar 

  71. Hubert N, Gilles M, Desbrosses K, Meyer JP, Felblinger J, Hubert J (2013) Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 9(2):142–147. https://doi.org/10.1002/rcs.1489 Epub 2013 Mar 26.

    Article  CAS  PubMed  Google Scholar 

  72. Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28(2):456–465. https://doi.org/10.1007/s00464-013-3213-z Epub 2013 Oct 3.

    Article  PubMed  Google Scholar 

  73. Heemskerk J, Zandbergen HR, Keet SW, Martijnse I, van Montfort G, Peters RJ, Svircevic V, Bouwman RA, Baeten CG, Bouvy ND (2014) Relax, it’s just laparoscopy! A prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy. Dig Surg 31(3):225–232. https://doi.org/10.1159/000365580 Epub 2014 Sep 25.

    Article  PubMed  Google Scholar 

  74. Zihni AM, Ohu I, Cavallo JA, Cho S, Awad MM (2014) Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 28(12):3379–3384. https://doi.org/10.1007/s00464-014-3604-9. Epub 2014 Jun 14

    Article  PubMed  Google Scholar 

  75. Elhage O, Challacombe B, Shortland A, Dasgupta P (2015) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115(2):274–281

    Article  Google Scholar 

  76. Moore LJ, Wilson MR, Waine E, McGrath JS, Masters RS, Vine SJ (2015) Robotically assisted laparoscopy benefits surgical performance under stress. J Robot Surg 9(4):277–284. https://doi.org/10.1007/s11701-015-0527-y. Epub 2015 Aug 2

    Article  PubMed  Google Scholar 

  77. Buchs NC, Nicholson GA, Ris F, Mortensen NJ, Hompes R (2015) Transanal total mesorectal excision: a valid option for rectal cancer? World J Gastroenterol 21(41):11700–11708. https://doi.org/10.3748/wjg.v21.i41.11700

    Article  PubMed  PubMed Central  Google Scholar 

  78. Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP (2016) A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18(1):19–36. https://doi.org/10.1111/codi.13151

    Article  CAS  PubMed  Google Scholar 

  79. Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380. https://doi.org/10.1186/s12885-016-2428-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, Tuynman JB, Lacy AM, Hanna GB, Bonjer HJ (2016) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30(8):3210–3215. https://doi.org/10.1007/s00464-015-4615-x Epub 2015 Nov 4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank mrs Dianne Backelandt for her dedication to the Amphia colorectal database.

Author information

Authors and Affiliations

  1. Department of Surgery, Amphia Breda, Breda, The Netherlands

    Rogier M. P. H. Crolla & George P. van der Schelling

  2. Consulting Biostatistician, Amphia Academy, Amphia Breda, Breda, The Netherlands

    Paul G. Mulder

Authors
  1. Rogier M. P. H. Crolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul G. Mulder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George P. van der Schelling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rogier M. P. H. Crolla.

Ethics declarations

Disclosures

Rogier Crolla and George van der Schelling are proctors for robotic colorectal surgery and their department receives financial compensation from Intuitive Surg. Paul Mulder has no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crolla, R.M.P.H., Mulder, P.G. & van der Schelling, G.P. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 32, 4562–4570 (2018). https://doi.org/10.1007/s00464-018-6209-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6209-x

Keywords

Search

Navigation