Skip to main content

Robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Study



The aim of this study is to compare the short-term results between robotic-assisted low anterior resection (R-LAR), using the da Vinci® Surgical System, and standard laparoscopic low anterior resection (L-LAR) in rectal cancer patients.


113 patients were assigned to receive either R-LAR (n = 56) or L-LAR (n = 57) between April 2006 and September 2007. Patient characteristics, perioperative clinical results, complications, and pathologic details were compared between the groups. Moreover, macroscopic grading of the specimen was evaluated.


Patient characteristics were not significantly different between the groups. The mean operation time was 190.1 ± 45.0 min in the R-LAR group and 191.1 ± 65.3 min in the L-LAR group (P = 0.924). The conversion rate was 0.0% in the R-LAR groups and 10.5% in the L-LAR group (P = 0.013). The serious complication rate was 5.4% in the R-LAR group and 19.3% in the L-LAR group (P = 0.025). The specimen quality was acceptable in both groups. However, the mesorectal grade was complete (n = 52) and nearly complete (n = 4) in the R-LAR group and complete (n = 43), nearly complete (n = 12), and incomplete (n = 2) in the L-LAR group (P = 0.033).


R-LAR was performed safely and effectively, using the da Vinci® Surgical System. The use of the system resulted in acceptable perioperative outcomes compared to L-LAR.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    Article  Google Scholar 

  2. 2.

    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery vs. open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    PubMed  Article  Google Scholar 

  3. 3.

    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional vs. laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicenter, randomised controlled trial. Lancet. 2005;365:1718–26.

    PubMed  Article  Google Scholar 

  4. 4.

    Cadière GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, et al. Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg. 2001;25:1467–77.

    PubMed  Google Scholar 

  5. 5.

    Cadière GB, Himpens J, Vertruyen M, Bruyns J, Germay O, Leman G, et al. Evaluation of telesurgical (robotic) NISSEN fundoplication. Surg Endosc. 2001;15:918–23.

    PubMed  Article  Google Scholar 

  6. 6.

    Balaji KC, Yohannes P, McBridge CL, Oleynikov D, Hemstreet GP. Feasibility of robot-assisted totally intracorporeal laparoscopic ileal conduit urinary diversion: initial results of a single institutional pilot study. Urology. 2004;63:51–5.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Baik SH, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, et al. Robotic total mesorectal excision for the treatment of rectal cancer. J Robotic Surg. 2007;1:99–102.

    Article  Google Scholar 

  8. 8.

    Ballantyne GH, Merola P, Weber A, Wasielewski A. Robotic solutions to the pitfalls of laparoscopic colectomy. Osp Ital Chir. 2001;7:405–12.

    Google Scholar 

  9. 9.

    Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1601–8.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    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. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20:1729–34.

    Google Scholar 

  11. 11.

    Baik SH, Kim NK, Lee YC, Kim H, Lee KY, Sohn SK, et al. Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer. Ann Surg Oncol. 2007;14:462–9.

    PubMed  Article  Google Scholar 

  12. 12.

    Baik SH, Lee WJ, Rha KH, Kim NK, Sohn SK, Chi HS, et al. Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc. 2008;22:792–7.

    PubMed  Article  Google Scholar 

  13. 13.

    Kim NK, Baik SH, Seong JS, Kim H, Roh JK, Lee KY, et al. Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor specific mesorectal excision for fixed locally advanced rectal cancer. Ann Surg. 2006;244:1024–30.

    PubMed  Article  Google Scholar 

  14. 14.

    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20:1521–5.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, et al. Robotic and laparoscopic surgery for treatment of colorectal disease. Dis Colon Rectum. 2004;47:2162–8.

    PubMed  Article  Google Scholar 

  16. 16.

    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.

    PubMed  Article  Google Scholar 

  17. 17.

    Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181:335–46.

    PubMed  CAS  Google Scholar 

  18. 18.

    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomic basis of autonomic nerve preserving total mesorectal excision for rectal cancer. Br J Surg. 1996;83:384–8.

    PubMed  Article  CAS  Google Scholar 

Download references


This study was supported by a faculty research grant of the Yonsei University College of Medicine in 2006 (6-2006-0111). The authors would like to thank Mrs. Mi Sun Park for her correction of the English of the manuscript.

Author information



Corresponding author

Correspondence to Seung Hyuk Baik MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Baik, S.H., Kwon, H.Y., Kim, J.S. et al. Robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Study. Ann Surg Oncol 16, 1480–1487 (2009).

Download citation


  • Robotic System
  • Total Mesorectal Excision
  • Circumferential Resection Margin
  • Robotic Group
  • Circumferential Resection Margin Involvement