Skip to main content

Advertisement

SpringerLink
Log in

Robot-assisted laparoscopic surgery of the colon and rectum

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic techniques have induced a tremendous revolution in the field 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 field of general surgery, allowing increased dexterity, improved operative view, and optimal ergonomics. 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 identified. A specific 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 and 15.1%, 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.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325

    Article  PubMed  CAS  Google Scholar 

  2. Ackroyd R, Watson DI, Majeed AW, Troy G, Treacy PJ, Stoddard CJ (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg 91:975–982

    Article  PubMed  CAS  Google Scholar 

  3. Kouhia ST, Heiskanen JT, Huttunen R, Ahtola HI, Kiviniemi VV, Hakala T (2010) Long-term follow-up of a randomized clinical trial of open versus laparoscopic appendicectomy. Br J Surg 97:1395–1400

    Article  PubMed  CAS  Google Scholar 

  4. Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134:647–653 discussion 654–655

    Article  PubMed  Google Scholar 

  5. (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350:2050–2059

  6. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7

    Article  PubMed  Google Scholar 

  7. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Google Scholar 

  8. 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

    Google Scholar 

  9. Koopmann MC, Heise CP (2008) Laparoscopic and minimally invasive resection of malignant colorectal disease. Surg Clin North Am 88:1047–1072

    Article  PubMed  Google Scholar 

  10. http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspx. Accessed 5 Dec 2010

  11. Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188(4A Suppl):19S–26S

    Article  PubMed  Google Scholar 

  12. Kwak JM, Kim SH (2010) Current status of robotic colorectal surgery. J Rob Surg. doi:10.1007/s11701-010-0217-8

  13. Hashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R, Koga F, Gotoh N, Konishi K, Maehara S, Sugimachi K (2002) Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc 16:1187–1191

    Article  PubMed  CAS  Google Scholar 

  14. Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694 discussion 1695–1696

    Article  PubMed  Google Scholar 

  15. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  16. 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 138:777–784

    Article  PubMed  Google Scholar 

  17. Vibert E, Denet C, Gayet B (2003) Major digestive surgery using a remote-controlled robot: the next revolution. Arch Surg 138:1002–1006

    Article  PubMed  Google Scholar 

  18. Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14:311–315

    Article  PubMed  Google Scholar 

  19. D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168

    Article  PubMed  Google Scholar 

  20. Anvari M, McKinley C, Stein H (2005) Establishment of the world’s first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community. Ann Surg 241:460–464

    Article  PubMed  Google Scholar 

  21. 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 48:1820–1827

    Article  PubMed  Google Scholar 

  22. 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 19:117–119

    Article  PubMed  CAS  Google Scholar 

  23. Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IH, Gooszen HG, Janssen LW, Simmermacher RK, Broeders IA (2005) Robot-assisted endoscopic surgery: a four-year single-center experience. Dig Surg 22:313–320

    Article  PubMed  Google Scholar 

  24. Woeste G, Bechstein WO, Wullstein C (2005) Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis 20:253–257

    Article  PubMed  Google Scholar 

  25. Ballantyne GH, Ewing D, Pigazzi A, Wasielewski A (2006) Telerobotic-assisted laparoscopic right hemicolectomy: lateral to medial or medial to lateral dissection? Surg Laparosc Endosc Percutan Tech 16:406–410

    Article  PubMed  Google Scholar 

  26. DeNoto G, Rubach E, Ravikumar TS (2006) A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A 16:551–556

    Article  PubMed  Google Scholar 

  27. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  PubMed  CAS  Google Scholar 

  28. Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20:1713–1718

    Article  PubMed  CAS  Google Scholar 

  29. Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M (2006) The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc 20:1389–1393

    Article  PubMed  CAS  Google Scholar 

  30. Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173

    Article  PubMed  Google Scholar 

  31. Braumann C, Jacobi CA, Menenakos C, Ismail M, Rueckert JC, Mueller JM (2008) Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech 18:260–266

    Article  PubMed  Google Scholar 

  32. Soravia C, Schwieger I, Witzig JA, Wassmer FA, Vedrenne T, Sutter P, Dufour JP, Racloz Y (2008) Laparoscopic robotic-assisted gastrointestinal surgery: the Geneva experience. J Robotic Surg 1:291–295

    Article  Google Scholar 

  33. Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51:1627–1632

    Article  PubMed  Google Scholar 

  34. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  PubMed  Google Scholar 

  35. Choi DJ, Kim SH, Lee PJ, Kim J, Woo SU (2009) Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients. Dis Colon Rectum 52:1824–1830

    Article  PubMed  Google Scholar 

  36. Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835

    Article  Google Scholar 

  37. Luca F, Cenciarelli S, Valvo M, Pozzi S, Faso FL, Ravizza D, Zampino G, Sonzogni A, Biffi R (2009) Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol 16:1274–1278

    Article  PubMed  Google Scholar 

  38. Ng KH, Lim YK, Ho KS, Ooi BS, Eu KW (2009) Robotic-assisted surgery for low rectal dissection: from better views to better outcome. Singapore Med J 50:763–767

    PubMed  CAS  Google Scholar 

  39. Ostrowitz MB, Eschete D, Zemon H, DeNoto G (2009) Robotic-assisted single-incision right colectomy: early experience. Int J Med Robot 5:465–470

    Article  PubMed  Google Scholar 

  40. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 16:450–457

    Article  PubMed  Google Scholar 

  41. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13:176–183

    PubMed  Google Scholar 

  42. Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24:2888–2894

    Article  PubMed  CAS  Google Scholar 

  43. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2010) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. doi:10.1007/s00464-010-1281-x

  44. D’Annibale A, Pernazza G, Morpurgo E, Monsellato I, Pende V, Lucandri G, Termini B, Orsini C, Sovernigo G (2010) Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease. Ann Surg Oncol 17:2856–2862

    Article  PubMed  Google Scholar 

  45. deSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006

    Article  PubMed  Google Scholar 

  46. Pandalai S, Kavanagh DO, Neary P (2010) Robotic assisted laparoscopic colectomy. Ir Med J 103:181–182

    PubMed  CAS  Google Scholar 

  47. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202

    Article  PubMed  Google Scholar 

  48. Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH (2010) Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 17:1614–1620

    Article  PubMed  Google Scholar 

  49. Ragupathi M, Ramos-Valadez DI, Patel CB, Haas EM (2011) Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature. Surg Endosc 25:199–206

    Article  PubMed  Google Scholar 

  50. Ragupathi M, Ramos-Valadez DI, Pedraza R, Haas EM (2010) Robotic-assisted single-incision laparoscopic partial cecectomy. Int J Med Robot 6:362–367

    Article  PubMed  Google Scholar 

  51. Zimmern A, Prasad L, Desouza A, Marecik S, Park J, Abcarian H (2010) Robotic colon and rectal surgery: a series of 131 cases. World J Surg 34:1954–1958

    Article  PubMed  Google Scholar 

  52. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  53. 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

    Google Scholar 

  54. Falk PM, Beart RW Jr, Wexner SD, Thorson AG, Jagelman DG, Lavery IC, Johansen OB, Fitzgibbons RJ Jr (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36:28–34

    Article  PubMed  CAS  Google Scholar 

  55. Ballantyne GH (1995) Laparoscopic-assisted colorectal surgery: review of results in 752 patients. Gastroenterologist 3:75–89

    PubMed  CAS  Google Scholar 

  56. Hazebroek EJ; Color Study Group (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953

    Google Scholar 

  57. Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Hewett PJ, Rieger NA, Smith S, Solomon MJ, Stevenson AR (2008) Australian and New Zealand study comparing laparoscopic and open surgeries for colon cancer in adults: organization and conduct. ANZ J Surg 78:840–847

    Article  PubMed  Google Scholar 

  58. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424

    Article  PubMed  Google Scholar 

  59. Arteaga González I, Díaz Luis H, Martín Malagón A, López-Tomassetti Fernández EM, Arranz Duran J, Carrillo Pallares A (2006) A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve. Int J Colorectal Dis 21:590–595

    Article  PubMed  Google Scholar 

  60. Pechlivanides G, Gouvas N, Tsiaoussis J, Tzortzinis A, Tzardi M, Moutafidis M, Dervenis C, Xynos E (2007) Lymph node clearance after total mesorectal excision for rectal cancer: laparoscopic versus open approach. Dig Dis 25:94–99

    Article  PubMed  Google Scholar 

  61. Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471

    Article  PubMed  Google Scholar 

  62. Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425

    Article  PubMed  Google Scholar 

  63. Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556

    Article  PubMed  CAS  Google Scholar 

  64. Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92:1124–1132

    Article  PubMed  CAS  Google Scholar 

  65. http://ctru.leeds.ac.uk/rolarr. Accessed 8 Dec 2010

  66. Satava R (2006) Robotics in colorectal surgery: telemonitoring and telerobotics. Surg Clin N Am 86:927–936

    Article  PubMed  Google Scholar 

  67. Antoniou GA, Riga CV, Mayer EK, Cheshire NJ, Bicknell CD (2010) Clinical applications of robotic technology in vascular and endovascular surgery. J Vasc Surg. doi:10.1016/j.jvs.2010.06.154

  68. Modi P, Rodriguez E, Chitwood WR Jr (2009) Robot-assisted cardiac surgery. Interact Cardiovasc Thorac Surg 9:500–505

    Article  PubMed  Google Scholar 

  69. Challacombe B, Wheatstone S (2010) Telementoring and telerobotics in urological surgery. Curr Urol Rep 11:22–28

    Article  PubMed  Google Scholar 

  70. Chen CC, Falcone T (2009) Robotic gynecologic surgery: past, present, and future. Clin Obstet Gynecol 52:335–343

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Ms. Aggeliki Zachou of the library of the Papageorgiou University Hospital of Thessaloniki for her valuable contribution.

Disclosures

Drs. S.A. Antoniou, G.A. Antoniou, O.O. Koch, R. Pointner, and F.A. Granderath have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital “Maria v. d. Aposteln” Neuwerk, Mönchengladbach, Germany

    Stavros A. Antoniou & Frank A. Granderath

  2. Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK

    George A. Antoniou

  3. Department of General Surgery, Hospital Zell am See, Zell am See, Austria

    Oliver O. Koch & Rudolf Pointner

  4. Souniou 11, Keratea Attikis, 19001, Athens, Greece

    Stavros A. Antoniou

Authors
  1. Stavros A. Antoniou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George A. Antoniou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oliver O. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rudolf Pointner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank A. Granderath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stavros A. Antoniou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Antoniou, S.A., Antoniou, G.A., Koch, O.O. et al. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc 26, 1–11 (2012). https://doi.org/10.1007/s00464-011-1867-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1867-y

Keywords

Search

Navigation