EAES Academy

Introduction

The incorporation of robotics into a minimally invasive surgery platform is the newest advancement and has the potential to change medical field even more drastically with minimization-and possibility of elimination human error. In the last few years robotic surgery changed the surgery field us a mini invasive surgical technique, despite advantages of laparoscopic procedures especially in treatment of colorectal cancer. The purpose of this study is to analyze the differences between laparoscopic and robotic techniques for treatment of colorectal cancer in terms of oncological and clinical outcomes.

Methods:

Clinico- pathological data of 158 patients surgically treated for colorectal deaseases in the period 2010-2018 with laparoscopy and robotic were analyzed. The procedures were right colonic , left colonic and rectal resections. A comparison betweem laparoscopic and robotic resections was made . The first robotic-assisted resection of rectum cancer with hybrid tecnhique we performed in our department in 2010. In may 2014 we started again and first total robotic-assisted resections of colon and rectum cancer were performed (single docking system). In the period 2014-2018, 61 patients were operated (48% female, 52 % male), the average age was 64,5 years,. 62% had ASA clasification II. Colorectal carcinoma were presented in 76 % patients, the others had diverticulosis and benign deasseases, 62 % had carcinoma of rectum and rectosigma. . Retrospectively we analized laparoscopic operations as well in period 2010-2018. 97 patients were operated (63 % male, 37 % female), the average age was 66,5 years. 40 % of the patients had ASA clasificatio III. Adenocarcinoma were presented in 80 % patients, the others had diverticulosis and benign deasseases. The most common localizationi in robotic procedure were rectum (25%) and rectosigma (41%), while in laparoscopic operations was cancer of coecum and colon ascendens
RESULTS
In all patients radical resection has been done.The average number of isolated lymphnodes in the robotic method was 18,5 while in laparoscopic method was 16,5. The hospitalization was shorter in robotic operated patients ( average 7,5days), on the other hand the time of the robotic operations was longer than laparoscopic operations. Intraoperative blood loss was in the robotic method smaller ( 50-150ml) in comparison with laparoscopic method (100-300 ml). Conversion to open surgery was in robotic method lower (4,5%) than in laparoscopic method( 7%). Laparoscopic method has more freqent complications 9 ( 10,3%) while robotic method 4 (9%).
In 8 years follow up 9 laparoscopically operated died (10,3%), ( 5 due to cardiovascular diease, 4 due to progression of disease). In this period 3 robotically operated patients died (6%), one due to progression of disease, the others due to cardiovascular disease. The most common operation was right hemicolectomy (46%) by laparoscopic procedure, in the robotic method was anterior resection of rectum (54%).
Conclusion:

Laparoscopic and robotic-assisted surgery are safe and able tecnhiques for the treatment of essentially all colorectal conditions requiring surgical intervention. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.
To determine suitable minimally invasive surgical approach, it is important to recognise the both laparoscopic and robotic surgeries, present benefits and limitations as compared with each other. Hence, the ideal approach should ultimately result in the use of tecnhique must approriate for the specific surgical indication.
KEYWORDS:colorectal surgery, robotic surgery, laparoscopic surgery