Skip to main content

Advertisement

SpringerLink
Log in

Robotic surgery for rectal cancer as a platform to build on: review of current evidence

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Laparoscopy in colorectal surgery reduces the rate of postoperative complications, shortens the length of stay in hospital, and improves the quality of patient care. Despite these established benefits, the technical challenges of rectal resection for cancer have resulted in most operations being performed through open surgery in the USA. Moreover, controversy in the current literature questions the oncologic safety of a laparoscopic approach for rectal cancer. How then can surgeons innovate to overcome the technical challenges while preserving the critical oncological outcomes of high-quality rectal cancer surgery? Robotics may be a platform that allows us to overcome the technical challenges in the pelvis while maintaining both oncological outcomes and the benefits of a minimally invasive technique. Current evidence suggests that the quality of total mesorectal excision, the rates of circumferential margin involvement, and postoperative outcomes are comparable between robotic and laparoscopic surgery. While a robotic approach demonstrates lower conversion rates and reduced surgeon workload, the operative time is longer and initial costs are higher; however, time and future science will determine its true benefits. We review the current state of robotic surgery and its impact on rectal cancer surgery.

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

Similar content being viewed by others

References

  1. Larson DW, Nelson H. Laparoscopic colectomy for cancer. J Gastrointest Surg. 2004;8(5):636–42.

    PubMed  Google Scholar 

  2. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–9.

    PubMed  Google Scholar 

  3. Larson DW, Davies MM, Dozois EJ, Cima RR, Piotrowicz K, Anderson K, et al. Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum. 2008;51(4):392–6.

    PubMed  Google Scholar 

  4. Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, Reyes-Díaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM, et al. Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Colorectal Dis. 2016;31(12):1807–15.

    PubMed  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre randomised controlled trial. Lancet. 2005;365(9472):1718–26.

    PubMed  Google Scholar 

  6. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the medical research council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.

    CAS  PubMed  Google Scholar 

  7. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8. https://doi.org/10.1016/S1470-2045(13)70016-0.

    Article  PubMed  Google Scholar 

  8. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. 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. 2014;15(7):767–74.

    PubMed  Google Scholar 

  9. Mathis KL, Nelson H. Laparoscopic proctectomy for cancer. Ann Surg. 2019;269(4):603–4. https://doi.org/10.1097/SLA.0000000000003211.

    Article  PubMed  Google Scholar 

  10. Damle A, Damle RN, Flahive JM, Schlussel AT, Davids JS, Sturrock PR, et al. Diffusion of technology: trends in robotic-assisted colorectal surgery. Am J Surg. 2017;214(5):820–4.

    PubMed  Google Scholar 

  11. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;264(4):589–95.

    Google Scholar 

  12. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg. 2019;269(4):596–602.

    PubMed  Google Scholar 

  13. Elhage O, Challacombe B, Shortland A, Dasgupta P. 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. 2015;115(2):274–81.

    PubMed  Google Scholar 

  14. Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc Other Interv Tech. 2006;20(10):1521–5.

    CAS  Google Scholar 

  15. Stewart CL, Ituarte PHG, Melstrom KA, Warner SG, Melstrom LG, Lai LL, et al. Robotic surgery trends in general surgical oncology from the National inpatient sample. Surg Endosc. 2019;33(8):2591–601.

    PubMed  Google Scholar 

  16. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. 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. 2017/10/27. Department of academic surgery, Leeds institute of biological and clinical sciences, university of Leeds, Leeds, UK. Department of surgery, university of California, Irvine. Clinical trials research unit, Leeds institute of clinical trials res. 318:1569–80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29067426https://jamanetwork.com/journals/jama/articlepdf/2658320/jama_Jayne_2017_oi_170064.pdf

  17. Corrigan N, Marshall H, Croft J, Copeland J, Jayne D, Brown J 2018 Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 2018/06/28. Clinical trials research unit, Leeds institute of clinical trials research, university of Leeds, Leeds, LS2 9JT, UK. n.corrigan@leeds.ac.uk. Clinical trials research unit, Leeds institute of clinical trials research, university of Leeds, Leeds, LS2 9JT, U. 19:339. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29945673https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020359/pdf/13063_2018_Article_2726.pdf

  18. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373:821–8.

    PubMed  PubMed Central  Google Scholar 

  19. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26:303–12.

    PubMed  Google Scholar 

  20. Kim MJ, Park SC, Park JW, Chang HJ, Kim DY, Nam BH, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg. 2018;267(2):243–51.

    PubMed  Google Scholar 

  21. Valverde A, Goasguen N, Oberlin O, Svrcek M, Fléjou JF, Sezeur A, et al. Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients. Surg Endosc Springer USA. 2017;31:4085–91.

    Google Scholar 

  22. Kim HJ, Choi GS, Park JS, Park SY, Lee HJ, Woo IT, et al. 2018 Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach. Surg Endosc 32:2466–73. Available from: https://dx.doi.org/10.1007/s00464-017-5948-4

  23. Kim J, Baek SJ, Kang DW, Roh YE, Lee JW, Kwak HD, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum. 2017;60(3):266–73.

    PubMed  Google Scholar 

  24. Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, et al. 2018 Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol. 2018/09/02. Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France. philippe.rouanet@icm.unicancer.fr. Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France. 25:3572–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30171509https://link.springer.com/content/pdf/10.1245%2Fs10434-018-6738-5.pdf

  25. Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, et al. The impact of robotic surgery for mid and low rectal cancer. Ann Surg. 2013;257(1):95–101.

    PubMed  Google Scholar 

  26. 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 Other Interv Tech. 2008;22(7):1601–8.

    CAS  Google Scholar 

  27. Allemann P, Duvoisin C, Di Mare L, Hübner M, Demartines N, Hahnloser D. 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. 2016;40(4):1010–6.

    PubMed  Google Scholar 

  28. Kim HJ, Choi GS, Park JS, Park SY. Multidimensional analysis of the learning curve for robotic total mesorectal excision for rectal cancer: lessons from a single surgeon’s experience. Dis Colon Rectum. 2014;57(9):1066–74.

    PubMed  Google Scholar 

  29. Colombo PE, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrère S, et al. Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach? A single-center series of 120 consecutive patients. Ann Surg Oncol. 2016;23(5):1594–600.

    PubMed  Google Scholar 

  30. Barnajian M, Pettet D, Kazi E, Foppa C, Bergamaschi R. Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases. Color Dis. 2014;16(8):603–9.

    CAS  Google Scholar 

  31. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267(6):1034–46.

    PubMed  Google Scholar 

  32. Li X, Wang T, Yao L, Hu L, Jin P, Guo T, Yang K. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore). 2017;96(29):e7585. https://doi.org/10.1097/MD.0000000000007585.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lim DR, Bae SU, Hur H, Min BS, Baik SH, Lee KY, et al. Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid–low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc. 2017;31(4):1728–37.

    PubMed  Google Scholar 

  34. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc. 2013;27(1):48–55.

    PubMed  Google Scholar 

  35. Crolla R, Mulder PG, van der Schelling GP. 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. 2018/05/16. Department of Surgery, Amphia Breda, Breda, The Netherlands. rcrolla@amphia.nl. Consulting Biostatistician, Amphia Academy, Amphia Breda, Breda, The Netherlands. Department of Surgery, Amphia Breda, Breda, The Netherlands.; 2018; Available from: https://www.ncbi.nlm.nih.gov/pubmed/29761276https://link.springer.com/content/pdf/10.1007%2Fs00464-018-6209-x.pdf

  36. Duchalais E, Machairas N, Kelley SR, Landmann RG, Merchea A, Colibaseanu DT, et al. Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer? Surg Endosc. 2018/03/17. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Division of Colon & Rectal Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. Division of Colon and Rectal Surgery, Mayo Clinic, 200 F; 2018; Available from: https://www.ncbi.nlm.nih.gov/pubmed/29546672https://link.springer.com/content/pdf/10.1007%2Fs00464-018-6098-z.pdf

  37. Morelli L, Di Franco G, Guadagni S, Rossi L, Palmeri M, Furbetta N, et al. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc. 2018;32(2):589–600.

    PubMed  Google Scholar 

  38. Morelli L, Guadagni S, Di Franco G, Palmeri M, Caprili G, D’Isidoro C, et al. Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®. Int J Med Robot Comput Assist Surg. 2017;13(1):e1728.

    Google Scholar 

  39. Gouvas N, Georgiou PA, Agalianos C, Tzovaras G, Tekkis P, Xynos E 2018. Does conversion to open of laparoscopically attempted rectal cancer cases affect short- and long-term outcomes? A systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A [Internet]. 2017/06/02. 1 Department of Colorectal Surgery, Worcestershire Acute Hospitals NHS Trust , Worcester, United Kingdom . 2 Department of Surgery and Cancer, Imperial College, Chelsea and Westminster Campus, London, United Kingdom . 3 The 2nd Department of General Surg 28:117–26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28570140https://www.liebertpub.com/doi/pdfplus/10.1089/lap.2017.0112

  40. Crippa J, Grass F, Achilli P, Mathis KL, Kelley SR, Merchea A, Colibaseanu DT, Larson DW. Risk factors for conversion in laparoscopic and robotic rectal cancer surgery. Br J Surg. 2020;107(5):560–6. https://doi.org/10.1002/bjs.11435.

    Article  CAS  PubMed  Google Scholar 

  41. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J. Robotic low anterior resection for rectal cancer: A national perspective on short-term oncologic outcomes. Ann Surg. 2015;262:1040–5.

    PubMed  Google Scholar 

  42. Sun Y, Xu H, Li Z, Han J, Song W, Wang J, et al. Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol. 2016;14(1):61.

    PubMed  PubMed Central  Google Scholar 

  43. Masoomi H, Carmichael JC, Mills S, Ketana N, Dolich MO, Stamos MJ. Predictive factors of splenic injury in colorectal surgery: data from the Nationwide Inpatient Sample, 2006–2008. Arch Surg. 2012;147(4):324–9. https://doi.org/10.1001/archsurg.2011.1010.

    Article  PubMed  Google Scholar 

  44. Shorthouse A. Splenic flexure mobilisation for anterior resection performed for sigmoid and rectal cancer. Ann R Coll Surg Engl. 2008;90(8):638–42.

    Google Scholar 

  45. Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum. 2007;50(3):302–7.

    CAS  PubMed  Google Scholar 

  46. Katory M, Tang CL, Koh WL, Fook-Chong SMC, Loi TT, Ooi BS, et al. A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization. Color Dis. 2008;10(2):165–9.

    CAS  Google Scholar 

  47. Marsden MR, Conti JA, Zeidan S, Flashman KG, Khan JS, Leary DPO, et al. 2011 The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections. Colorectal Dis. 2012;14(10):1255–61. https://doi.org/10.1111/j.1463-1318.2011.02927.x.

    Article  CAS  PubMed  Google Scholar 

  48. Isik O, Aytac E, Ashburn J, Ozuner G, Remzi F, Costedio M, et al. Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Surg Endosc Springer New York LLC. 2015;29:1039–44.

    Google Scholar 

  49. Isik O, Sapci I, Aytac E, Snyder K, Stocchi L, Kessler H, et al. 2018 Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery. Tech Coloproctol [Internet]. Springer International Publishing 22:767-71 Available from: https://dx.doi.org/10.1007/s10151-018-1861-7

  50. Liang JT, Huang J, Chen TC. Standardize the surgical technique and clarify the relevant anatomic concept for complete mobilization of colonic splenic flexure using da vinci xi® robotic system. World J Surg Springer New York LLC. 2019;43:1129–36.

    Google Scholar 

  51. Isik O, Benlice C, Gorgun E. A novel approach for robotic mobilization of the splenic flexure. Tech Coloproctol Springer-Verl Ital s.r.l. 2017;21:53–7.

    CAS  Google Scholar 

  52. Lange MM, Marijnen CAM, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, et al. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer. 2009;45(9):1578–88.

    CAS  PubMed  Google Scholar 

  53. Banerjee AK. Sexual dysfunction after surgery for rectal cancer. Lancet. 1999;353(9168):1900–2.

    CAS  PubMed  Google Scholar 

  54. Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005;242(2):212.

    PubMed  PubMed Central  Google Scholar 

  55. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH. 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. 2012;19(8):2485–93.

    PubMed  Google Scholar 

  56. D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc. 2013;27(6):1887–955.

    PubMed  Google Scholar 

  57. Kim HJ, Choi GS, Park JS, Park SY, Yang CS, Lee HJ. The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Color Dis. 2018;20(5):O103–O113113.

    CAS  Google Scholar 

  58. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. 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 J Am Med Assoc. 2017;318(16):1569–80.

    Google Scholar 

  59. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.

    PubMed  Google Scholar 

  60. Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 2010;210(3):306–13.

    PubMed  Google Scholar 

  61. Berguer R, Smith WD, Chung YH. Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc. 2001;15(10):1204–7.

    CAS  PubMed  Google Scholar 

  62. Law KE, Lowndes BR, Kelley SR, Blocker RC, Larson DW, Hallbeck MS, Nelson H. NASA-task load index differentiates surgical approach: opportunities for improvement in colon and rectal surgery. Ann Surg. 2020;271(5):906–12. https://doi.org/10.1097/SLA.0000000000003173.

    Article  PubMed  Google Scholar 

  63. Pernar LIM, Robertson FC, Tavakkoli A, Sheu EG, Brooks DC, Smink DS. An appraisal of the learning curve in robotic general surgery. Surg Endosc. 2017;31(11):4583–96.

    PubMed  Google Scholar 

  64. Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc. 2013;27(9):3297–307.

    PubMed  Google Scholar 

  65. Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, et al. Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc. 2015;29(7):1679–85.

    PubMed  Google Scholar 

  66. Park IJ, Choi GS, Kang BM, Lim KH, Lee IT, Jeon SW, et al. Comparison of one-stage managements of obstructing left-sided colon and rectal cancer: stent-laparoscopic approach vs. intraoperative colonic lavage. J Gastrointest Surg. 2009;13(5):960–5.

    PubMed  Google Scholar 

  67. Tandogdu Z, Vale L, Fraser C, Ramsay C. A systematic review of economic evaluations of the use of robotic assisted laparoscopy in surgery compared with open or laparoscopic surgery. Appl Health Econ Health Policy. 2015;13(5):457–67.

    PubMed  Google Scholar 

  68. Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, et al. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis. 2017;32(10):1423–9.

    PubMed  Google Scholar 

  69. Cleary RK, Mullard AJ, Ferraro J, Regenbogen SE. The cost of conversion in robotic and laparoscopic colorectal surgery. Surg Endosc. 2018;32(3):1515–24.

    PubMed  Google Scholar 

  70. M L, G S, L V, DF G, C L, P M, et al. 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. 2016;31(9):1639–48.

    Google Scholar 

  71. Byrn JC, Hrabe JE, Charlton ME. An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience. Surg Endosc. 2014;28(11):3101–7.

    PubMed  PubMed Central  Google Scholar 

  72. Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, et al. A Comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic Rochester MN, 200 First Street SW, Rochester, MN, 55905, USA

    Pietro Achilli, Fabian Grass & David W. Larson

Authors
  1. Pietro Achilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabian Grass
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David W. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pietro Achilli.

Ethics declarations

Conflict of interest

Pietro Achilli and his co-authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Achilli, P., Grass, F. & Larson, D.W. Robotic surgery for rectal cancer as a platform to build on: review of current evidence. Surg Today 51, 44–51 (2021). https://doi.org/10.1007/s00595-020-02008-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02008-4

Keywords

Search

Navigation