Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature

Hidetoshi Katsuno; Tsunekazu Hanai; Koji Masumori; Yoshikazu Koide; Keigo Ashida; Hiroshi Matsuoka; Yosuke Tajima; Tomoyoshi Endo; Masahiro Mizuno; Yeongcheol Cheong; Kotaro Maeda; Ichiro Uyama

doi:10.23922/jarc.2019-037

Review Article

Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature

Hidetoshi Katsuno, Tsunekazu Hanai, Koji Masumori, Yoshikazu Koide, Keigo Ashida, Hiroshi Matsuoka, Yosuke Tajima, Tomoyoshi Endo, Masahiro Mizuno, Yeongcheol Cheong, Kotaro Maeda, Ichiro Uyama

Author information

Hidetoshi Katsuno
Department of Surgery, Fujita Health University, School of Medicine
Tsunekazu Hanai
Department of Surgery, Fujita Health University, School of Medicine
Koji Masumori
Department of Surgery, Fujita Health University, School of Medicine
Yoshikazu Koide
Department of Surgery, Fujita Health University, School of Medicine
Keigo Ashida
Department of Surgery, Fujita Health University, School of Medicine
Hiroshi Matsuoka
Department of Surgery, Fujita Health University, School of Medicine
Yosuke Tajima
Department of Surgery, Fujita Health University, School of Medicine
Tomoyoshi Endo
Department of Surgery, Fujita Health University, School of Medicine
Masahiro Mizuno
Department of Surgery, Fujita Health University, School of Medicine
Yeongcheol Cheong
Department of Surgery, Fujita Health University, School of Medicine
Kotaro Maeda
International Medical Center, Fujita Health University Hospital
Ichiro Uyama
Department of Surgery, Fujita Health University, School of Medicine

Keywords: Robotic surgery, Laparoscopic surgery, Minimally invasive surgery, Rectal cancer, Mesorectal excision, Lateral lymph node dissection

JOURNAL OPEN ACCESS

2020 Volume 4 Issue 1 Pages 14-24

DOI https://doi.org/10.23922/jarc.2019-037

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Abstract

The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincter-preserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and long-term oncological outcomes, lateral lymph node dissection, and the cost of the procedure.

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