Robotic approach for rectal cancer, is the best approach?

Turgut Bora Cengiz, Emre Gorgun


Rectal cancer surgery (RCS) practice has shown substantial changes after the introduction of minimally invasive techniques which provided shorter length of hospital stay and reduced morbidity rates compared to open surgery. Challenges about minimally invasive approach in rectal surgery settings are magnified when the rigid nature of the laparoscopic instruments intervene with the precise dissection, especially in the confined spaces such as pelvis. Robotic surgery, is a novel technique addressing the restrictions of the laparoscopic surgery by utilizing endo-wristed equipment, three-dimensional visualization, stable retraction and better ergonomics for the surgeon. Up-to-date, robotic surgery has reached 849,000 operations worldwide within multiple disciplines, including urology, gynecology and cardiothoracic surgery. Coherently, rectal surgery has been benefiting the ample opportunities that robotic system offers, yet, unavailability of the platform in every medical center, prolonged operative time and the increased economic burden of the surgery pose obstacles for the employment of the robotics globally. Debates keep climbing toward whether the purported advantages of the robotic system will actually translate into clinical effectiveness over conventional laparoscopy. This review article discusses the current role of robotic approach in RCS and future directions of the robotic RCS.