Updates in robotic colorectal surgery

Since the introduction of master-slave manipulators (otherwise known as telemanipulators) in 1990, minimally invasive surgery paved way for the development of the first robotic surgical systems to overcome the limitations of laparoscopic surgery. Over the last decade, the robotic system has rapidly gained acceptance and popularity among surgeons, especially colorectal surgeons around the world. Advantages of robotic surgical systems includes superior instrumentation and stable field of vision which enable precise dissection in confined spaces such as the pelvis. The feasibility and safety of robotic rectal surgery is now well established and there is increasing evidence that it might offer superior perioperative and postoperative outcomes when compared to laparoscopic rectal surgery. Robotic rectal surgery is easier to learn than laparoscopic surgery and the creation of a structured training program for robotic rectal surgery in Europe and USA has facilitated the learning of this technique in an environment that promotes patient safety and improved patient outcomes through equipment fidelity and operator skills. It is foreseeable that in the near future robotic systems will become part of routine surgical practice in colorectal surgery.     

Robotic colorectal surgery

Master–slave manipulators (otherwise known as telemanipulators) were introduced into minimally invasive surgery in the 1990s to overcome the limitations of laparoscopic surgery. This led to the development of the first robotic surgical systems which, over the last 10 years, have rapidly gained acceptance among colorectal surgeons. Advantages of robotic surgical systems such as superior instrumentation and field of vision enable precise dissection in confined spaces such as the pelvis which make it a particularly attractive tool for rectal surgery. The feasibility and safety of robotic rectal surgery is now well established and there is increasing evidence that it might offer superior peri- and postoperative outcomes when compared to laparoscopic rectal surgery. Robotic rectal surgery is easier to learn than laparoscopic surgery and the creation of a structured training programme for robotic rectal surgery in Europe has facilitated the learning of this technique in an environment that promotes patient safety and improved patient outcomes through equipment fidelity and operator skill. It is foreseeable that in the near future robotic systems will become part of routine surgical practice in colorectal surgery.     

结直肠癌机器人手术临床应用现状

回顾机器人手术系统的组成和发展史。在结直肠癌根治术中,机器人手术系统已得到广泛应用,手术操作时间明显缩短,手术安全。机器人手术系统具有三维图像稳定性和清晰性、手术操作便利性等优势。触觉反馈缺失、手术时间延长等是其不足。     

机器人手术系统在结直肠手术的应用

腹腔镜手术改善了结直肠手术患者的短期预后且有着不劣于开腹手术的长期预后,但对骨盆狭窄的低位直肠癌男性患者或肥胖的右半结肠癌患者,因其空间窄、暴露困难及腔镜器械灵活不足,腹腔镜手术的开展存在一定难度。机器人手术系统有视野更清晰、操作更灵活等优点而逐渐在结直肠手术中得到推广,但目前对于机器人手术系统在结直肠领域的应用现状和效果并不明确。本文将从手术机器人在传统结直肠手术中应用、机器人结直肠手术新进展、机器人手术不足三方面进行综述。     

Computer-enhanced robotic surgery in gynecologic oncology

Background This study aimed to report the computer-enhanced robotic surgery experience of the authors’ gynecologic oncology division. Methods From January 2001 to August 2006, 41 patients underwent laparoscopic surgery by our gynecologic oncology service using a computer-enhanced surgical robot. This report describes a retrospective review of these patients. Results The patients ranged in age from 27 to 77 years (mean, 44.2 years), in weight from 44 to 131 kg (mean, 72.1 kg), in operative time from 1 h and 50 min to 9 h (mean, 5 h and 2 min), and in estimated blood loss from 50 to 1,500 ml (mean, 253 ml). Of the 20 patients with gynecologic malignancies, 14 had cervical cancer. A total of 21 patients had benign indications for surgery. Complications included shoulder palsy, robot failure, colotomy, bradycardia, and intraabdominal bleeding requiring minilaparotomy and ligation of a bleeding pedicle. Conclusion This case series is one of the first to report the use of a computer-enhanced surgical robot in gynecologic oncology. This approach proved to be feasible and well tolerated in this series of patients and deserves further study for clarification of its indications, benefits, and safety.     

机器人结直肠癌手术中国专家共识(2020版)

机器人微创手术是当代外科技术发展的重要趋势.为推动我国机器人结直肠癌手术的发展,我国相关学术组织于2015年编撰了《机器人结直肠癌手术专家共识(2015版)》.5年来,机器人手术的设备与技术均取得了长足进步,故对其进行修订,形成《机器人结直肠癌手术中国专家共识(2020版)》,以期为目前正在或将要开展机器人结直肠癌手术...     

Comparison of robotic reduced-port and laparoscopic approaches for left-sided colorectal cancer surgery

Background/objectiveThe reduced-port approach can overcome the limitations of single-incision laparoscopic surgery while maintaining its advantages. Here, we compared the effects of robotic reduced-port surgery and conventional laparoscopic approaches for left-sided colorectal cancer.MethodsBetween January 2015 and December 2016, the clinicopathological characteristics and treatment outcomes of 17 patients undergoing robotic reduced-port surgery and 49 patients undergoing laparoscopic surgery for left-sided colorectal cancer were compared.ResultsThe two groups were comparable in almost all outcome measures except for the distal resection margin, which was significantly longer in the laparoscopic group (P < 0.001). The between-group differences in reoperation, incisional hernia development, and overall and progression-free survival were nonsignificant; however, the total hospital cost was significantly higher in the robotic group than in the laparoscopic group (US$13779.6 ± US$3114.8 vs. US$8556.3 ± US$2056.7, P < 0.001).ConclusionRobotic reduced-port surgery for left-sided colorectal cancer is safe and effective but more expensive with no additional benefit compared with the conventional laparoscopic approach. This observation warrants further evaluation.     

Minimizing opioid consumption following robotic surgery

The American opioid epidemic has led to one of the worse public health crises in recent history, and emerging evidence has highlighted the role of healthcare professionals in exposing patients and communities to potent opioid drugs. Surgeons, in treating postoperative pain, are at the forefront of this epidemic. In Urology, investigators are beginning to establish how patients handle and consume opioids following common urologic procedures in an effort to limit excess prescribing. However, there is a paucity of data to define acceptable amounts of opioid medications to adequately treat postoperative pain after urologic surgery. Many common urologic procedures are now routinely performed with robotic technology. Robotic, minimally-invasive approaches decrease incision size and accelerate postoperative recovery, thereby presenting a unique opportunity to curb excessive opioid prescribing in the postoperative patient. Herein, we explore the roots of the current crisis, outline current literature guiding pain control after surgery, and review the current, though sparse, literature that may guide urologists in decreasing opioid use after robotic surgery.     

达芬奇机器人手术系统在结直肠癌根治术中的应用

达芬奇机器人手术系统行结直肠癌根治术在许多国家和地区已经得到了开展.该系统的优势在于:三维显示图像,具有高度稳定性和清晰度,医师学习曲线较短,操作便利,可远程操控等.其劣势在于:价格昂贵,尚无力反馈,手术时间长等.目前,达芬奇机器人手术系统与腹腔镜手术比较,在结直肠癌根治术中尚未体现出足够的优势,但随着临床数据的积累和达芬奇机器人手术系统的更新换代,运用该系统行结直肠癌根治术的未来令人期待.     

机器人在结直肠癌手术中的应用

机器人系统因应用于结直肠癌的手术治疗具有精准操作的优势,但其也有花费高、装机费时、缺乏触觉反馈等问题。机器人结直肠癌手术技术的发展有助于促进其推广,已有的研究表明机器人系统在保证手术安全可行的同时,更好地保护了盆腔自主神经功能。但目前仍需多中心、前瞻性随机研究的临床数据证明其肿瘤根治性。     

Overview of robotic colorectal surgery:Current and future practical developments

Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery,while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow,mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical,allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology,surgery may eventually become obsolete.