Robot-assisted Colorectal Operations Compare to Laparoscopic Approach

Igor Černi*

General and Teaching Hospital Celje, Department of General and Abdominal Surgery Celje, Slovenia

*Corresponding Author: Igor Černi, General and Teaching Hospital Celje, Department of General and Abdominal Surgery Celje, Slovenia.

Received: August 10, 2023; Published: Sepetember 22, 2023

Abstract

Introduction: Minimally invasive approach has gained interest in the treatment of patients with colorectal cancer. The purpose of this study is to analyze the differences between laparoscopy and robotics for colorectal cancer in terms of oncologic and clinical outcomes in an initial experience We present our initial observations and results of robotic operations of the large intestine with special regard to the patient undergoing robotic surgery of the colon , rectum cancer and compare to the laparoscopic.

Methods: The first totally robotic-assisted resection of rectum cancer in our department in Slovenia (single docking system with da Vinci SI system) was performed in May 2014. The last patient in 2020 was operated on before the outbreak of SARS-CoV-2 virus infection, and then no robotic operations were performed until September 2022. Due to the lack of staff, we only carried out emergency operations. After that, we started again and more than 100 operations of colon and rectum have been done. Retrospectively we analized 85 patients operated robotically, (49% female, 51% male). The average age was 63,5 years. 62% had ASA classification II, colorectal carcinoma were presented in 76% patients, the others had diverticulosis and benign diseases. 62% had carcinoma of rectum and rectosigma. Retrospectively we analized 110 laparoscopic operations as well (64% male, 36% female), the average age was 65,5 years. 40% of the patients had ASA classification III. Adenocarcinoma were presented in 75% patients, the others had diverticulosis and benign diseases. The degree of differentiation of the tumor (gradus II) in laparoscopic method was presented in 67% patients, while in robotic method was presented in 68% patients. According to the TNM classification in both methods was dominated stage T3 (laparoscopic 44%, robotic 46%). Stage N0 for lymph nodes was in laparoscopically operated patients 54%, in robotically operated patients was 40%. T1 and T2 tumor were presented in 26% in the robotic operated patients, 23% patients operated laparoscopically.

The most common localization in laparoscopic operations was cancer of coecum and colon ascenders (45%), in the robotic was rectum (22%) and rectosigma (40%).

Results: In all patients radical resection has been done. The average number of isolated lymphnodes in the robotic method was 19 while in laparoscopic method was 15,5. The hospitalization was shorter in robotic operated patients (average 7,3days), on the other hand the time of the robotic operations was longer than laparoscopic operations. Intraoperative blood loss was in the robotic method smaller (50-120 ml) 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 frequent complications 9 ( 10,3%) while robotic method 4 (9%). In 10 years follow up 9 laparoscopically operated died (10,3%), (5 due to cardiovascular disease, 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: RCS is a promising technique and is safe and effective alternative to LCS for colorectal surgery. The advantages of RCS include reduced EBLs, lower conversion rates and shorter times to recovery of bowel function. Further studies are required to define the financial effects of RCS and the effects of RCS on long -term oncologic outcomes.

Keywords: Robotic Surgery; Colorectal Cancer; Oncologic Outcomes

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Citation

Citation: Igor Černi. “Robot-assisted Colorectal Operations Compare to Laparoscopic Approach". Acta Scientific Clinical Case Reports 4.10 (2023): 13-20.

Copyright

Copyright: © 2023 Igor Černi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.