Robotic colorectal surgery: more than a fantastic toy?

Robotic versus laparoscopic pelvic lateral lymph node dissection in locally advanced rectal cancer: a systemic review and meta-analysis

BACKGROUND

There are few available studies that compare the feasibility, efficacy, and safety of robotic pelvic lateral lymph node dissection compared to laparoscopic pelvic lateral lymph node dissection (LPLND) in advanced rectal cancer. This meta-analysis aims to compare perioperative outcomes between robotic and LPLND.

METHODS

We performed a systemic literature review of PubMed, Embase, and Web of Science databases. Perioperative parameters were extracted and pooled for analysis. This meta-analysis provided an analysis of heterogeneity and prediction intervals.

RESULTS

Five studies were included: 567 patients divided between 266 robotic and 301 LPLND. Overall operation time was longer in the robotic group than laparoscopic group (difference in means = 67.11, 95% CI [30.80, 103.42], p < 0.001) but the difference in the pelvic lateral lymph dissection time was not statistically significant (difference in means =  - 1.212, 95% CI [ - 11.594, 9.171], p = 0.819). There were fewer overall complications in the robotic than in the laparoscopic group (OR = 1.589, 95% CI [1.009, 2.503], p = 0.046), especially with respect to urinary retention (OR = 2.23, 95% CI [1.277, 3.894], p = 0.005). More pelvic lateral lymph nodes were harvested by robotic surgery than by laparoscopy (differences in means =  - 1.992, 95% CI [ - 2.421, 1.563], p < 0.001).

CONCLUSIONS

In this meta-analysis, robotic pelvic lateral lymph node dissection was associated with more pelvic lateral lymph nodes harvested and lower overall complications, especially urinary retention when compared to LPLND. Further studies are needed to reinforce these findings.

Robotic surgery in colorectal cancer: the way forward or a passing fad

Introduced mainly to overcome the technical limitations of laparoscopy, robotic colorectal surgery (CRS) has been touted to provide superior optics, ergonomics, and surgeon autonomy. This technological advancement is nonetheless associated with certain drawbacks, mainly involving its cost and the lack of unequivocal benefit over conventional laparoscopy. In this era of evidence-based medicine, robotic CRS remains predominantly a subject of individual institution case series, retrospective studies, matched comparisons at best, and repeated reviews of the above literature. This article provides a critique of the more contemporary data regarding the use of robotics in colorectal cancer surgery and the controversies surrounding the literature.