At this year’s ESCP meeting in Dublin, Ireland, Professor Andrea Coratti (Chief, Division of Oncological and Robotic General Surgery, Professor at General Surgery School, University of Florence and the University of Siena, Italy), will outline in his Keynote Lecture the role of robotics in colorectal surgery and assess whether it is time for the technology to be more widely adopted in Europe…
Since the first robotic colorectal procedure was performed in 2001 (Ballantyne GH, Merola P, Weber A, Wasielewski A. Robotic solutions to the pitfalls of laparoscopic colectomy. Osp Ital Chir. 2001;7:405–41), use of the technology has been steadily increasing primarily in the United States and Asia, in particular for low/ultralow anterior rectal resection. Nevertheless, its use in Europe is still limited. According to Professor Coratti this is due to several factors including the high cost of robotic surgery vs. standard laparoscopy and a lack of data.Unfortunately, until today, we do not have ‘strong evidences’ to support the use of robotic system in colorectal surgery,” he explained. “However, there are more papers which suggest advantages of robotic rectal resection as lower conversion rate and bleeding, shorter learning curve, better functional results (maintaining the same oncological results of open and laparoscopic surgery). We are waiting the definitive results of two trials: ROLARR and COREAN.”
He added that although the learning curve of robotic surgery is often cited as a disadvantage the learning curve is usually reported as shorter for robotic surgery, than in standard laparoscopy and the operative time, after the learning curve of the surgical time and console surgeon, is similar to standard laparoscopy.
Despite the lack of data, Coratti explained that robotic surgery technology offers several advantages for different colorectal procedures:
- Rectal surgery - Better vision and dissection in pelvic surgery: the ability to dissect the mesorectum (TME), preserving the nerves, is improved by the robotic assistance even in very deep and narrow pelvis (the trans-anal approach, used more and more in laparoscopy for low anterior resection, is practically useless in robotic surgery).
The major technical advantages are appreciable in low tumors (especially in cases requiring inter-sphinteric dissection and ultralow resection), males and obese patients”, he added.
- Colonic surgery - Advantages in case of extended/complex lymphadenectomy (enlarged right colectomy, transverse colectomy); intra-corporeal anastomosis; obese patients.
- Bleeding - In cases of major bleeding, the haemostasis it’s easier to perform in robotic surgery than in standard laparoscopy.
- Complex cases - In complex cases, requiring multi-organ resection (like pelvic posterior exenteration, resection of left colonic angle “en bloc” with distal pancreas and spleen, etc.) or synchronous colorectal and liver surgery (metastases), the robotics may do a real technical difference.
For surgeons who wish to perform robotic colorectal surgery, I would recommend that they perform a correct educational and training programme before approaching the clinical application,” he concluded. “Robotic surgery is not another surgery: it’s an advanced evolution of minimally invasive surgery. To demonstrate its technical superiority’ in comparison with standard laparoscopy it’s very difficult using the common scientific methods: but when you approach complex minimally invasive surgery by the robot, it’s very difficult to come back!”
Professor Coratti’s Keynote Lecture, ‘Is robotic surgery hype, or the next best thing in colorectal surgery?’, will be presented at 15.30 on Thursday 24th September, in the Auditorium.
