Robotic Surgery in Colorectal Cancer

Special Issue Article: Colorectal Cancer

Austin J Cancer Clin Res 2014;1(4): 1018.

Robotic Surgery in Colorectal Cancer

Taggarshe D1*, Attuwaybi BO2 and Butler BN2

1Department of Surgery, Virginia Commonwealth University, USA

2Department of Surgery, University at Buffalo, USA

*Corresponding author: Taggarshe D, Department of Surgery, Virginia Commonwealth University, West Hospital 15th Floor, Room 15-408, Richmond Virginia 23298, USA

Received: September 16, 2014; Accepted: October 04,, 2014; Published: October 09, 2014


Background: In the last two decades, colorectal surgery has seen a dramatic advancement in from open to laparoscopic and now, robotic surgery. The aim of this article is to review the role of robotic surgery in colorectal cancer, especially in comparison with laparoscopic surgery.

Methods: A literature search was performed using PUBMED and Google- Scholar for all papers published discussing Robotic surgery in colorectal cancer upto July 2014. We also reviewed articles comparing laparoscopic colorectal surgery versus robotic colorectal surgery.

Results: Robotic colectomies had a mean operative time of 224 minutes and mean estimated blood loss of 47.67 mls. The rate of conversions to open varied from 0% to 5%. Robotic colectomies were slightly longer compared to laparoscopic colectomies. But comparable with number of retrieved lymph nodes and postoperative morbidity.

Robotic rectal surgery had a mean operative time of 269 minutes (range, 170-700 minutes). Conversion rates for the robotic group were 0% - 8% in comparison with 0% - 22% for the laparoscopic group. The median anastomotic leak rate was 7.3% for the robotic group and 6.3% for the laparoscopic group. Rates of erectile dysfunction varied from 0% -36.6% after robotic surgery to 1% - 56.5% after laparoscopic surgery. With oncologic outcomes, robotic surgery was comparable with laparoscopic surgery.

Conclusions: Robotic surgery is safe, feasible and suitable for colorectal cancer. Compared to laparoscopic surgeries there are fewer conversions to open and blood loss, with comparable postoperative and oncologic outcomes.

Keywords: Robotic surgery; Colon cancer; Rectal cancer; Laparoscopic surgery


The surgical management of colorectal cancer has changed since the inception of minimally invasive techniques. Major international trials have established the safety of laparoscopic surgery, with oncological outcomes comparable to open surgery in colorectal cancer [1-3]. Laparoscopic surgery has an edge over conventional open surgery with a decreased analgesia requirement, shorter length of stay, and an improved quality of life [4]. Laparoscopic surgery is associated with decreased postoperative morbidity and incisional hernias.

However, laparoscopic surgery has not gained wide acceptance and majority of colorectal resections in USA are still being performed open [5]. This has been due to a combination of the steep learning curve and the inherent limitations with laparoscopic surgery. Limitations of laparoscopic surgery include poor visualization with a two –dimension view resulting in poor depth perception, need of a trained assistant to hold the camera, poor ergonomics, straight instruments and enhanced tremor effects. Alternatives for laparoscopic surgery have been developed to overcome some of these limitations.

The Food and Drug Administration approved robotic assisted surgery with the da Vinci operating console in 2000. Weber et al demonstrated the feasibility of robotic assisted colectomies in 2002 [6]. The advantages of the da Vinci platform – da Vinci Si HD, which was used in most of the publications, include a three dimensional high definition camera, articulating instruments with seven degrees of freedom, a stable camera and operating platform, reduced physiological tremors, ergonomic comfort and superior dexterity. Robotic surgery can enable precision surgery in conditions with difficult target organ exposure such as narrow male pelvis, distal tumors and obese patients. Robotic surgery has exponentially increased in all specialties worldwide and in the US, along with a similar increase in robotic colorectal surgery [7].

The aim of this article is to review the use of robotic surgery in colon and rectal cancer and determine its safety and feasibility. The article also aims to compare it with laparoscopic surgery for colon and rectal cancers.

Materials and Methods

A literature search was performed using PUBMED and Google Scholar for all articles involving robotic surgery in colorectal cancer up to July 2014. The keywords used for search in combinations were “robotic surgery”, “colorectal cancer”, “rectal cancer”, “proctectomy”, “colectomy”, and “sigmoid resection”. The abstracts were examined and articles with application of robotic surgery in colorectal cancers were further reviewed. Furthermore, the reference lists of selected articles were searched manually. Only articles published in English were included. The included articles included randomized clinical trials, comparative studies and case series.

Data extracted included number of patients, operative details and outcomes. Costs involved with robotic surgery were included if mentioned in the articles. Operative details included type of surgery, operating time, estimated blood loss and intra operative complications. Pathological features included were number of retrieved lymph nodes in all cases and circumferential resection margin (CRM) status and distal resection margin (DRM) in rectal cancer. Postoperative outcomes included length of stay and postoperative complications.


Sixty-five articles met the initial criteria for robotic surgery in colorectal cancer. Twelve articles with benign and malignant disease and six articles with inseparable colonic and rectal data were excluded. Articles (n=10) with data in overlapping periods from the same institutions were excluded. Nine articles meeting the criteria for robotic colectomies [8-16] and twenty-eight articles for robotic rectal surgery for cancer [11,17-43] were included for this review.

Robotic Colonic Surgery for Cancer

Clinical outcomes

The review identified 316 robotic colectomies for cancer. This included 233 right colectomies, 68 sigmoid resections, 3 total abdominal colectomies and 12 left hemicolectomies (Table 1). Ballantyne et al compared robotic right colectomies with medial to lateral dissection versus robotic colectomies with lateral to medial dissection [8]. Two articles reported on right colectomies with intracorporeal anastomosis [15,16].