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Advantages of Robotic Surgery for Rectal Cancer: A Multidisciplinary Approach

Explore the benefits and drawbacks of robotic surgery in treating rectal cancer, comparing it to laparoscopic techniques. Learn about the technical aspects, outcomes, and surgical strategies involved. Join our robotics courses for advanced training.

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Advantages of Robotic Surgery for Rectal Cancer: A Multidisciplinary Approach

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  1. Il trattamento multidisciplinare del cancro del retto Ferrara, 9 ottobre 2012 La TME robotica a. coratti – m. di marino UO Chirurgia Generale, Grosseto

  2. Laparoscopic surgery • DRAWBACKS • Unnatural movements • Poor ergonomics for the surgeon • Reduced degrees of freedom • Dissociated visual-mechanical • control • Bidimensional vision • Limited sutures • ADVANTAGES • Pain control • Blood losses negligible • Immunitary system • Shorter ileus • Abdominal wall • Morbidity • Post-op stay

  3. Robotic surgery

  4. Robotic surgery The new system “da Vinci SI HD” OVERCOMES LAPAROSCOPIC PITFALLS • 3D / HD vision • Fine dissection • Deep, small operating fields • High precision suturing • Easier setup • Tutoring

  5. Robotic surgery • ENDO-WRIST ™ SYSTEM • 6 degrees of freedom • Tremor elimination • Motion scaling

  6. Robotic surgery in Grosseto October 2000 – September 2012 Total series

  7. Robotic rectal resection Reported series * Includingcolonicresections

  8. Robotic rectal resection No randomized prospective study – 66 pts Casciola (JSLS 2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection.

  9. Robotic rectal resection Casciola (JSLS 2009) Intraoperative and pathologic data

  10. Robotic rectal resection Casciola (JSLS 2009) Early and long-term outcomes

  11. Robotic rectal resection Casciola (JSLS 2009) Oncological results Local recurrence ROB: 0 LAP: 5.4% (NS) (NS) Conclusions Robot-assistedrectalsurgeryis a safe and feasible procedure thatfacilitateslaparoscopictotalmesorectalexcision.

  12. Robotic rectal resection Retrospective multicentric study – 143 pts Pigazzi et Al (Ann Surg Oncol 2010) Multicentric Study on Robotic Tumor-Specific Mesorectal Excision for the Treatment of Rectal Cancer. Conclusions Robot-assisted rectal surgery is a safe and feasible procedure that may facilitate mesorectal excision.

  13. Experience in Grosseto Perioperativeresults: 58 pts. (2001-2012)

  14. Experience in Grosseto Oncologicaloutcomes - Rectal carcinoma

  15. Experience in Grosseto Long termsurvival (DFS, OS) -Rectal carcinoma 3-Years overall survival (OS) 3-Years disease free survival (DFS)

  16. Experience in Grosseto Functionaloutcomes: 58 pts. (2001-2012)

  17. Rectal robotic surgery Technical aspects SURGICAL STRATEGY Full robotic technique Hybrid (lap/rob) technique Surgical steps Patient positioning Robotic cart Ports ■ ROBOTIC ■ LAPAROSCOPY ■ ROBOTIC

  18. Docking 1 . Paziente supino . Posizione ginecologica . Arti super. Addotti . Anti-trendelenburg 30 ° . Ruotato sul fianco destro di 15 ° . Carello robotico dalla spalla sinistra

  19. Docking 2 . Paziente supino . Posizione ginecologica . Arti super. Addotti . Trendelenburg 25 ° . Ruotato sul fianco destro di 15 ° . Carello robotico dalla gamba sinistra

  20. Posizionamento dei trocars I step II step ottica ottica R 1 R 2 Ass R 2 R 3 R 3 Ass Ass Ass R 1 minilaparomia

  21. Posizionamento dei trocars I step II step ottica ottica R 1 R 2 Ass R 2 R 3 R 3 Ass Ass Ass R 1 Minilaparotomia

  22. Personal experience Very difficult at the beginning • Ports positioning • Cart docking • Pelvic exposure • Time consuming • Laparoscopy it’s better?

  23. Personal experience Very difficult at the beginning Intermediate experience • Switch from hybrid to full robotic • Changing in port and cart setup

  24. Personal experience Very difficult at the beginning Intermediate experience Advanced experience • Full robotic technique • Starting by pelvic dissection • Ultralow intersphyncteric dissection • No return to laparoscopy!

  25. Robot-assisted LAR - I step video

  26. Robot-assisted LAR – II step video

  27. Rectalroboticsurgery Technical aspects ADVANTAGES • 3D/HD vision - Endowrist • TME • Nervessparing • Intersphyntericdissection • Pelvicdissection (deep, narrow) • Obese patients • Reduction of conversions (?)

  28. Rectalroboticsurgery Technical aspects DRAWBACKS • Large operating field • Change of cart/patients positioning • Bowel retraction • Expert assistant surgeon • High cost procedure

  29. Conclusions • Robot-assistedrectalresection are feasible and safe. • The robotictechniquemayimprove TME, nervessparing and intersphyntericdissection in ultralowrectalresection. • Major advantages can be appreciated in males, in narrow and deeppelvis, and in obese patients. • The long-termfunctional and oncologicalresults are veryinteresting. • We are waiting the ROLARR trial.

  30. Scuola ACOI di Chirurgia Robotica www.roboticschool.it COURSES 2012 BASIC May, 21-25 1st ADVANCED (Upper GI, HPB, Endocrine) June, 25-29 2nd ADVANCED (Colorectal, HPB, Endocrine) November, 26-30

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