Evaluation of Impact of Surgical Robotic Technology on Quality of Total Mesorectal Excision for Rectal Cancer:Chinese Experience of R-TME <i>via</i> Diverse Robotic Technology

Abstract

Objective: The advantages and disadvantages of robotic technology compared with conventional surgery for low rectal cancer has been discussed extensively, but few studies of the impact on total mesorectal excision (TME) efficacy based on different robotic technologies have been reported. This study aims to evaluate the differences in TME quality between two different robot-assisted TME (R-TME) methods. Methods: Between January 2017 and May 2019, patients who suffered from rectal cancer (cT1-3NxM0) were prospectively registered. Patients independently chose to undergo da Vinci R-TME, MicroHand S R-TME, or laparoscopic TME (L-TME). The integrity of the TME sample served as the primary outcome. Secondary outcomes included the involvement of circumferential and distal resection margins (CRM and DRM), lymph node retrieval number, blood loss, operative time (OT), conversion rate, comprehensive complication index (CCI) scores, IPSS,IIEF and FSFI scores. Results: In total, 46 patients underwent laparoscopic TME, 45 patients underwent da Vinci R-TME and 43 patients underwent MicroHand S R-TME. TME quality improved in both two R-TME groups, which was reflected by a reduced DRM involvement rate, more retrieved lymph nodes, reduced blood loss, reduced incidence of severe complications, and earlier urogenital function recovery. However, the operative times for both R-TME methods were significantly longer than that of the L-TME approach. Conclusion: In this study, compared with laparoscopic surgery, Da Vinci or MicroHand R-TME exhibit similar superiority in oncologic resection quality, postoperative morbidity, and recovery of postoperative function. Trial Registration: This study was registered with Clinicaltrials.gov (ID: NCT02752698). Funding Statement: This study was supported by the National Natural Science Foundation of China (No: 51875580) and National Key Research and Development Plan Fund (Grant No: 2017YFC0110402). Declaration of Interests: All authors declare that there are no conflicts of interest. Ethics Approval Statement: Approved by the Association for the Accreditation of Human Research Protection Program (AAHRPP) (Project number: T16007).