Laparoscopic and Robotic Colorectal Surgery: A Comparison and Contrast

Abstract

Laparoscopic surgery is now considered by many experts as the approach of choice for the surgical treatment of both benign and malignant colonic diseases. In contrast, robotic-assisted laparoscopic surgery is gaining acceptance and use in the colorectal surgery field. Currently, enthusiasm for the robotic platform, as a minimally invasive approach, has gained most interest for cases involving rectal surgery and pelvic anatomy. The robotic technique offers enhanced optics and mechanical instrumentation, which were designed to greatly improve visualization, exposure, and dissection in confined spaces such as the pelvic cavity. Nevertheless, during robotic surgery, attention to adjacent or distant operative field usually requires cumbersome repositioning of the camera and robotic arms. Thus, the robotic platform is best suited for surgical approach in a confined visual field and optimizes optics, fine tissue handling, and intracorporeal suturing technique, whereas laparoscopic surgery may be best suited for wider operative field of view and gross manipulation and dissection, requires smaller and fewer ports, and affords ready adaptation to various surgical maneuvers. In regard to colon resection, robotic surgery results in comparable short-term outcomes as compared with laparoscopy, although with longer operative time and higher expenses. Thus, the routine use of the robotic platform is not currently supported. However, robotic sigmoid colectomy may be beneficial for cases of complex diverticulitis. In addition, robotic sigmoid colectomy may be used in the teaching/training setting as a learning curve procedure before performing more challenging pelvic procedures. Robotic-assisted laparoscopic rectal resection represents the main indication of the use of the robotic platform in colorectal surgery. In this setting, its optical and operative attributes are actualized, whereas the laparoscopic pitfalls are maximally exposed. Although many rectal resections may be successfully accomplished using conventional laparoscopy, it requires extensive surgical expertise. Randomized controlled trials comparing laparoscopy with robotic technique for the treatment of rectal cancer are currently being conducted, and it will not be until the results of such studies are available that we can draw solid conclusions regarding the role of robotic-assisted laparoscopic surgery in the treatment of rectal cancer. Laparoscopic and robotic-assisted surgeries are safe and viable techniques for the treatment of essentially all colorectal conditions requiring surgical intervention. To determine a suitable minimally invasive surgical approach, it is important to recognize that both laparoscopic and robotic surgeries present benefits and limitations as compared with each other. Hence, the ideal approach should ultimately result in the use of the technique most appropriate for the specific surgical indication, thus realizing the benefits and avoiding the drawbacks of the approach.