Abstract
BackgroundThe robotic system has advantages of high-definition three-dimensional vision and articular instruments with high dexterity, allowing more precise dissection in the deep and narrow pelvic cavity.MethodsWe enrolled 95 patients with stage I-III rectal cancer (adenocarcinoma) who underwent totally robotic-assisted total mesorectal excision (TME) with single-docking technique at a single institution between September 2013 and December 2016.ResultsOf the 95 patients, 48 (50.5%) and 30 (31.6%) patients had lower and middle rectal cancers, respectively. Of the 75 (78.9%) patients undergoing preoperative concurrent chemoradiotherapy (CCRT), 27 (28.4%) exhibited pathologic complete response (pCR). Only four (4.2%) patients underwent abdominoperineal resection and the sphincter preservation rate was 95.8%. R0 resection was performed in 92 (96.8%) patients. Circumferential resection margin (CRM) and distal resection margin (DRM) were positive in 2 (2.1%) and 1 (1.1%) patients, respectively. The anastomotic leakage rate was 5.4% (5/95 patients). The overall complication rate was 17.9% (17/95 patients); most of them were mild. No 30-day hospital mortality occurred, and no patients required conversion to open surgery. In 92 patients undergoing R0 resection, 2-year overall survival was 94% and 2-year disease-free survival was 83%.ConclusionsThe results demonstrated that totally robotic-assisted TME with the single-docking technique is safe and feasible for patients with rectal cancer, with or without preoperative CCRT. Moreover, favorable pCR rate, R0 resection rate, CRM, DRM, sphincter preservation rate, and short-term oncological outcomes can be achieved by combining this approach with appropriate preoperative CCRT.
Highlights
The robotic system has advantages of high-definition three-dimensional vision and articular instruments with high dexterity, allowing more precise dissection in the deep and narrow pelvic cavity
We present a method of the single-docking technique without moving the robotic surgical cart and repositioning robotic arms to perform totally robotic radical rectal cancer surgery
We demonstrate that this technique is safe and feasible for patients with rectal cancer, with or without preoperative concurrent chemoradiotherapy (CCRT)
Summary
The robotic system has advantages of high-definition three-dimensional vision and articular instruments with high dexterity, allowing more precise dissection in the deep and narrow pelvic cavity. Laparoscopic rectal surgery with TME is still not accepted worldwide as the standard surgical procedure for rectal cancer treatment because it requires highly technically skilled surgeons experienced in minimally invasive surgeries [8, 9]. The robotic system (da Vinci® Surgical System, Intuitive Surgical, Inc., Sunnyvale, CA) has several advantages such as high-definition three-dimensional vision with up to 10× magnification, the articulatory instruments of the system, the surgeon-controlled camera platform, and stable traction provided by the robotic arm. Several studies have reported that compared with conventional laparoscopic and open surgeries for rectal cancers, clinical and short-term oncological outcomes of robotic surgery are more favorable [11,12,13,14]
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