The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review.

Tou Pin Chang,Christos Kontovounisios,Shahnawaz Rasheed,Aik Yong Chok,Dominic Tan,Ailin Rogers,Paris Tekkis

doi:10.3390/jcm10071518

Abstract

Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered.

Highlights

In locally advanced rectal cancer, where the tumour extends beyond the mesorectal envelope, thereby involving the circumferential resection margin (CRM) or even direct contiguous invasion of the adjacent organ(s), a multivisceral pelvic exenteration beyond conventional total mesorectal excision (TME) surgical planes is required
The aim of this article is to provide a comprehensive review on the recent developments in the field of robotic surgery in pelvic exenteration surgery for locally advanced rectal cancers with a specific focus on new innovations and emerging frontiers
Whilst laparoscopic surgery is associated with less intraoperative blood loss, quicker recovery rates, less delayed bowel function, and shorter hospital lengths of stay compared to standard TME surgery [6], the approach encounters technical difficulties due to the complex nature of beyond TME pelvic dissection in multivisceral resections, and there is a compelling need for a more ergonomically and visually enhanced minimally invasive approach