A consistent conclusion in the majority of papers is that robotic colorectal surgery tends to be associated with a higher cost and a longer operative time. While some studies have reported no significantly superior outcomes when compared with laparoscopy, others have shown a trend toward lower conversion rates and superior circumferential resection margins in robotic surgery. 10 – 17 In general, authors have found robotic surgery to be feasible and safe, referring to it as a “promising” technology that may have a role in selected patients, for example, obese male rectal cancer patients undergoing radical proctectomy.
Many authors have also published on robot-assisted laparoscopic colorectal surgery since the first robotic colectomy was described by Weber et al in 2002. The fulcrum effect of laparoscopic ports also causes the instrument tips to move paradoxically to that of the surgeon’s hands. For example, the ability to achieve appropriate traction and precise dissection in the pelvis during laparoscopic total mesorectal excision (TME) has been limited by the restrictive single-jointed movements of straight-shaft laparoscopic instruments. 9 Part of the challenge arises from the incongruity between the quality of surgery required for good oncological outcomes and the technology of available equipment. 8 Data from the Surgical Care and Outcomes Assessment Program (SCOAP) subsequently demonstrated an increase from 23.3% in 2005 to 41.6% in 2010. 7 Data from the American Board of Colon and Rectal Surgery (ABCRS) showed that 3.6% of major colorectal operations were performed laparoscopically in 1994, and the increase was only up to 24.3% by 2005. 3– 6 However, the adoption of laparoscopic colorectal surgery remained slow due to the technical complexity of such procedures. 2 Since then, numerous authors have compared the outcomes of laparoscopic versus open colorectal surgery, with the more recent articles citing superior short-term outcomes and comparable oncological results.
IVINCI JOB REVIEWS SERIES
The German gynecologist Kurt Semm performed the first laparoscopic appendectomy in 1980, 1 and the first case series of laparoscopic colectomies was published by Jacobs et al in 1991. Minimally invasive techniques have been incorporated into colorectal surgery for more than three decades. Keywords: review, multiquadrant, minimally invasive, colorectal, surgery This review appraises the existing literature on robotic colorectal surgery while elaborating how the improved capabilities of the Xi serve to usher in a new era of minimally invasive colorectal surgery. While commonly criticized for its cost and prolonged operative time, robotic colorectal surgery holds the potential for enhanced ergonomics, superior precision, and a reduction in the learning curve involved in training an expert surgeon. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures – from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. James Chi-Yong Ngu, 1 Charles Bih-Shiou Tsang, 2,3 Dean Chi-Siong Koh, 2,3ġDepartment of General Surgery, Changi General Hospital, 2Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 3Colorectal Clinic Associates, Mount Elizabeth Novena Specialist Center, SingaporeĪbstract: The Xi is the latest da Vinci surgical system approved for use in colorectal surgery.
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