Robotic Assisted Rectal Cancer Surgery

The intended application of robotics in surgery was in the field of cardiac surgery. The addition of robot was thought to improve surgeon dexterity in a small field with the added advantage of a minimal invasive approach. Shortly thereafter, urologists recognized that this modality could be used in the deep pelvis and brought the robot to its current most widely used application, the robotic prostatectomy. In the subsequent years, the use of this technology for other “pelvic organs” such as the uterus, rectum, and bladder evolved. Similarly, during this time period, minimally invasive surgical techniques were being studied in colorectal surgery. The results of the Clinical Outcomes of Surgical Therapy trial in 2004 concluded that laparoscopic approaches to colon cancer could be performed without compromise of oncological or quality of life outcomes (Fleshman J, Sargent DJ, Green E, et al; for the Clinical Outcomes of Surgical Therapy Study group: Ann Surg 246:655-662, 2007). Current meta-analyses have yet to show a significant oncological advantage to laparoscopic colon surgery; however, many studies have demonstrated short-term benefits with early mobilization, reduced pain, and early discharge (Kuhry E, Schwenk WF, Gaupset R, et al: Cochrane Database Syst Rev 3:CD003145, 2005). Recent data have shown that between 6% and 10% of colon surgeries are performed using laparoscopic techniques in the United States (Kemp JA, Finlayson SR: Surg Endosc 22:1181-1187, 2008). With wider acceptance of these techniques, the natural evolution within the field of colorectal surgery was to apply them to rectal cancer surgery.