Robotic Nerve-Sparing Total Mesorectal Excision

The laparoscopic approach to rectal cancer is a technically difficult procedure associated with a long learning curve, leading to high rates of conversion to open surgery and to a high risk of involvement of the resection margins. The robotic-assisted approach could overcome some limitations of conventional laparoscopy in rectal surgery, thanks to its steady camera, wristed motion of instruments, and greater ergonomic comfort, especially in very small surgical fields and when a high level of precision is required. Although the results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting, data from population-based multicenter studies have shown the potential advantages of robotic surgery over conventional laparoscopy in terms of reduced conversion and complication rates and shorter length of stay. Otherwise, no differences have been found regarding involvement of the circumferential and distal resection margins and long-term oncological outcomes. One of the main drawbacks of robotic surgery is the higher costs related to the purchase and maintenance of robotic equipment. However, the costs should be carefully evaluated taking into account both the direct and indirect costs, the latter including the savings related to the lower complication rates and shorter hospital stays and therefore potentially counterbalancing the high direct costs.