Endowrist Versus Wrist: A Case-controlled Study Comparing Robotic Versus Hand Assisted Laparoscopic Surgery for Rectal Cancer

Frederick H Koh, Ker-kan Tan, Charles B Tsang, Dean C Koh. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore

Introduction:

Laparoscopic total mesorectal excision (TME) is one of the most challenging colorectal procedures. This study aimed to compare the outcomes of robotic assisted laparoscopic (RAL) and hand assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers.

Methods:

A retrospective review of all patients who underwent RAL TME for mid to distal rectal cancers from October 2004 to August 2011 was performed. These cases were then matched for age, gender and stage of malignancy with patients who underwent HAL TME during the same period. Only patients who had TME completed laparoscopically were included.

Results:

The study group comprised of 19 RAL and 19 matched HAL patients with a median age of 61.5 (range, 47-92) years. Neoadjuvant chemo-radiotherapy was administered to eleven (28.9%) patients (RAL: 8 (42.1%), HAL: 3 (15.8%), p=0.048). There was no significant difference in the TNM stages of the disease between the groups. The median number of lymph nodes harvested were 16 and 14 for the RAL and HAL groups respectively.

The median operative times were significantly longer in the RAL group (390 vs. 225 minutes, p<0.001), and open conversions were required in 6 (15.8%) patients (RAL: 1 (5.3%), HAL: 5 (26.3%), p=0.180). There were no significant differences in the lengths of stay (RAL: 7, HAL: 6 days, p=0.476) and rates of peri-operative complications (RAL: 3 (15.8%), HAL: 7 (37.8%), p=0.269) between the 2 groups. The grades of the quality of the TME were similar in both groups as well. Circumferential resection margin involvements were seen in 2 (5.3%) patients (RAL: 2 (10.5%), HAL: 0 (0.0%), p=0.486).

Conclusions:

RAL TME can be performed safely for low rectal cancers with similar peri-operative outcomes in comparison with the HAL technique. There was no difference in the quality of surgical resection. However, operating times were significantly longer.