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Laparoscopic Versus Robotic Rectal Resections. Comparative Analysis of Perioperative Results

Vesselin Marinov

Abstract

INTRODUCTION: Globally, the minimally invasive approach in colorectal surgery is accepted as more effective compared to open surgery in terms of better perioperative results with comparable oncological long-term ones. Laparoscopy in low rectal resection is challenging, even for experienced surgeons and is related to a high conversion rate. Robotic surgery has advantages in rotations of the instruments, 3D image, ergonomic position of the surgeon, precise movements, and intelligent systems for electrosurgery. The advantages are more visible in dissections in narrow spaces, such as the pelvis. On the other hand, the operating theater price of robotic surgery is higher compared to conventional laparoscopy. There are still limitations of both techniques in cases of advanced rectal cancer, obesity patients, and previous major surgery. Collected data in the literature show lower conversion rates in robotic rectal resections.

AIM: The aim of this article is to conduct a comparative analysis of the perioperative results of a personal series of patients with laparoscopic and robotic rectal resections. We aim to assess the levels of perioperative complications and conversion rate.

MATERIALS AND METHODS: This study is based on an individual series of 76 minimally invasive rectal resections divided into two subgroups—46 laparoscopic resections and 30 robotic ones. An assessment is performed on perioperative results using all clinical methods

RESULTS: There were no differences between the patients according to gender and age distribution. The male to female ratio was approximately 2:3. In the group of laparoscopic operations, 21 were high anterior rectal resections. In the group of robotics, the number of high resections was only 4. The conversion rate for the laparoscopic group was 23.9% compared with 12.9% for the robotic one. The mortality rate was 0% for both techniques. The perioperative morbidity rate was 11.4% for the laparoscopic group and 19.2% for the robotic one. The median operative time the laparoscopic group vs. the robotic group was 144.7 min vs. 194.7 min; the median hospital stay—6.0 vs. 6.2 days; the median blood loss—34.7 vs. 43.9 mL; the extracted lymph nodes—12.2 vs. 8.8, respectively.

CONCLUSION: Robotic rectal resections have a lower conversion rate. It seems to have higher morbidity rate with the other perioperative results being comparable to conventional laparoscopy. The prevalence of low rectal resections in the group of robotic operations might explain this fact.


Keywords

robotic resection, rectal, laparoscopic, conversion

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DOI: http://dx.doi.org/10.14748/ssm.v55i0.9290
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About The Author

Vesselin Marinov
Medical University of Varna, Bulgaria HBP and General Surgery Clinic, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

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