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Chouhan et al. Mini-invasive Surg 2018;2:18 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.40

Review Open Access

Is robotic rectal resection the preferred option for
resectable cancer?

Hanumant Chouhan , James Shin , Seon-Hahn Kim 1
3
1,2
1 Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul
02841, South Korea.
2 Department of Colorectal Surgery, Monash Health, Melbourne 3175, Australia.
3 Nepean Hospital, Kingswood, Sydney 2747, Australia.

Correspondence to: Prof. Seon-Hahn Kim, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea
University College of Medicine, Seoul 02841, South Korea. E-mail: drkimsh@korea.ac.kr

How to cite this article: Chouhan H, Shin J, Kim SH. Is robotic rectal resection the preferred option for resectable cancer? Mini-
invasive Surg 2018;2:18. http://dx.doi.org/10.20517/2574-1225.2018.40

Received: 11 Jun 2018 First Decision: 2 Jul 2018 Revised: 16 Jul 2018 Accepted: 17 Jul 2018 Published: 20 Jul 2018
Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
The ultimate goal of rectal cancer surgery is to achieve a negative circumferential, distal resection margin and intact
mesorectal excision; however, controversy remains as to what is the best approach. Based on the current evidence, open
surgery remains the “gold standard”, however recent improvements in minimally invasive surgery (MIS) techniques with
the introduction of robotic surgery and transanal total mesorectal excision have questioned the historical approach of
open rectal dissection. A robotic system (da Vinci) overcomes many of the limitations of laparoscopic surgery. A robotic
system is more like an open surgery: it gives a 3-dimensional magnified view, endowrist movements, has a shorter learning
curve when compared with laparoscopic surgery, with the added advantage of an MIS procedure. However, the higher cost
associated with robotic surgery has limited uptake of this approach in rectal cancer surgery in many parts of world.

Keywords: Rectal cancer, open surgery, robotic surgery

INTRODUCTION
Complete mesorectal excision in the total mesorectal excision (TME) plane, as popularised by Prof. Heald,
is the ultimate goal of rectal cancer surgery, as this technique has been shown to reduce local recurrence
rates. The controversy, though, lies in defining the best approach to achieve good quality TME. Laparoscopic
colorectal resection has been shown to improve postoperative pain, reduce blood loss, reduce the ileus rate,
as well as lead to earlier recovery and hospital discharge . However, data on oncological outcomes after
[1]

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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