Page 26 - Read Online

Moroni et al. Mini-invasive Surg 2019;3:36 I http://dx.doi.org/10.20517/2574-1225.2019.34 Page 5 of 12

Table 3. Table post-operative
Clavien-Dindo postoperative complications
Author Conversion (%) Leak Reoperation (%) Readmission (%)
1 (%) 2 (%) 3 (%) 4 (%)
Ballantyne et al. 19] 0 0
D’Annibale et al. [20] 0 1 (2) 0 1 (2) 0
Juo et al. [21] 1 (3.2) 0 0 0
Trastulli et al. [17] 4 (3.9) 3 (2.9) 7 (6.8) 0
Formisano et al. [22] 1 (1.8) 0 0 0
Petz et al. [23] 0 0 0 2 (10) 0 0 0 0
Lujan et al. [24] 2 (2.3) 19 (21.3) 6 (6.7) 1 (1.1) 0 1 (1.1) 1 (1.1) 2 (2.2)
Mégevand et al. [25] 0 2 (4)
Blumberg [26] 0
Cleary et al. [27]
Scotton et al. [28] 5 (2.4) 1 (0.4) 6 (2.9)
Johnson et al [29] 0 0 0
Spinoglio et al. [30] 0 2 (2) 1 (0.9) 2 (2)
Park et al. [31] 0 1 (2.8) 1 (2.8) 1 (2.8) 0
Schulte et al. [32] 0 9 (29) 2 (6.4) 0 0 0

robotic assistance [55,56] . EA may require an extensive mobilization of the transverse colon for reaching
the specimen extraction incision [54,57] . Two recent meta-analyses in LRC have shown shorter time for
first defecation, and oral liquid diet, and decreased length of hospital stay in the IA group [58,59] . Van
[59]
Oostendorp et al. also showed a reduction of the short-term postoperative morbidity and surgical-
site infection rate in the IA group. No differences were found regarding the other short-term clinical and
[59]
histopathological variables evaluated . Technical advantages of robotic surgery permit performing
[25]
an IA more easily. Mégevand et al. reported a series of 100 cases comparing RRC and LRC with IA,
and they observed faster intestinal recovery and fewer conversions in the RRC group. Solaini et al. , in a
[60]
subgroup meta-analysis comparing only EA, found no significant differences between RRC and LRC. To
date, no randomized controlled trial has been reported comparing RRC and LRC with the same type of
anastomosis. Further studies are therefore needed before drawing any conclusion regarding the potential
benefits of both IA and robotic assistance in decreasing the odds of anastomotic leak or improving
intestinal recovery after RC.

THREE-DIMENSIONAL VERSUS TWO-DIMENSIONAL VIEW IN LRC
Since the first steps of minimally-invasive surgical procedures, technological research continues to improve
its outcomes. In the field of surgical view, a notorious revolution is expected and it is still ongoing. The
new laparoscopic platforms together with the new generation of optics allow exceeding the limits of the
two-dimensional (2D) view. Abdelrahman et al. reported that three-dimensional (3D) optics with ultra-
[61]
[62]
high definition 4k allow a faster learning curve. This experimental evidence was confirmed by Currò et al. ,
who concluded that the 3D vision improves the depth of perception, which is especially useful in performing
an IA, and it also produces less physical strain to the surgeon. However, further studies are needed before
drawing any definitive conclusions regarding the potential benefits of 3D (with or without 4k) versus
conventional 2D. To date, the choice between 3D and 2D systems relies only on the surgeon’s preferences
and the hospital’s resources.

LEARNING CURVE OF MINIMALLY-INVASIVE RC
Robotic surgery, similar to all the minimally-invasive surgical procedures, requires the acquisition of
specific abilities and skills. The learning curve is the number of cases required to achieve expertise with
minimal procedural time and complications [63,64] . LRC requires a high degree of dexterity and technical
skills which result in a learning curve of 20-30 procedures [36,65,66] ; this number may increase with IA
[67]
[59]
fashioning . Operative time for the first cases of robotic surgery is shorter than that in laparoscopy .