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Sebastián-Tomás et al. Mini-invasive Surg 2019;3:30 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.29

Review Open Access

Robotic total mesorectal excision: state of the art

Juan Carlos Sebastián-Tomás , Sandra Santarrufina-Martínez , Sergio Navarro-Martínez , Paula
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Gonzálvez-Guardiola , Elías Martínez-López , Carmen Payá-Llorente , Eduardo García-Granero , Aleix
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Martínez-Pérez 1
1 Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia 46017, Spain.
2 Department of General and Digestive Surgery, Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain.
Correspondence to: Dr. Aleix Martínez-Pérez, Department of General and Digestive Surgery, Hospital Universitario Doctor
Peset, Avenida Gaspar Aguilar 90, Valencia 46017, Spain. E-mail: aleix.martinez.perez@gmail.com
How to cite this article: Sebastián-Tomás JC, Santarrufina-Martínez S, Navarro-Martínez S, Gonzálvez-Guardiola P, Martínez-
López E, Payá-Llorente C, García-Granero E, Martínez-Pérez A. Robotic total mesorectal excision: state of the art.
Mini-invasive Surg 2019;3:30. http://dx.doi.org/10.20517/2574-1225.2019.29
Received: 27 Aug 2019 First Decision: 23 Sep 2019 Revised: 3 Oct 2019 Accepted: 11 Oct 2019 Published: 15 Oct 2019

Science Editor: Nicola de'Angelis Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Minimally-invasive conventional up-to-down laparoscopic approach is a widespread alternative for rectal cancer
resection. Its potential benefits towards open surgery have been shown to rely, however, at secondary clinical outcomes,
and its oncological non-inferiority compared with the traditional open approach has not been demonstrated yet. In
this scenario, robotic-assisted minimally-invasive rectal resection has gained increasing popularity and promising
expectancies. This narrative review aims to assemble the most updated evidence available and to discuss the future
perspectives and challenges for this emergent surgical tool. The main benefit over conventional laparoscopy appears
to be a reduction of conversion rates to open surgery, whereas the oncologic and functional outcomes seem similar
than the other alternatives. Increased costs are the main limitation of the widespread of robotic technology. Low
quality of the current evidence is remarkable.

Keywords: Rectal cancer, total mesorectal excision, robotic surgery, minimally-invasive surgery

INTRODUCTION
In 2018, colorectal cancer (CRC) was the third most commonly diagnosed cancer (10.2%), and the second
leading cause of cancer death (9.2%). Nearby two million of new CRC cases and more than 800,000 deaths
[1]
were estimated to occur worldwide in 2018 . Surgery remains as the mainstay treatment for rectal cancer,
improvements on the outcomes have been observed since the introduction and widespread of the principles

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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