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Page 2 of 8 Kavalukas et al. Mini-invasive Surg 2020;4:61 I http://dx.doi.org/10.20517/2574-1225.2020.71
[2-5]
bowel obstruction, wound complications, and mortality . The disadvantages of laparoscopic surgery
comprise a relative loss of tactile sensation compared to open surgery and technical difficulty with fine
movement. There is heightened awareness of surgeon ergonomics due to overuse injuries and workplace
musculoskeletal disorders in laparoscopic surgeons. Improper table height, position of the monitors, and
handling of long instruments are factors contributing to these afflictions.

The introduction of the robotic DaVinci operating system (Sunnyvale, CA) in 2000 brought forth another
dimension of minimally invasive technology. This platform was utilized in colorectal surgery in March 2001
[6]
when the first sigmoid and right colectomies were described . Robotic surgery has now gained widespread
acceptance both in terms of surgeon satisfaction and patient outcomes. The strengths of robotic surgery
lie principally in wristed instruments providing seven degrees of freedom. Many surgeons endorse greater
comfort during the procedure, improved visualization of the operative field, and less technical difficulty
operating in challenging locations including the narrow pelvis. The limitations of robotic surgery can
include the operative time required to dock the robot, loss of tactile sensation, and increased cost compared
to laparoscopic surgery.

Standards by which successful surgical outcomes are evaluated examine intraoperative events, postoperative
complications, and long-term sequelae. These facets have been extensively studied comparing laparoscopic
and robotic surgery. This paper explores any potential differences between the two methods regarding non-
oncological perioperative outcomes. Conversion rate, postoperative pain or ileus, anastomotic leak, surgical
site infection, length of stay, cost, long-term urogenital function, and learning curve are the specific topics
that are addressed.

INTRAOPERATIVE OUTCOME
Conversion rate
Challenges that present to a surgeon include patient body habitus, fibrosis from chronic inflammatory
processes, adherence to surrounding structures by infiltrating tumours, and adhesions from previous
surgeries. These situations can result in conversion to an open procedure. One of the unique tasks specific
to colorectal surgeons is removing a low rectal tumour. Particularly in a narrow pelvis, this task can be
challenging due to the limited range of motion of laparoscopic instruments. Colorectal robotic surgery
first gained popularity specifically for this scenario. Precise dissection down to the pelvic floor with wristed
instruments facilitates total mesorectal excision over the pelvic brim.

Given the above situations, investigators hypothesized that robotic surgery would result in a lower
conversion rate compared to laparoscopic procedures, but the data exhibit many conflicting reports when
examining conversion rates. One must consider the research design when interpreting these results. A few
studies utilized nation-wide databases, while others performed retrospective reviews, case-matched studies,
or propensity-matched groups. Several studies report equivalent conversion rates between laparoscopic and
robotic procedures [7-10] . Feinberg et al. performed a retrospective National Surgical Quality Improvement
[11]
Program study of over 8,864 patients undergoing either laparoscopic or robotic colorectal procedures,
finding a statistically significant difference in the conversion rate of 13.7% and 9.5% for laparoscopic and
robotic procedures, respectively (P < 0.008). A subgroup analysis was performed to identify risk factors for
increased conversion rates, finding that patients with colon cancer [odds ratio (OR) 1.8], Crohn’s disease
(OR 2.19), and diverticular disease (OR 1.9) had higher likelihood of conversion. The two most interesting
findings in this study were that neither body mass index > 30 kg/m nor rectal resection procedures
2
conferred a significant risk of conversion to open. These findings are noteworthy because body habitus and
pelvic operations had been theorized as situations in which the use of the surgical robot would confer an
advantage.