ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Robotic Versus Laparoscopic Low Anterior Resection of Rectal
Cancer: Short-Term Outcome of a Prospective Comparative
Study
Seung Hyuk Baik, MD
1
, Hye Youn Kwon, MD
1
, Jin Soo Kim, MD
1
, Hyuk Hur, MD
1
, Seung Kook Sohn, MD
1
,
Chang Hwan Cho, MD
1
, and Hoguen Kim, MD
2
1
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea;
2
Department of Pathology, Yonsei
University College of Medicine, Seoul, Korea
ABSTRACT
Background. The aim of this study is to compare the
short-term results between robotic-assisted low anterior
resection (R-LAR), using the da Vinci
Ò
Surgical System,
and standard laparoscopic low anterior resection (L-LAR)
in rectal cancer patients.
Methods. 113 patients were assigned to receive either R-
LAR (n = 56) or L-LAR (n = 57) between April 2006 and
September 2007. Patient characteristics, perioperative
clinical results, complications, and pathologic details were
compared between the groups. Moreover, macroscopic
grading of the specimen was evaluated.
Results. Patient characteristics were not significantly dif-
ferent between the groups. The mean operation time was
190.1 ± 45.0 min in the R-LAR group and
191.1 ± 65.3 min in the L-LAR group (P = 0.924). The
conversion rate was 0.0% in the R-LAR groups and 10.5%
in the L-LAR group (P = 0.013). The serious complication
rate was 5.4% in the R-LAR group and 19.3% in the L-LAR
group (P = 0.025). The specimen quality was acceptable in
both groups. However, the mesorectal grade was complete
(n = 52) and nearly complete (n = 4) in the R-LAR group
and complete (n = 43), nearly complete (n = 12), and
incomplete (n = 2) in the L-LAR group (P = 0.033).
Conclusion. R-LAR was performed safely and effectively,
using the da Vinci
Ò
Surgical System. The use of the system
resulted in acceptable perioperative outcomes compared to
L-LAR.
Recently, laparoscopic colorectal resection has been
popularized because it results in decreased postoperative
pain, shorter length of hospitalization, and earlier return to
normal functioning, and increasing demand for laparo-
scopic surgery from patients.
1–3
However, rectal cancer
surgery is a more technically demanding procedure than
colon cancer surgery because it is performed in the narrow
pelvic cavity. Thus, the surgeon needs highly technical
skills for the laparoscopic rectal resection.
Meanwhile, the da Vinci
Ò
Surgical System (Intuitive
Surgical, Sunnyvale, CA, USA) was developed to over-
come the disadvantages of conventional laparoscopic
surgery such as an assistant-dependent unstable camera
platform, two-dimensional view, limited dexterity of
instruments inside the patient, and fixed instrument tips.
4,5
Moreover, the robotic system provides excellent ergo-
nomics, tremor elimination, ambidextrous capability,
motion scaling, and instruments with multiple degrees of
freedom. These advantages of the robotic system are even
more beneficial when the operation field is narrow such as
in prostatectomy. Thus, the robotic system’s applications
have expanded since it was first used in urology in June
2006.
6
We thought that the robotic system would have the
same beneficial effect when used for rectal dissection such
as prostatectomy in the urology area. These two kinds of
surgeries have the same narrow operation field. Therefore,
we have used the robotic system for rectal cancer surgery
since 2006.
7
Robotic colorectal surgery was first performed
in 2001.
8
However, experience with robotic rectal cancer
surgery has been limited worldwide. Moreover, few pre-
vious studies have assessed its use for rectal cancer surgery
compared with conventional laparoscopic surgery. There-
fore, this study was designed to evaluate the difference of
the short-term outcome after robotic or conventional
Ó Society of Surgical Oncology 2009
First Received: 11 August 2008;
Published Online: 17 March 2009
S. H. Baik, MD
e-mail: whitenoja@yuhs.ac
Ann Surg Oncol (2009) 16:1480–1487
DOI 10.1245/s10434-009-0435-3