Robot-assisted laparoscopic rectal surgery: operative technique and initial experiences

A minimally invasive access for rectal surgery provides many advantages. Still, laparoscopic surgery has its limits when it comes to preparation in the small, narrow pelvis. Technical features of robot-assisted surgery have the high potential to overcome these limitations. The operative technique of robot-assisted laparoscopic rectal surgery is described according to the experience of our department and based on a literature survey using Medline (PubMed). Data of our patients were obtained by retrospective analysis. From May 2015 to June 2020, 192 surgical interventions of the rectum were carried out with the DaVinci® Xi system (Intuitive Surgical, CA, USA) in our department. 3D visualization, ability to scale motions, and steady presentation enable an improved view of the operative field and a better anatomical discrimination of nerves and other structures. Articulated instruments with seven degrees of freedom increase the range of motion. Therefore, pelvic dissection can gain precision and accuracy. Taking all aspects into consideration, robotic surgery might be a good prognostic factor for oncologic and functional outcome. Further technical developments like robotic single-port platforms might even expand the possibilities of dissection. Superior or equal oncological results and long-term outcomes compared to conventional open or laparoscopic techniques have yet to be examined and should be the subject of future randomized clinical trials.