• Humans
• Robotic Surgical Procedures/trends
• Robotic Surgical Procedures/statistics & numerical data
• Robotic Surgical Procedures/methods
• Male
• Female
• Retrospective Studies
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Laparoscopy/trends
• Middle Aged
• Aged
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/epidemiology
• Adenocarcinoma/surgery
• Adenocarcinoma/epidemiology
• United States/epidemiology
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/trends
• Minimally Invasive Surgical Procedures/statistics & numerical data
• Colectomy/methods
• Colectomy/trends
• Colectomy/statistics & numerical data

• 5T32CA009599-33 National Institute of Health / National Cancer Institute

• anus function
• laparoscopic intersphincteric resection
• rectal cancer
• robotic intersphincteric resection
• short-term outcomes

• Colorectal Cancer
• Postoperative Complications
• Robotic surgery
• Survival Outcomes
• sarcopenia
• skeletal muscle index

• Humans
• Sarcopenia/complications
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/mortality
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Male
• Female
• Retrospective Studies
• Propensity Score
• Aged
• Middle Aged
• Prognosis
• Survival Rate

• SJCX24_2342 Postgraduate Research & Practice Innovation Program of Jiangsu Province
• (NO.81972269) National Natural Science Foundation of China

• health promotion
• non-communicable diseases
• rectal cancer
• risk factors
• robotic-assisted surgery

• Humans
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Operative Time
• Laparoscopy/adverse effects
• Length of Stay/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Blood Loss, Surgical/statistics & numerical data

• endoscopic surgery
• guideline
• large intestine

• Humans
• Clinical Competence
• Endoscopy, Gastrointestinal/standards
• Endoscopy, Gastrointestinal/education

• Laparoscopic surgery
• Meta-analysis
• Randomized controlled trials
• Rectal cancer
• Robotic surgery

• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/statistics & numerical data
• Treatment Outcome

• Laparoscopy
• Lateral lymph-node dissection
• Open surgery
• Rectal cancer
• Robot

• Humans
• Blood Loss, Surgical/statistics & numerical data
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Lymph Node Excision/methods
• Operative Time
• Postoperative Complications/epidemiology
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/methods
• Time Factors
• Treatment Outcome

• Colorectal
• Laparoscopy meta-analysis
• Robot-assisted
• Surgery

• Humans
• Colorectal Surgery
• Laparoscopy
• Obesity/complications
• Robotic Surgical Procedures/methods

• 22SXQT0017 Nanchong city school cooperation

• Future directions of robotic surgery
• New robotic surgical systems
• Robotic colorectal surgery

• Humans
• Robotic Surgical Procedures/methods
• Robotics
• Colorectal Surgery
• Digestive System Surgical Procedures
• Laparoscopy/methods
• Colorectal Neoplasms

• Endorectal ultrasound
• Pelvic lymph node dissection
• Rectal cancer
• Short-course radiotherapy
• Total neoadjuvant therapy

• CUSUM
• Learning curve
• Oncological outcomes
• Rectal cancer
• Robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Learning Curve
• Retrospective Studies
• Operative Time
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Laparoscopy/methods
• Treatment Outcome

• Implementation
• Laparoscopic surgery
• Oncological outcomes
• Rectal cancer
• Robotic surgery
• Robotic-assisted surgery

• Humans
• Robotic Surgical Procedures/methods
• Retrospective Studies
• Treatment Outcome
• Propensity Score
• Rectal Neoplasms
• Laparoscopy
• Surgeons

• Colorectal malignancy
• Gynaecological malignancy
• Laparoscopic surgery
• Minimally invasive surgery
• Pelvic exenteration
• Robotic surgery
• Surgical outcomes
• Urological malignancy

• Humans
• Pelvic Neoplasms/surgery
• Pelvic Neoplasms/pathology
• Pelvic Exenteration/methods
• Pelvis/pathology
• Minimally Invasive Surgical Procedures/methods
• Blood Loss, Surgical

• long-term outcomes
• rectal cancer
• robotic anterior resection
• total mesorectal excision

• Anal function
• Laparoscopic NOSES
• Middle rectal cancer
• Robotic NOSES
• Short-time outcomes

• 202310016 Science and technology plan project of Jiangxi Provincial Health Commission

• Robotic colorectal surgery
• Robotic pouch surgery, Robotic IPAA surgery

• Humans
• Proctocolectomy, Restorative/methods
• Robotic Surgical Procedures/methods
• Propensity Score
• Colonic Pouches/adverse effects
• Colitis, Ulcerative/surgery
• Treatment Outcome
• Laparoscopy/methods
• Anastomosis, Surgical/methods
• Postoperative Complications/etiology

• Hamad Medical Corporation

• Laparoscopic TME (LapTME)
• Open TME (OpTME)
• Rectal cancer
• Robotic TME (RoTME)
• Total mesorectal excision (TME)
• Transanal TME (TaTME)

• Humans
• Rectum/surgery
• Rectum/pathology
• Margins of Excision
• Robotic Surgical Procedures
• Treatment Outcome
• Transanal Endoscopic Surgery/methods
• Neoplasm Recurrence, Local/surgery
• Rectal Neoplasms/pathology
• Laparoscopy/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery

• Rectal cancer
• enhanced recovery
• laparoscopic surgery
• outcome
• robotic surgery

• Male
• Humans
• Robotic Surgical Procedures/methods
• Cross-Sectional Studies
• Postoperative Complications/etiology
• Rectal Neoplasms/surgery
• Rectum/surgery
• Laparoscopy/methods
• Treatment Outcome
• Retrospective Studies

• Bariatric surgery
• Laparoscopic surgery
• Robotic surgery
• SADI
• SADI-S
• Single anastomosis duodeno-ileal bypass with sleeve gastrectomy

• Adult
• Anastomosis, Surgical/methods
• Bariatrics
• Duodenum/surgery
• Gastrectomy/methods
• Gastric Bypass/adverse effects
• Humans
• Middle Aged
• Obesity, Morbid/complications
• Obesity, Morbid/surgery
• Retrospective Studies
• Weight Loss

The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL^® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL^®.

Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL^® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed.

Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47–80 years) and a median body mass index of 28 kg/m² (range 23–33 kg/m²). The median time to rectal transection was 155 min (range 118–280 min) and the median total operative time was 276 min (range 192–458 min). The median estimated blood loss was 30 ml (range 5–70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12–28). Total mesorectal excision (TME) quality was ‘good’ in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7–14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality.

Low anterior resection with ARTISENTIAL^® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL^® in comparison with standard laparoscopic instruments through a larger study.

The online version contains supplementary material available at 10.1007/s10151-022-02588-y.

• ARTISENTIAL
• Articulation
• Colorectal surgery
• Laparoscopy
• Low anterior resection

• Approach
• Laparoscopic
• Open
• Rectal cancer
• Robotic

• Chemoradiotherapy
• Neoadjuvant therapy
• Non-operative management
• Rectal cancer
• Surgery
• Watchful waiting

Robot-assisted surgery is being increasingly adopted in treating colorectal cancer, and the transition from laparoscopic surgery to robot-assisted surgery is a trend. The evidence of the benefits of robot-assisted surgery is sparse. However, findings are associated with improved patient-related outcomes and overall morbidity rates compared to laparoscopic surgery. This induction is unclear, considering both surgical modalities are characterized as minimally invasive. This study aims to evaluate the systemic and peritoneal inflammatory stress response induced by robot-assisted surgery compared with laparoscopic surgery for elective colon cancer resections in a prospective, randomized controlled clinical trial.

This study is a single-centre randomized controlled superiority trial with 50 colon cancer participants. The primary endpoint is the level of systemic inflammatory response expressed as serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels between postoperative days one and three. Secondary endpoints include (i) levels of systemic inflammation in serum expressed by a panel of inflammatory and pro-inflammatory cytokines measured during the first three postoperative days, (ii) postoperative surgical and medical complications (30 days) according to Clavien-Dindo classification and Comprehensive Complication Index, (iii) intraoperative blood loss, (iv) conversion rate to open surgery, (v) length of surgery, (vi) operative time, (vii) the number of harvested lymph nodes, and (viii) length of hospital stay. The exploratory endpoints are (i) levels of peritoneal inflammatory response in peritoneal fluid expressed by inflammatory and pro-inflammatory cytokines between postoperative day one and three, (ii) patient-reported health-related quality of recovery-15 (QoR-15), (iii) 30 days mortality rate, (iv) heart rate variability and (v) gene transcript (mRNA) analysis.

To our knowledge, this is the first clinical randomized controlled trial to clarify the inflammatory stress response induced by robot-assisted or laparoscopic surgery for colon cancer resections.

Trial registration This trial is registered at Clinicaltrials.gov (Identifier: NCT04687384) on December, 29, 2020, Regional committee on health research ethics, Region of Southern Denmark (N75709) and Data Protection Agency, Hospital Sønderjylland, University Hospital of Southern Denmark (N20/46179).

The online version contains supplementary material available at 10.1186/s12893-021-01355-4.

• Colon cancer
• Inflammatory surgical stress response
• Laparoscopic surgery
• Minimally invasive surgery
• Robot-assisted surgery

• practice guideline
• rectal cancer
• surgery
• treatment

• robotic surgical procedures
• exoskeleton device
• colorectal surgery
• colorectal neoplasms
• colonic neoplasms
• procedimentos cirúrgicos robóticos
• exoesqueleto energizado
• cirurgia colorretal
• neoplasias colorretais
• neoplasias do colo
• procedimentos cirúrgicos minimamente invasivos
• trato gastrointestinal

• Colorectal Surgery
• Digestive System Surgical Procedures
• Humans
• Laparoscopy
• Proctectomy
• Robotic Surgical Procedures

Background: Robotic colorectal surgery has been increasingly performed in recent years. The safety and feasibility of its application has also been demonstrated worldwide.However, limited studies have presented clinical data for patients with colorectal cancer (CRC) receiving robotic surgery in China. The aim of this study is to present short-term clinical outcomes of robotic surgery and further confirm its safety and feasibility in Chinese CRC patients.

Methods: The clinical data of 109 consecutive CRC patients who received robotic surgery at Sun Yat-sen University Cancer Center between June 2016 and May 2019 were retrospectively reviewed. Patient characteristics,tumor traits, treatment details, complications, pathological details, and survival status were evaluated.

Results: Among the 109 patients, 35 (32.1%) had sigmoid cancer, and 74 (67.9%) had rectal cancer. Thirty-seven (33.9%) patients underwent neoadjuvant chemoradiotherapy. Ten (9.2%) patients underwent sigmoidectomy, 38 (34.9%) underwent high anterior resection (HAR), 45 (41.3%) underwent low anterior resection (LAR), and 16 (14.7%) underwent abdominoperineal resection (APR). The median surgical procedure time was 270 min (range 120–465 min). Pathologically complete resection was achieved in all patients. There was no postoperative mortality. Complications occurred in 11 (10.1%) patients, including 3 (2.8%) anastomotic leakage, 1 (0.9%) anastomotic bleeding, 1 (0.9%) pelvic hemorrhage, 4 (3.7%) intestinal obstruction, 2 (1.8%) chylous leakage, and 1 (0.9%) delayed wound union. At a median follow-up of 17 months (range 1–37 months), 1 (0.9%) patient developed local recurrence and 5 (4.6%) developed distant metastasis, with one death due to disease progression.

Conclusions: Our results suggest that robotic surgery is technically feasible and safe for Chinese CRC patients, especially for rectal cancer patients who received neoadjuvant treatment. A robotic laparoscope with large magnification showed a clear surgical space for pelvic autonomic nerve preservation in cases of mesorectal edema.

• neoadjuvant chemoradiotherapy
• oncological outcome
• rectal cancer
• robotic surgery
• sigmoid cancer
• surgery outcome

• rectal cancer
• robotic low anterior resection
• robotic surgery
• total mesorectal excision

• colorectal surgery
• robotic colorectal surgery
• robotic surgery
• robotic training
• safety
• surgical innovation

Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR).

A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann–Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias.

A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10–0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001).

Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.

• Complications
• Conversion
• Laparoscopy
• Rectal resection
• Robotic

• Anisotropy
• Constitutive modeling
• Gastrointestinal
• Gut immune response
• Histology
• Multi-axial tensile experiments

• Colorectal surgery
• Enhanced recovery after surgery
• Laparoscopic
• Robotic surgery

• Laparoscopic surgery
• Micro Hand S surgical robot system
• Rectal cancer
• Robotic surgery
• Total mesorectal excision

Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted.

We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response.

Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates.

Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.

• Colorectal cancer
• Laparoscopic colorectal surgery
• Minimally invasive surgery
• Postoperative inflammatory stress response
• Robot-assisted colorectal surgery
• Surgical oncology

• Digestive System Surgical Procedures
• Humans
• Laparoscopy
• Rectal Prolapse/surgery
• Rectum/surgery
• Surgical Mesh
• Treatment Outcome

The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Fields such as general surgery, urology, and gynecology have widely adopted robotic surgery as part of everyday practice. The use of robotic systems in the field of spine surgery has recently begun to be explored. Surgical procedures involving the spine often require fixation via pedicle screw placement, which is a task that may be augmented by the use of robotic technology. There is little margin for error with pedicle screw placement, because screw malposition may lead to serious complications, such as neurologic or vascular injury. Robotic systems must provide a degree of accuracy comparable to that of already-established methods of screw placement, including free-hand, fluoroscopically assisted, and computed tomography–assisted screw placement. In the past several years, reports have cataloged early results that show the robotic systems are associated with equivalent accuracy and decreased radiation exposure compared with other methods of screw placement. However, the literature is still lacking with regard to long-term outcomes with these systems. This report provides a technical overview of robotics in spine surgery based on experience at a single institution using the ExcelsiusGPS (Globus Medical; Audobon, PA, USA) robotic system for pedicle screw fixation. The current state of the field with regard to salient issues in robotics and future directions for robotics in spinal surgery are also discussed.

• minimally invasive spine surgery
• neuronavigation
• pedicle screw fixation
• robotic spine surgery
• robotics

• morbidity and mortality in robotic surgery
• rectal neoplasm
• robotic colorectal surgery

• Minimally invasive colorectal surgery
• Robotic colorectal surgery
• Robotic rectal surgery
• Robotic surgery training
• Surgical training

• Circumferential resection margins
• Laparoscopy
• Rectal resection
• Robotic surgery
• Total mesorectal excision (TME)

Robotic surgery has progressively gained popularity in the treatment of rectal cancer. However, only a few studies on its oncologic effectiveness are currently present, with contrasting results. The purpose of this study is to report a single surgeon’s experience on robotic rectal resection (RRR) for cancer, focusing on the analysis of oncologic outcomes, both in terms of pathological features and long-term results. One-hundred and twenty-two consecutive patients who underwent RRR for rectal cancer from January 2013 to December 2019 were retrospectively enrolled. Patients’ characteristics and perioperative outcomes were collected. The analyzed oncologic outcomes were pathological features [distal (DM), circumferential margin (CRM) status and quality of mesorectal excision (TME)] and long-term outcomes [overall (OS) and disease-free survival (DFS)]. The mean operative time was 275 (± 60.5) minutes. Conversion rate was 6.6%. Complications occurred in 27 cases (22.1%) and reoperation was needed in 2 patients (1.5%). The median follow-up was 30.5 (5.9–86.1) months. None presented DM positivity. CRM positivity was 2.5% (2 cases) while a complete TME was reached in 94.3% of cases (115 patients). Recurrence rate was 5.7% (2 local, 4 distant and 1 local plus distant tumor relapse). OS and DFS were 90.7% and 83%, respectively. At the multivariate analysis, both CRM positivity and near complete/incomplete TME were recognized as negative prognostic factors for OS and DFS. Under appropriate logistic and operative conditions, robotic surgery for rectal cancer proves to be oncologically effective, with adequate pathological results and long-term outcomes. It also offers acceptable peri-operative outcomes, further confirming the safety and feasibility of the technique.

• Long-term outcomes
• Oncological outcomes
• Rectal cancer
• Robotic surgery

• Humans
• Laparoscopy
• Neoplasm Recurrence, Local/epidemiology
• Rectal Neoplasms/surgery
• Retrospective Studies
• Robotic Surgical Procedures
• Treatment Outcome

• Università Cattolica del Sacro Cuore

Despite the technical limitations of minimally invasive surgery, laparoscopic total mesorectal excision (LTME) for rectal cancer has short-term advantages over open surgery, but the pathological outcomes reported in randomized clinical trials are still in controversy. Minimally invasive robotic total mesorectal excision (RTME) has recently been gaining popularity as robotic surgical systems potentially provide greater benefits than LTME. Compared to LTME, RTME is associated with lower conversion rates and similar or better genitourinary functions, but its long-term oncological outcomes have not been established. Although the operating time of RTME is longer than that of LTME, RTME has a shorter learning curve, is more convenient for surgeons, and is better for sphincter-preserving operations than LTME. The robotic surgical system is a good technical tool for minimally invasive surgery for rectal cancer, especially in male patients with narrow deep pelvises. Robotic systems and robotic surgical techniques are still improving, and the contribution of RTME to the treatment of rectal cancer will continue to increase in the future.

• Rectal neoplasms
• Robotic surgical procedures
• Total mesorectal excision

• En bloc lymphadenectomy
• Esophageal cancer
• Extended transhiatal esophagectomy
• Long-term survival
• Short-term outcome