• Erectile dysfunction
• Meta-analysis
• Rectal cancer
• Rectal neoplasms
• Sexual dysfunctions
• Surgery
• Systematic review

• Humans
• Rectal Neoplasms/surgery
• Erectile Dysfunction/epidemiology
• Erectile Dysfunction/etiology
• Male
• Prevalence
• Postoperative Complications/epidemiology
• Time Factors

• Functional outcomes
• Meta-analysis
• Quality of life
• Rectal cancer
• Systematic review
• Total mesorectal excision

• Humans
• Rectal Neoplasms/surgery
• Quality of Life
• Robotic Surgical Procedures/methods
• Laparoscopy/methods
• Transanal Endoscopic Surgery/methods
• Proctectomy/methods
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Treatment Outcome

• Health-related quality of life
• Neoadjuvant chemotherapy
• Prognostic factors
• Rectal cancer

• Autonomic nerve
• Raman spectroscopy
• colorectal cancer
• minimally invasive surgery
• postoperative dysfunction

• Hybrid surgery
• Laparoscopic surgery
• Rectal cancer
• Robotic surgery
• Transanal total mesorectal excision (TaTME)

We aimed to evaluate the advantages and disadvantages of initial robotic surgery for rectal cancer in the introduction phase. This study retrospectively evaluated patients who underwent initial robotic surgery (n = 36) vs. patients who underwent conventional laparoscopic surgery (n = 95) for rectal cancer. We compared the clinical and pathological characteristics of patients using a propensity score analysis and clarified short-term outcomes, urinary function, and sexual function at the time of robotic surgery introduction. The mean surgical duration was longer in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (288.4 vs. 245.2 min, respectively; p = 0.051). With lateral pelvic lymph node dissection, no significant difference was observed in surgical duration (508.0 min for robot-assisted laparoscopy vs. 480.4 min for conventional laparoscopy; p = 0.595). The length of postoperative hospital stay was significantly shorter in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (15 days vs. 13.0 days, respectively; p = 0.026). Conversion to open surgery was not necessary in either group. The International Prostate Symptom Score was significantly lower in the robot-assisted laparoscopy group compared with the conventional laparoscopy group. Moderate-to-severe symptoms were more frequently observed in the conventional laparoscopy group compared with the robot-assisted laparoscopy group (p = 0.051). Robotic surgery is safe and could improve functional disorder after rectal cancer surgery in the introduction phase. This may depend on the surgeon’s experience in performing robotic surgery and strictly confined criteria in Japan.

• Laparoscopic surgery
• Propensity score analysis
• Rectal cancer
• Robotic surgery

• clinical efficacy
• da Vinci robot
• intersphincteric resection
• laparoscope
• low rectal cancer

• Erectile dysfunction
• colorectal surgery
• rectal cancer
• rectal tumors

The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincter-preserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and long-term oncological outcomes, lateral lymph node dissection, and the cost of the procedure.

• Laparoscopic surgery
• Lateral lymph node dissection
• Mesorectal excision
• Minimally invasive surgery
• Rectal cancer
• Robotic surgery

• PROM
• Urinary dysfunction
• rectal cancer

During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci^® robotic system. The fourth generation da Vinci^® system, introduced in 2014, includes integrated table motion, intelligent laser targeted docking and more sophisticated instrumentation and imaging. These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations. Firefly^® technology allows assessment of colon perfusion and identification of ureters, and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers. Wristed instrumentation has increased the technical ease of intracorporeal anastomosis (ICA) for many surgeons, leading to more common use of ICA during right colectomy. Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery, as has been the case in robotic urologic procedures. Finally, the robotic platform lends itself to surgical simulation for surgical trainees, as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons. Given these advantages, surgeons should anticipate continued and increased utilization of this beneficial technology.

• Robotic
• Colorectal
• Infrared
• Intracorporeal
• Simulation
• Skills assessment

• Laparoscopic surgery
• Rectal cancer
• Robotic surgery
• Sexual function
• Urinary function
• Urogenital function

To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.

A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.

Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.

There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

• Rectal neoplasms
• Robotic surgical procedures
• Colorectal surgery
• Sexual dysfunction
• Physiological
• Urinary bladder
• Neurogenic
• Humans

• Robotic surgery
• minimally invasive surgery (MIS)
• rectal dissection
• robotic-assisted surgery
• total mesorectal excision (TME)