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Original Articles
Minimally invasive surgery
Expanding the boundaries of minimally invasive surgery: the feasibility of robotic natural orifice transluminal extraction colectomy and robotic no-incision colectomy in colorectal practice
Thalia Petropoulou, Kyriacos Evangelou, Andreas Polydorou
Ann Coloproctol. 2025;41(4):346-353.   Published online August 28, 2025
DOI: https://doi.org/10.3393/ac.2025.00647.0092
  • 1,396 View
  • 30 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
Minimally invasive surgery offers reduced trauma, accelerated recovery, and shorter hospital stays. Robotic technology further enhances laparoscopic precision, particularly in colorectal procedures. This study investigated the safety and effectiveness of robotic natural orifice transluminal extraction colectomy (R-NOTEC) and robotic no-incision colectomy (R-NIC), comparing these techniques to the conventional robotic colectomy.
Methods
Outcomes of patients undergoing robotic-assisted colorectal resection—either conventional robotic colectomy or R-NOTEC/R-NIC—using a single docking technique at a tertiary hospital over 3 years were analyzed. All patients were managed according to established Enhanced Recovery After Surgery protocols.
Results
In total, 100 patients were included, with 25 receiving R-NOTEC or R-NIC. The median age was 65 years (range, 30–82 years), and the median body mass index was 31.0 kg/m2 (range, 20.1–43.0 kg/m2). The median length of stay was significantly shorter in the R-NOTEC/R-NIC group than in the conventional robotic group (2.0 days vs. 3.4 days, P=0.021). Other outcomes, such as circumferential resection margin status, lymph node yield, and mortality, were similar between groups. The R-NOTEC/R-NIC group exhibited a slightly lower complication rate, as well as less opioid use. No conversions to open surgery occurred in either group.
Conclusion
R-NOTEC/R-NIC offer significant promise in colorectal surgery by minimizing trauma, expediting recovery, and maintaining oncologic safety. Nevertheless, these procedures require specialized surgical expertise and careful patient selection. Further research should focus on long-term outcomes and standardization of these techniques. 

Citations

Citations to this article as recorded by  
  • Robotic-Assisted Surgery in Emergency General Surgery: A Prospective, Single-Center, Case Series
    Thalia Petropoulou, Kyriacos Evangelou, Andreas Polydorou
    Cureus.2025;[Epub]     CrossRef
  • Minimally Invasive Versus Conventional Colectomy: Evaluating Clinical Outcomes, Complications, and Recovery in Modern Surgical Practice
    Vaseem Akram Vadhooth, Krishnaprasad K, Priyanka L Reddy, Sailesh Kumar S
    Cureus.2025;[Epub]     CrossRef
Minimally invasive surgery
Propensity score–matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci
Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Hiromi Kanai, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise
Ann Coloproctol. 2025;41(4):310-318.   Published online August 25, 2025
DOI: https://doi.org/10.3393/ac.2025.00136.0019
  • 2,641 View
  • 44 Download
  • 1 Web of Science
  • 1 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
The hinotori Surgical Robot System (hereafter “hinotori”) is a novel platform for robot-assisted surgery, while the da Vinci Surgical System (“da Vinci”) remains the field standard. This study compared short-term surgical outcomes of rectal cancer surgery between these systems using propensity score–matched analysis.
Methods
A retrospective analysis was conducted of 209 consecutive patients who underwent robot-assisted surgery with the da Vinci and 58 patients with the hinotori system. After 2:1 propensity score matching, 108 da Vinci and 54 hinotori cases were included. Surgical outcomes, including operative time, blood loss, postoperative complications, length of hospital stay, and pathological findings, were compared.
Results
After matching, the baseline demographics were well balanced between groups. The hinotori system was associated with significantly longer operative time (266 minutes vs. 227 minutes, P=0.014) and console time (156 minutes vs. 110 minutes, P=0.001). However, estimated blood loss and postoperative complication rate did not differ significantly. Pathological findings, including the number of lymph nodes retrieved and the incidence of positive surgical margins, were comparable between systems.
Conclusion
In rectal surgery, the hinotori system demonstrates comparable short-term safety outcomes to da Vinci. Despite longer operative times and limited integrated instrumentation, hinotori‐assisted procedures may be feasible in selected patients. Further research should address long-term oncological outcomes and strategies to improve procedural efficiency.

Citations

Citations to this article as recorded by  
  • Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci
    Sung Uk Bae
    Annals of Coloproctology.2025; 41(4): 259.     CrossRef
Minimally invasive surgery
Robotic surgery may lead to reduced postoperative inflammatory stress in colon cancer: a propensity score–matched analysis
Eun Ji Park, Gyong Tae Noh, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Byung Soh Min
Ann Coloproctol. 2024;40(6):594-601.   Published online December 6, 2024
DOI: https://doi.org/10.3393/ac.2024.00171.0024
  • 3,246 View
  • 91 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDFSupplementary Material
Purpose
Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.
Methods
This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.
Results
After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.
Conclusion
Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.

Citations

Citations to this article as recorded by  
  • Übergangsphase zur roboterassistierten Chirurgie beim kolorektalen Karzinom: eine vergleichende konsekutive Kohortenstudie
    U. A. Dietz, M. Kalisvaart, S. Maksimovic, R. Frey, M. Ramser, B. M. Erhart, U. Pfefferkorn
    Die Chirurgie.2025; 96(11): 942.     CrossRef
  • Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon
    Hao Chen, Dong-Ping Han, Jian-Yang Xiong, Zhen-Sheng Li, Teng-Cheng Hu, Zheng-Rong Li, Yi Cao
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Comparison of the perioperative outcomes of robotic vs. open distal pancreatectomy: a meta-analysis of propensity-score-matched studies
    Junjie Wang, Yuanjun Liu, Yakun Wu
    Frontiers in Surgery.2025;[Epub]     CrossRef
  • Effectiveness of Guardix-SG in Preventing Postoperative Bowel Complications After Radical Cystectomy: A Single-Arm Prospective Observational Study
    Jiwoong Yu, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Seong Il Seo, Seong Soo Jeon, Byong Chang Jeong
    Journal of Urologic Oncology.2025; 23(3): 253.     CrossRef
  • Laparoscopic surgery should be a viable option for T4 colon cancer: evidence from a propensity score matching analysis
    Xiaomei Jiang, Hang Zhou, Zhaoyang Zheng, Xiaodong Wang, Zongguang Zhou, Lie Yang
    Updates in Surgery.2025;[Epub]     CrossRef
Video
Minimally invasive surgery
Robotic abdominoperineal resection, bilateral robotic groin node dissection and simultaneous perineal gracilis flap reconstruction for locally advanced node-positive anal squamous cell carcinoma
Mohammed Ali, Melanie Holzgang, Vivekanandan Kumar, Dhalia Masud, Sandeep Kapur, Ahmed El-Hadi, Dolly Dowsett, Irshad Shaikh
Ann Coloproctol. 2024;40(6):613-615.   Published online December 2, 2024
DOI: https://doi.org/10.3393/ac.2023.00801.0114
  • 2,566 View
  • 72 Download
PDFSupplementary Material
Review
Minimally invasive surgery
Robotic colorectal surgery training: Portsmouth perspective
Guglielmo Niccolò Piozzi, Sentilnathan Subramaniam, Diana Ronconi Di Giuseppe, Rauand Duhoky, Jim S. Khan
Ann Coloproctol. 2024;40(4):350-362.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00444.0063
  • 8,440 View
  • 151 Download
  • 6 Web of Science
  • 6 Citations
AbstractAbstract PDF
This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Citations

Citations to this article as recorded by  
  • Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
    Engeng Chen, Li Chen, Wei Zhang
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • Entwicklung und Implementation eines strukturierten Ausbildungsprogramms in der robotischen Chirurgie
    Sarah Englert, Natascha Tschukewitsch, Alexa Wölfl, Christoph Justinger
    Die Chirurgie.2025; 96(9): 765.     CrossRef
  • The evolution of training in robotic colorectal surgery
    R. Smyth, N. Francis, S. Vasudevan
    Journal of Robotic Surgery.2025;[Epub]     CrossRef
  • Evaluating the Toumai MT‑1000 for urologic surgery: a systematic review and single-arm meta-analysis with remote and on-site experiences
    Chi Zhang, Jinwan Wang
    Journal of Robotic Surgery.2025;[Epub]     CrossRef
  • A systematic review of comprehensive Robotic-assisted surgical (RAS) curricula
    Anna K. Kieslich, Ruari Jardine, Hussain Ibrahim, Areeg Calvert, Kenneth G. Walker, Kim A. Walker, Angus J. M. Watson
    Journal of Robotic Surgery.2025;[Epub]     CrossRef
  • From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
    In Ja Park
    Annals of Coloproctology.2024; 40(4): 285.     CrossRef
Videos
Video clip
Robotic total colectomy and ileorectal anastomosis
Jonathan Yu Jin Chua, Nan Zun Teo, James Chi-Yong Ngu
Ann Coloproctol. 2024;40(2):186-187.   Published online April 22, 2024
DOI: https://doi.org/10.3393/ac.2024.00066.0009
  • 5,423 View
  • 157 Download
  • 2 Web of Science
  • 1 Citations
AbstractAbstract PDFSupplementary Material
The benefits of minimally invasive approaches in colorectal surgery have been well demonstrated. However, some hesitancy remains with regards to the utilization of the robotic platform for total colectomies, mostly due to the perceived need for multiple re-dockings in multiquadrant surgery. This video aims to demonstrate how the robotic platform can be efficiently utilized in multiquadrant surgery without the need for multiple re-dockings, as well as some tips on how to overcome the potential challenges that may be encountered during this procedure.

Citations

Citations to this article as recorded by  
  • Fully Robotic Total Colectomy in High‐Risk Patients and Review of Literature
    Igor Monsellato, Teresa Gatto, Maria Antonietta Alagia, Federico Sangiuolo, Marco Palucci, Celeste del Basso, Martina Girardi, Irene Gandini, Gabriela Del Angel‐Millan, Marco Lodin, Fabio Giannone, Gianluca Cassese, Fabrizio Panaro
    The International Journal of Medical Robotics and Computer Assisted Surgery.2025;[Epub]     CrossRef
Tips and tricks for robotic lateral pelvic node dissection
James Chi-Yong Ngu, Nan-Zun Teo
Ann Coloproctol. 2023;39(6):531-531.   Published online December 26, 2023
DOI: https://doi.org/10.3393/ac.2023.00766.0109
  • 4,095 View
  • 148 Download
AbstractAbstract PDFSupplementary Material
Lateral pelvic node dissection can be challenging. In addition to detailed anatomical knowledge of the pelvic side wall, surgeons also need to be proficient in performing fine dissection within the confines of this limited operative field. While the incorporation of robotics can facilitate the safe completion of this technically demanding procedure, this is nonetheless dependent on the way the robotic system is used. This video aims to demonstrate several tips and tricks for performing robotic lateral pelvic node dissection.
Technical Note
Minimally invasive surgery
Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection
Toan Duc Pham, Tomas Larach, Bushra Othman, Amrish Rajkomar, Alexander G. Heriot, Satish K. Warrier, Philip Smart
Ann Coloproctol. 2023;39(6):526-530.   Published online December 19, 2023
DOI: https://doi.org/10.3393/ac.2022.00458.0065
  • 7,736 View
  • 124 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract PDFSupplementary Material
Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.

Citations

Citations to this article as recorded by  
  • Laparoscopic natural orifice specimen extraction for diverticular disease: a systematic review
    Jasmine Mui, Mina Sarofim, Ernest Cheng, Andrew Gilmore
    Surgical Endoscopy.2025; 39(5): 3049.     CrossRef
  • Current Application Status and Innovative Development of Surgical Robot
    Aimin Jiang, Zhao Tang, Hanzhong Zhang, Jinxin Li, Jialin Meng, Ying Liu, Yu Fang, Juan Lu, Xu Zhang, Le Qu, Anqi Lin, Linhui Wang
    Med Research.2025;[Epub]     CrossRef
  • Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management
    Dheeraj Surya, Pankaj Gharde
    Cureus.2024;[Epub]     CrossRef
  • Beyond survival: a comprehensive review of quality of life in rectal cancer patients
    Won Beom Jung
    Annals of Coloproctology.2024; 40(6): 527.     CrossRef
Review
Colorectal cancer
Essential anatomy for lateral lymph node dissection
Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara
Ann Coloproctol. 2023;39(6):457-466.   Published online December 8, 2023
DOI: https://doi.org/10.3393/ac.2023.00164.0023
  • 6,553 View
  • 279 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by  
  • da Vinci robotic-assisted micro-space dissection and autonomic nerve network preservation technique in the total mesorectal excision procedure for rectal cancer: a single-center, retrospective, observational, real-world study
    Fanghai Han, Yequan Xie, Guangyu Zhong, Jintao Zeng, Yang Chen, Jianan Tan, Shengning Zhou
    Journal of Robotic Surgery.2025;[Epub]     CrossRef
  • Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
    D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
    Techniques in Coloproctology.2025;[Epub]     CrossRef
  • Deep learning-based vessel and nerve recognition model for lateral lymph node dissection: a retrospective feasibility study
    Shoma Sasaki, Daichi Kitaguchi, Tomohiro Noda, Hiroki Matsuzaki, Hiro Hasegawa, Nobuyoshi Takeshita, Masaaki Ito
    Langenbeck's Archives of Surgery.2025;[Epub]     CrossRef
  • The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
    Gyu-Seog Choi, Hye Jin Kim
    Annals of Coloproctology.2024; 40(4): 363.     CrossRef
  • Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
    Daichi Kitaguchi, Masaaki Ito
    Annals of Coloproctology.2024; 40(4): 375.     CrossRef
Original Article
Colorectal cancer
Partial mesorectal excision can be a primary option for middle rectal cancer: a propensity score–matched retrospective analysis
Ee Jin Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Ann Coloproctol. 2024;40(3):253-267.   Published online March 31, 2023
DOI: https://doi.org/10.3393/ac.2022.00689.0098
  • 5,875 View
  • 221 Download
  • 1 Web of Science
  • 2 Citations
AbstractAbstract PDF
Purpose
Although partial mesorectal excision (PME) and total mesorectal excision (TME) is primarily indicated for the upper and lower rectal cancer, respectively, few studies have evaluated whether PME or TME is more optimal for middle rectal cancer.
Methods
This study included 671 patients with middle and upper rectal cancer who underwent robot-assisted PME or TME. The 2 groups were optimized by propensity score matching of sex, age, clinical stage, tumor location, and neoadjuvant treatment.
Results
Complete mesorectal excision was achieved in 617 of 671 patients (92.0%), without showing a difference between the PME and TME groups. Local recurrence rate (5.3% vs. 4.3%, P>0.999) and systemic recurrence rate (8.5% vs. 16.0%, P=0.181) also did not differ between the 2 groups, in patients with middle and upper rectal cancer. The 5-year disease-free survival (81.4% vs. 74.0%, P=0.537) and overall survival (88.0% vs. 81.1%, P=0.847) also did not differ between the PME and TME groups, confined to middle rectal cancer. Moreover, 5-year recurrence and survival rates were not affected by distal resection margins of 2 cm (P=0.112) to 4 cm (P>0.999), regardless of pathological stages. Postoperative complication rate was higher in the TME than in the PME group (21.4% vs. 14.5%, P=0.027). Incontinence was independently associated with TME (odds ratio [OR], 2.009; 95% confidence interval, 1.015–3.975; P=0.045), along with older age (OR, 4.366, P<0.001) and prolonged operation time (OR, 2.196; P=0.500).
Conclusion
PME can be primarily recommended for patients with middle rectal cancer with lower margin of >5 cm from the anal verge.

Citations

Citations to this article as recorded by  
  • Review of definition and treatment of upper rectal cancer
    Elias Karam, Fabien Fredon, Yassine Eid, Olivier Muller, Marie Besson, Nicolas Michot, Urs Giger-Pabst, Arnaud Alves, Mehdi Ouaissi
    Surgical Oncology.2024; 57: 102145.     CrossRef
  • Tumour-specific mesorectal excision for rectal cancer: Systematic review and meta-analysis of oncological and functional outcomes
    Fabio Carbone, Wanda Petz, Simona Borin, Emilio Bertani, Stefano de Pascale, Maria Giulia Zampino, Uberto Fumagalli Romario
    European Journal of Surgical Oncology.2023; 49(11): 107069.     CrossRef
Case Report
Colorectal cancer
Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature
Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim
Ann Coloproctol. 2024;40(Suppl 1):S38-S43.   Published online February 8, 2023
DOI: https://doi.org/10.3393/ac.2022.00829.0118
  • 3,997 View
  • 108 Download
  • 1 Citations
AbstractAbstract PDF
Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform. The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

Citations

Citations to this article as recorded by  
  • International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome
    Guglielmo Niccolò Piozzi, Krunal Khobragade, Vusal Aliyev, Oktar Asoglu, Paolo Pietro Bianchi, Vlad‐Olimpiu Butiurca, William Tzu‐Liang Chen, Ju Yong Cheong, Gyu‐Seog Choi, Andrea Coratti, Quentin Denost, Yosuke Fukunaga, Emre Gorgun, Francesco Guerra, Ma
    Colorectal Disease.2023; 25(9): 1896.     CrossRef
Original Articles
Minimally invasive surgery
A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer
René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius
Ann Coloproctol. 2024;40(2):154-160.   Published online December 28, 2022
DOI: https://doi.org/10.3393/ac.2022.00332.0047
  • 4,646 View
  • 143 Download
  • 2 Web of Science
  • 3 Citations
AbstractAbstract PDF
Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by  
  • Robotic Surgery for Rectal Cancer Treatment: Clinical Outcomes and Quality of Life. Comparison of Surgical Methods
    Raminta Akelaitytė, Justas Žilinskas
    Lietuvos chirurgija.2025; 24(3): 184.     CrossRef
  • Can robotic surgery lead the way in the treatment of rectal cancer?
    Jeonghee Han
    Annals of Coloproctology.2024; 40(2): 87.     CrossRef
  • Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
    E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
    Journal of Robotic Surgery.2023; 17(6): 3013.     CrossRef
Minimally invasive surgery
Learning curve for single-port robot-assisted colectomy
Moon Suk Choi, Seong Hyeon Yun, Sung Chul Lee, Jung Kyong Shin, Yoon Ah Park, Jungwook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee
Ann Coloproctol. 2024;40(1):44-51.   Published online December 20, 2022
DOI: https://doi.org/10.3393/ac.2022.00745.0106
  • 6,582 View
  • 258 Download
  • 8 Web of Science
  • 7 Citations
AbstractAbstract PDF
Purpose
Since the introduction of robotic surgery, robots for colorectal cancer have replaced laparoscopic surgery, and a single-port robot (SPR) platform has been launched and is being used to treat patients. We analyzed the learning curve and initial complications of using an SPR platform in colorectal cancer surgery.
Methods
We reviewed 39 patients who underwent SPR colectomy from April to October 2019. All surgeries were performed by the same surgeon using an SPR device. A learning curve was generated using the cumulative sum methodology to assess changes in total operation time, docking time, and surgeon console time. We grouped the patients into 3 groups according to the time period: the first 11 were phase 1, the next 11 were phase 2, and the last 17 were phase 3.
Results
The mean age of the patients was 61.28±13.03 years, and they had a mean body mass index of 23.79±2.86 kg/m2. Among the patients, 23 (59.0%) were male, and 16 (41.0%) were female. The average operation time was 186.59±51.30 minutes, the average surgeon console time was 95.49±35.33 minutes, and the average docking time (time from skin incision to robot docking) was 14.87±10.38 minutes. The surgeon console time differed significantly among the different phases (P<0.001). Complications occurred in 8 patients: 2 ileus, 2 postoperation hemoglobin changes, 3 urinary retentions, and 1 complicated fluid collection.
Conclusion
In our experience, the learning curve for SPR colectomy was achieved after the 18th case.

Citations

Citations to this article as recorded by  
  • A systematic review of the Da Vinci® Single-Port system (DVSP) in the context of colorectal surgery
    Francesco Brucchi, Isacco Montroni, Roberto Cirocchi, Giovanni Taffurelli, Marco Vitellaro, Gianluca Mascianà, Giovanni Battista Levi Sandri, Gianlorenzo Dionigi, Sara Lauricella
    International Journal of Colorectal Disease.2025;[Epub]     CrossRef
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    Francesco Celotto, Niccolò Ramacciotti, Alberto Mangano, Giacomo Danieli, Federico Pinto, Paula Lopez, Alvaro Ducas, Jessica Cassiani, Luca Morelli, Gaya Spolverato, Francesco Maria Bianco
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    Sung Uk Bae
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    Arcangelo Picciariello, Alfredo Annicchiarico, Gaetano Gallo, Agnese Dezi, Ugo Grossi
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Review
Malignant disease, Rectal cancer ,Functional outcomes,Colorectal cancer,Minimally invasive surgery
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Ann Coloproctol. 2021;37(6):351-367.   Published online November 17, 2021
DOI: https://doi.org/10.3393/ac.2021.00836.0119
  • 10,447 View
  • 217 Download
  • 47 Web of Science
  • 48 Citations
AbstractAbstract PDF
Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

Citations

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Technical Note
Malignant disease, Rectal cancer,Minimally invasive surgery
Single-port robot-assisted abdominoperineal resection: a case review of the first four experiences
Moon Suk Choi, Seong Hyeon Yun, Jung Kyong Shin, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee
Ann Coloproctol. 2022;38(1):88-92.   Published online October 18, 2021
DOI: https://doi.org/10.3393/ac.2021.00395.0056
  • 5,730 View
  • 137 Download
  • 7 Web of Science
  • 7 Citations
AbstractAbstract PDF
Recently, abdominoperineal resection (APR) using a robot has been demonstrated in other studies. However, there has been no report on APR for rectal cancer using the single-port robot (SPR) platform. In response to this research gap, we described the clinical experience of APR using a SPR. From April 2019 to March 2020, APR using a SPR platform was performed in a total of 4 patients. Three patients had a transumbilical approach, and 1 patient had a transstoma site approach. The average operation time was 307 minutes, and the patient docking time to the SPR platform was 133.5 minutes. There were no complications during the operation, and no laparoscopy or open conversion. No reoperation occurred within 30 days. Mild postoperative complications occurred in 2 patients. We found that APR has safety and feasibility in surgery using an SPR platform. There was no intraoperative event and severe postoperative complications.

Citations

Citations to this article as recorded by  
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    Jin-Min Jung, Young Il Kim, Yong Sik Yoon, Songsoo Yang, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
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Video
Malignant disease, Rectal cancer
Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor
Seung Yoon Yang, Nam Kyu Kim
Ann Coloproctol. 2020;36(6):415-416.   Published online December 31, 2020
DOI: https://doi.org/10.3393/ac.2020.06.29
  • 5,709 View
  • 86 Download
  • 10 Web of Science
  • 6 Citations
AbstractAbstract PDFSupplementary Material
Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en-bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Citations

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  • Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
    Youn Young Park, Nam Kyu Kim
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    Hyo Seon Ryu, Jin Kim
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    Young Il Kim
    The Ewha Medical Journal.2022;[Epub]     CrossRef
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    Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
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Review
Malignant disease, Rectal cancer
Robotic Total Mesorectal Excision for Rectal Cancer: Current Evidences and Future Perspectives
Je-Ho Jang, Chang-Nam Kim
Ann Coloproctol. 2020;36(5):293-303.   Published online October 31, 2020
DOI: https://doi.org/10.3393/ac.2020.06.16
  • 7,661 View
  • 114 Download
  • 17 Web of Science
  • 19 Citations
AbstractAbstract PDF
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.

Citations

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    Kyeong Eui Kim, Sung Uk Bae, Seung Hyun Lee, Dae-Ro Lim, Heon-Kyun Ha, Jin Kim, Hyo Seon Ryu, Soo Yeon Park, Sung Il Kang, Gyung Mo Son, Soo Young Lee, Chang Hyun Kim, Kyung Ha Lee, Gi Won Ha, Hye Jin Kim, Woong Bae Ji, Woo Ram Kim, Sang Hee Kang, Nak Son
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    P. Rouanet, M. Lehiany, A. Mourregot, P.-E. Colombo, C. Taoum
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Video
Malignant disease, Rectal cancer,Minimally invasive surgery,Surgical technique
Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection
Jung Hoon Bae, Wooree Koh, Hyun Ho Kim, Yoon Suk Lee
Ann Coloproctol. 2021;37(1):58-60.   Published online September 18, 2020
DOI: https://doi.org/10.3393/ac.2020.08.05
  • 9,723 View
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AbstractAbstract PDFSupplementary Material
We aimed to show that a standardized step-by-step robotic approach using surgical landmarks could make lateral pelvic lymph node dissection (LPND) less complicated. We performed robot-assisted LPND consisting of 4 steps using surgical landmarks. The first step is a dissection of uretero-hypogastric fascia, which envelopes the ureter and the hypogastric nerve. The second step is a dissection of the medial side of the external iliac vein located at the lateral border of the obturator lymph nodes (LNs) group. The third step is a dissection of the vesico-hypogastric fascia, which is at the medial border of the obturator LNs group. The final step is a dissection of the internal iliac artery until the Alcock’s canal. Indocyanine green was injected just before surgery around the dentate line to identify the lateral pelvic LNs. Standardization using a robotic approach for LPND guided by surgical landmarks allows a safer and more effective surgery.

Citations

Citations to this article as recorded by  
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    D. Kehagias, C. Lampropoulos, A. Bellou, I. Kehagias
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    Shuichi Morizane, Jun Miki, Masaki Shimbo, Toru Kanno, Noriyoshi Miura, Yuta Yamada, Takeshi Yamasaki, Takashi Saika, Atsushi Takenaka
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Original Article
Transanal Endoscopic and Transabdominal Robotic Total Mesorectal Excision for Mid-to-Low Rectal Cancer: Comparison of Short-term Postoperative and Oncologic Outcomes by Using a Case-Matched Analysis
Ki Young Lee, Jung Kyoung Shin, Yoon Ah Park, Seong Hyeon Yun, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee
Ann Coloproctol. 2018;34(1):29-35.   Published online February 28, 2018
DOI: https://doi.org/10.3393/ac.2018.34.1.29
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AbstractAbstract PDF
Purpose

This study aimed to compare short-term postoperative and oncologic outcomes of a transanal endoscopic total mesorectal excision (TME) to those of a transabdominal robotic TME.

Methods

A total of 62 patients with rectal cancer underwent transanal (n = 26) or robotic (n = 36) TME between June 2013 and December 2014. After case-matching by tumor location and TNM stage, 45 patients were included for analysis. The median follow-up period was 21.3 months. Operative, histopathologic and postoperative outcomes and recurrences were analyzed.

Results

Patients younger than 60 years of age were more frequently observed in the robotic TME group (75.0% vs. 47.6%, P = 0.059), but tumor location, cT and cN category, and preoperative chemoradiotherapy were not different between the 2 groups. Estimated blood loss was greater in the transanal group (283 mL vs. 155 mL, P = 0.061); however, the operation time and the rate of a diverting ileostomy and subsequent ileostomy repair were not different between the groups. The proximal resection margin was longer in the transanal TME group (20.8 cm ± 16.0 cm, P = 0.030), but the distal resection margins, involvements of the circumferential resection margin, TME quality, numbers of retrieved lymph nodes, postoperative complications, including anastomotic leak and voiding difficulty, and recurrence rates for the 2 groups were not statistically different.

Conclusion

Transanal endoscopic and transabdominal robotic TME showed similar histopathologic and postoperative outcomes with the exception of the estimated blood loss and the proximal resection margin for a select group of patients.

Citations

Citations to this article as recorded by  
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    Mohamed Ali Chaouch, Mohammad Iqbal Hussain, Maissa Jellali, Amine Gouader, Alessandro Mazzotta, Adriano Carneiro da Costa, Bassem Krimi, Jim Khan, Hani Oweira
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Review
The Future Medical Science and Colorectal Surgeons
Young Jin Kim
Ann Coloproctol. 2017;33(6):207-209.   Published online December 31, 2017
DOI: https://doi.org/10.3393/ac.2017.33.6.207
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AbstractAbstract PDF

Future medical technology breakthroughs will build from the incredible progress made in computers, biotechnology, and nanotechnology and from the information learned from the human genome. With such technology and information, computer-aided diagnoses, organ replacement, gene therapy, personalized drugs, and even age reversal will become possible. True 3-dimensional system technology will enable surgeons to envision key clinical features and will help them in planning complex surgery. Surgeons will enter surgical instructions in a virtual space from a remote medical center, order a medical robot to perform the operation, and review the operation in real time on a monitor. Surgeons will be better than artificial intelligence or automated robots when surgeons (or we) love patients and ask questions for a better future. The purpose of this paper is looking at the future medical science and the changes of colorectal surgeons.

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Original Articles
Laparoscopic and Robotic Surgeries for Patients With Colorectal Cancer Who Have Had a Previous Abdominal Surgery
Soeun Park, Jeonghyun Kang, Eun Jung Park, Seung Hyuk Baik, Kang Young Lee
Ann Coloproctol. 2017;33(5):184-191.   Published online October 31, 2017
DOI: https://doi.org/10.3393/ac.2017.33.5.184
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  • 14 Citations
AbstractAbstract PDF
Purpose

The impact of previous abdominal surgery (PAS) on surgical outcomes from laparoscopic and robot surgeries is inconclusive. This study aimed to investigate the impact of PAS on perioperative outcomes from laparoscopic and robotic colorectal surgeries.

Methods

From March 2007 to February 2014, a total of 612 and 238 patients underwent laparoscopic and robotic surgeries, respectively. Patients were divided into 3 groups: those who did not have a PAS (NPAS), those who had a major PAS, and those who had a minor PAS. We further divided the patients so that our final groups for analysis were: patients with NPAS (n = 478), major PAS (n = 19), and minor PAS (n = 115) in the laparoscopy group, and patients with NPAS (n = 202) and minor PAS (n = 36) in the robotic surgery group.

Results

In the laparoscopy group, no differences in the conversion rates between the 3 groups were noted (NPAS = 1.0% vs. major PAS = 0% vs. minor PAS = 1.7%, P = 0.701). In the robotic surgery group, the conversion rate did not differ between the NPAS group and the minor PAS group (1.0% vs. 2.8%, P = 0.390). Among the groups, neither the operation time, blood loss, days to soft diet, length of hospital stay, nor complication rate were affected by PAS.

Conclusion

PAS did not jeopardize the perioperative outcomes for either laparoscopic or robotic colorectal surgeries. Therefore, PAS should not be regarded as an absolute contraindication for minimally invasive colorectal surgeries.

Citations

Citations to this article as recorded by  
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Comparison of Surgical Skills in Laparoscopic and Robotic Tasks Between Experienced Surgeons and Novices in Laparoscopic Surgery: An Experimental Study
Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park
Ann Coloproctol. 2014;30(2):71-76.   Published online April 25, 2014
DOI: https://doi.org/10.3393/ac.2014.30.2.71
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AbstractAbstract PDF
Purpose

Robotic surgery is known to provide an improved technical ability as compared to laparoscopic surgery. We aimed to compare the efficiency of surgical skills by performing the same experimental tasks using both laparoscopic and robotic systems in an attempt to determine if a robotic system has an advantage over laparoscopic system.

Methods

Twenty participants without any robotic experience, 10 laparoscopic novices (LN: medical students) and 10 laparoscopically-experienced surgeons (LE: surgical trainees and fellows), performed 3 laparoscopic and robotic training-box-based tasks. This entire set of tasks was performed twice.

Results

Compared with LN, LEs showed significantly better performances in all laparoscopic tasks and in robotic task 3 during the 2 trials. Within the LN group, better performances were shown in all robotic tasks compared with the same laparoscopic tasks. However, in the LE group, compared with the same laparoscopic tasks, significantly better performance was seen only in robotic task 1. When we compared the 2 sets of trials, in the second trial, LN showed better performances in laparoscopic task 2 and robotic task 3; LE showed significantly better performance only in robotic task 3.

Conclusion

Robotic surgery had better performance than laparoscopic surgery in all tasks during the two trials. However, these results were more noticeable for LN. These results suggest that robotic surgery can be easily learned without laparoscopic experience because of its technical advantages. However, further experimental trials are needed to investigate the advantages of robotic surgery in more detail.

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Initial Clinical Experience with Robotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer
Ju-A Park, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park
J Korean Soc Coloproctol. 2012;28(5):265-270.   Published online October 31, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.5.265
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AbstractAbstract PDF
Purpose

This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer.

Methods

A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed.

Results

In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days).

Conclusion

Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.

Citations

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Comparison of Short-term Surgical Outcomes between a Robotic Colectomy and a Laparoscopic Colectomy during Early Experience
Jin Yong Shin
J Korean Soc Coloproctol. 2012;28(1):19-26.   Published online February 29, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.1.19
  • 6,838 View
  • 58 Download
  • 43 Citations
AbstractAbstract PDF
Purpose

Although robotic surgery was invented to overcome the technical limitations of laparoscopic surgery, the role of a robotic (procto)colectomy (RC) for the treatment of colorectal cancer compared to that of a laparoscopic (procto)colectomy (LC) was not well defined during the initial adoption periods of both procedures. This study aimed to evaluate the efficacy and the safety of a RC for the treatment of colorectal cancer by comparing the authors' initial experiences with both a RC and a LC.

Methods

The first 30 patients treated by using a RC for colorectal cancer from July 2010 to March 2011 were compared with the first 30 patients treated by using a LC for colorectal cancer from December 2006 to June 2007 by the same surgeon. Perioperative variables and short-term outcomes were analyzed. In addition, the 30 RC and the 30 LC cases involved were divided into rectal cancer (n = 17 and n = 12, respectively), left-sided colon cancer (n = 7 and n = 12, respectively) and right-sided colon cancer (n = 6 and n = 6, respectively) for subgroup analyses.

Results

The mean operating times for RC and LC were significantly different at 371.8 and 275.5 minutes, respectively, but other perioperative parameters (rates of open conversion, numbers of retrieved lymph node, estimated blood losses, times to first flatus, maximal pain scores before discharge and postoperative hospital stays) were not significantly different in the two groups. Subgroup analyses showed that the mean operative times for a robotic proctectomy and a laparoscopic proctectomy were 396.5 and 298.8 minutes, respectively (P < 0.000). Postoperative complications occurred in five patients in the RC group and in six patients in the LC group (P = 0.739).

Conclusion

Although the short-term outcomes of a RC during its initial use were better than those of a LC (with the exception of operating time), differences were not found to be significantly different. On the other hand, the longer operation time of a robotic proctectomy compared to that of a laparoscopic proctectomy during the early period may be problematic.

Citations

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Review
Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Robotic Surgery from an Expert's View
Nam-Kyu Kim, Jeonghyun Kang
J Korean Soc Coloproctol. 2010;26(6):377-387.   Published online December 31, 2010
DOI: https://doi.org/10.3393/jksc.2010.26.6.377
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AbstractAbstract PDF

Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.

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