Robotic Surgery in the Treatment of Colorectal Cancer

Robotic Surgery in the Treatment of Colorectal Cancer

BY DR. ELISA MARIA BIANCHI

Each year in the United States about 150,00 new cases of colorectal cancer are diagnosed and approximately 53,000 Americans will die of the disease.

Even as the mortality rate for colorectal cancers has been on the decline since 1990, it continues to be the third most common cause of death for both men and women in the United States. In contrast to the overall mortality decline, the incidence in patients under the age of 50 has been steadily increasing since 1992. This represents a chilling trend, especially given the low likelihood that patients under 50 will undergo screening colonoscopy.

Laparoscopic assisted colorectal surgery is widely used in the treatment of this disease. Many colorectal surgeons have adapted laparoscopic surgery as their technique of choice for most of the abdominal procedures they perform. Laparoscopic surgery for the treatment of colorectal cancers is widely used because it does not compromise oncological outcomes and allows for rapid postoperative recovery. However, laparoscopic low pelvic dissections are extremely technically demanding, particularly in male patients who tend to have narrow pelvises. Furthermore, laparoscopic instruments are nonarticulating, thus requiring unnatural coordination and non-ergonomic positioning. This is all done with imaging systems that only provide flat, 2-dimensional views. What’s more, laparoscopic low rectal cancer surgery has a high rate of conversion to open surgery and has an increased rate of postoperative male sexual dysfunction. While we have made many advances in the last decades, laparoscopic surgery still has numerous drawbacks.

Robotic surgery is an alternative method of performing minimally invasive colon and rectal surgery. The technology has evolved greatly since it was first used for colon and rectal surgery in 2001. The modern iteration of robotic assisted surgery begins with NASA, developed as an outgrowth of virtual reality systems for visualizing data being returned from the Voyager mission. This idea then developed into telepresence surgery, or remote robotic surgery. First developed as a prototype for use by the military to provide remote immediate surgical care on the battlefield. Eventually, the PUMA 560 system was the first robotic device used to perform robotic assisted surgery, a percutaneous brain biopsy in 1985.

Robotic surgery has evolved over the years and is today largely used by surgeons who are physically in the same room as their patients. In 1999, the da Vinci Robotic Surgical System entered the market. This robotic system was notable for its three-dimensional vision system, three arms and EndoWrist® technology. In 2014 the Xi system was introduced and has fast become the most widely used system. This robotic platform has four arms, allows for multi-quadrant surgery, has upgraded optics and technology that improves arm positioning.

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