Page 38 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic vs Robotic Approach for Rectal Cancer:

A Meta‑analysis

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Aniket Agrawal , Gursev Sandlas , Charu Tiwari , Sachit Anand , Anoli Agrawal , Vivek Viswanathan 6
Received on: 12 April 2022; Accepted on: 14 September 2022; Published on: 07 December 2022
AbstrAct
Technology is evolving constantly today, and among the plethora of innovations, the one with the most potential to look forward to, in
surgery, is the introduction and evolution of Robotics. Demand, as well as a pursuit of minimally invasive surgery, has increased exponentially
particularly in the last decade, with Robotics being at the leading edge of this evolution. It has shown a potential to provide outcomes that
were comparable to those achieved with the laparoscopic approach, with some evidence suggesting even better outcomes than laparoscopy
in high-risk groups such as patients with obesity, those treated by extended procedures, and male patients. Despite all its benefits, there is
still no sturdy evidence established yet about the overall superiority of robotic surgery over the laparoscopic approach. This lack of concrete
evidence warranted the need for a meta-analysis that would help reveal any significant differences between the two approaches (robotics
vs laparoscopic). Our study aimed to understand and establish the differences between the two approaches of rectal cancer resections, as
well as to ascertain the positive efficacy and benefits of robotic surgery, if any, over the conventional laparoscopic approach. The results
of this study found that the rates of sphincter preservation, intersphincteric resection (ISR), and conversion were lower with the robotic
total mesorectal excision (TME) compared to laparoscopic TMEs, while no significant difference was found in the rate of major (grade ≥III)
complications between the two groups.
Keywords: Minimal access surgery, Open and laparoscopic surgery, Rectal cancer, Robotic surgery.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1537

IntroductIon 1 Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani
Technology is evolving constantly today, and among the plethora Hospital and Medical Research Institute, Mumbai, Maharashtra, India
of innovations, the one with the most potential to look forward to, 2 Department of Paediatric Surgery, Topiwala National Medical
in surgery is the introduction and evolution of robotics. Demand, College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai,
as well as a pursuit of minimally invasive surgery, has increased Maharashtra, India
exponentially particularly in the last decade, with Robotics being 3 Department of Paediatric Surgery, All India Institute of Medical
at the leading edge of this evolution. It has shown a potential to Sciences, Raipur, Chhattisgarh, India
provide outcomes that were comparable to those achieved with 4 Department of Paediatric Surgery, All India Institute of Medical
the laparoscopic approach, with some evidence suggesting even Sciences, New Delhi, India
better outcomes than laparoscopy in high-risk groups such as 5 Department of Public Health Dentistry, JMF’s ACPM Dental College,
patients with obesity, those treated by extended procedures, and Dhule, Mumbai, Maharashtra, India
male patients. 6 Department of Paediatric Surgery, Kokilaben Dhirubhai Ambani
Robotic surgery, however, is not new. It has been around for Hospital and Medical Research Institute, Vadodara, Gujarat, India
over three decades, with the first documented robot-assisted Corresponding Author: Aniket Agrawal, Department of Pediatric
1
surgical procedure done as early as 1985. However, in the year Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research
2000, the introduction of the da Vinci Robotic Surgical System, Institute, Mumbai, Maharashtra, India, Phone: +91 8668862655, e-mail:
which became the first robotic surgery system to get the US Food aniketagrawal.24967@gmail.com
and Drug Administration (FDA) approval, revolutionized the field of How to cite this article: Agrawal A, Sandlas G, Tiwari C, et al. Laparoscopic
robotic surgery, and it has only found evermore wider applications vs Robotic Approach for Rectal Cancer: A Meta-analysis. World J Lap
in various surgical procedures ever since. 2 Surg 2022;15(3):224–228.
Despite all these benefits, there is still no sturdy evidence Source of support: Nil
established yet about the overall superiority of robotic surgery Conflict of interest: None
over the laparoscopic approach. This lack of concrete evidence
warranted the need for a meta-analysis that would help reveal
any significant differences between the two approaches (robotics MAterIAls And Methods
vs laparoscopic). The study is a meta-analysis conducted by the first author by doing
Our study aimed to understand and establish the differences a preliminary search in the PubMed and Cochrane databases to
between the two approaches of rectal cancer resections, as well as identify the literature on this topic. A systematic search of the
to ascertain the positive efficacy and benefits of robotic surgery, if PubMed and Cochrane Library databases was conducted in
any, over the conventional laparoscopic approach. August 2020. The keywords used were (laparoscopic surgery or

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