Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot?
- PDF / 344,017 Bytes
- 9 Pages / 595 x 842 pts (A4) Page_size
- 81 Downloads / 181 Views
Eur Surg https://doi.org/10.1007/s10353-020-00677-6
Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot? Dirk Wilhelm
· Thomas Vogel · Philipp-Alexander Neumann · Helmut Friess · Michael Kranzfelder
Received: 9 March 2020 / Accepted: 9 October 2020 © The Author(s) 2020
Summary Background Robotic surgery offers favorable prerequisites for complex minimally invasive surgeries which are delivered by higher degrees of freedom, improved instrument stability, and a perfect visualization in 3D which is fully surgeon controlled. In this article we aim to assess its impact on complete mesocolic excision (CME) in colon cancer and to answer the question of whether the current evidence expresses a need for robotic surgery for this indication. Methods Retrospective analysis and review of the current literature on complete mesocolic excision for colon cancer comparing the outcome after open, laparoscopic, and robotic approaches. Results Complete mesocolic excision results in improved disease-free survival and reduced local recurrence, but turns out to be complex and prone to complications. Introduced in open surgery, the transfer to minimally invasive surgery resulted in comparable results, however, with high conversion rates. In comparison, robotic surgery shows a reduced conversion rate and a tendency toward higher lymph node yield. Data, however, are insufficient and no high-quality studies have been published to date. Almost no oncologic follow-up data are available in the literature. Conclusion The current data do not allow for a reliable conclusion on the need of robotic surgery for CME, but show results which hypothesize an equivalence if not superiority to laparoscopy. Due to recently published technical improvements for robotic Prof. Dr. med. D. Wilhelm () · T. Vogel · P.-A. Neumann · H. Friess · M. Kranzfelder Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaningerstr. 22, 81675 Munich, Germany [email protected]
K
CME and supplementary features of this method, we suppose that this approach will gain in importance in the future. Keywords Conversion · Robotic surgery · Laparoscopy · Technology · Suprapubic approach · Lymph node yield
Introduction Robotic surgery is gaining popularity and is supposed to be advantageous as compared to standard laparoscopy due to a more precise manipulation, better visualization, and improved ergonomics. Especially in complex interventions, these features could impact on patient outcome and the results of surgery. As complete mesocolic excision recommends radical dissection along central and vulnerable anatomical structures, the focus of this article was set on this kind of intervention and we purposed to assess here the need for robotic surgery.
Background While the discussion is still ongoing regarding whether laparoscopic surgery is adequate for the treatment of colorectal cancer, a new candidate enters the stage—robotic surgery. Having lived a shadow existence
Data Loading...
