Robotic Rectal Surgery in India: the Financial Viability and Lack of Collective Collaboration Still Remains the Biggest
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LETTER TO THE EDITOR
Robotic Rectal Surgery in India: the Financial Viability and Lack of Collective Collaboration Still Remains the Biggest Challenge Diwakar Pandey 1 & Jitender Rohila 1 & Vivek Sukumar 1 & Sanket Bankar 1 & Ashwin deSouza 1 & Avanish Saklani 1 Received: 18 June 2020 / Accepted: 19 August 2020 # Indian Association of Surgical Oncology 2020
Dear Editor, We read with great interest this important seminal work on the status of robotic rectal surgery in India by S.P. Somashekhar et al. [1]. To the best of our knowledge, this is the largest published prospective Indian series, emphasizing the safety, technique and outcomes of robotic-assisted rectal surgery on Indian patients. While most of the studies in literature showed non-inferiority of robotic surgery over laparoscopic approach for rectal resections, the much publicized ROLARR (The RObotic versus Laparoscopic Resection of Rectal Cancer Trial) study unfortunately did not demonstrate any advantage of robotic surgery over laparoscopy [2]. This is probably the first prospective study comparing robotic versus open surgery for rectal cancers. The findings are very relevant in India where the uptake of minimally invasive surgery is low. At the same time, it offers a ray of hope to surgeons performing open surgeries, who, with the right training, can move on to robotic plate with minimum experience of laparoscopy. However, as far as patient’s expectation is concerned, robotic surgery may not be available in all parts of the country and may not be affordable to a majority as well [2]. It implies that the traditional laparoscopic training has to be offered in resource limited economies and national training centres like Tata Memorial Centre. While we appreciate the authors for this excellent work, majority of the work done in our centre is still laparoscopic and after the initial part of the learning curve, we have reserved robotic surgery for complex multivisceral resection, extended resection, high BMI patients and narrow pelvis with distal tumour requiring inter-sphincteric resection [3, 4]. Our institute has recently
come up with a paper on our own experience of 202 complex robotic rectal procedures [5]. This somehow seems to make a roadmap for similar complex laparoscopic resections as well [6, 7]. We once again would like to congratulate the authors for their work. To conclude, while robotic surgery for rectal cancers look promising, the need of the hour in a country like India is to expand the existing comprehensive minimally invasive training programme for our resident and fellows with inter-institutional collaborations and produce highly trained young laparoscopic surgeons so that those interested may join the robotic surgery programme.
Compliance with Ethical Standards Conflict of Interest The authors declare that they have no conflicts of interest.
References 1.
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3. * Avanish Saklani [email protected] 1
Division of Colorectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National
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