title: Robotic and laparoscopic surgery for treatment of colorectal diseases.
abstract: OBJECTIVE
  In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases.
  
  
  METHODS
  The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da Vinci robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results.
  
  
  RESULTS
  The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 +/- 77 minutes vs. robotic group, 240 +/- 61 minutes), specimen length (laparoscopic group, 29 +/- 11 cm vs. robotic group, 27 +/- 13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 +/- 9 vs. robotic group, 17 +/- 10). It took significantly longer to prepare the operating room and patient in the robotic group (24 +/- 12 minutes) than in the laparoscopic group (18 +/- 7 minutes). There were three conversions to laparotomy in the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay.
  
  
  CONCLUSIONS
  Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.
authors.affiliation: Divisione di Chirurgia Generale, Ospedale di Camposampiero, Padova, Italy. adannibale@tin.it
authors.forename: Annibale
authors.initials: A
authors.lastname: D'Annibale
authors.forename: Emilio
authors.initials: E
authors.lastname: Morpurgo
authors.forename: Valentino
authors.initials: V
authors.lastname: Fiscon
authors.forename: Paolo
authors.initials: P
authors.lastname: Trevisan
authors.forename: Gianna
authors.initials: G
authors.lastname: Sovernigo
authors.forename: Camillo
authors.initials: C
authors.lastname: Orsini
authors.forename: Daniela
authors.initials: D
authors.lastname: Guidolin
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003082:Colectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012002:Rectal Diseases / Q000601:surgery; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D012449:Safety; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome