title: Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer.
abstract: BACKGROUND
  Laparoscopic total mesorectal excision (TME) remains a technically challenging procedure. This study aims to compare the surgical outcomes of the robotic-assisted laparoscopic (RAL) versus hand-assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers.
  
  
  METHODS
  A retrospective review of all patients who underwent RAL TME for rectal cancers was performed. These cases were matched for age, sex, and stage of malignancy with patients who underwent HAL TME. Data collected included age, sex, American Society of Anesthesiologists scores, comorbid conditions, types of surgical resections and operative times, perioperative complications, length of hospital stays, and histopathologic outcomes were analyzed.
  
  
  RESULTS
  From August 2008 to August 2011, 19 patients, with a median age of 62 (range, 47 to 92) years underwent RAL TME. Eight (42.1%) patients received neoadjuvant chemoradiotherapy. The median docking and operative times were 10 (range, 3 to 34) and 390 (range, 289 to 771) minutes, respectively. There was 1 (5.3%) conversion to open surgery. The grade of mesorectal excision was histopathologically reported as complete in all 19 cases. Positive circumferential margin was reported in 1 (5.3%) patient.Comparing the 2 groups, more patients in the RAL group received neoadjuvant chemoradiotherapy (8 vs. 3; P=0.048). The operative times were longer in the RAL group (390 vs. 225 min; P<0.001). A higher proportion of patients in the HAL group required conversion to open surgery (5 vs. 1; P=0.180) and developed perioperative morbidities (3 vs. 7; P=0.269). The median length of hospitalization was comparable between both groups (RAL: 7 vs. HAL: 6 d; P=0.476).The procedural cost was significantly higher in the RAL group (US$12,460 vs. US$8560; P<0.001), whereas the nonprocedural cost remained comparable between the 2 groups (RAL: US$4470 vs. HAL: US$4500; P=0.729).
  
  
  CONCLUSIONS
  RAL TME is associated with lower conversion and morbidity rates compared with HAL TME. The longer operating times and higher procedural costs are current limitations to its widespread adoption.
authors.affiliation: *Yong Loo Lin School of Medicine, National University of Singapore †Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore ‡Colorectal Clinic Associates, Mount Elizabeth Novena Specialist Center, Singapore.
authors.forename: Frederick H X
authors.initials: FH
authors.lastname: Koh
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
authors.forename: Bettina
authors.initials: B
authors.lastname: Lieske
authors.forename: Marianne L
authors.initials: ML
authors.lastname: Tsang
authors.forename: Charles B
authors.initials: CB
authors.lastname: Tsang
authors.forename: Dean C
authors.initials: DC
authors.lastname: Koh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D058733:Hand-Assisted Laparoscopy / Q000191:economics; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics