title: Robotic-Assisted Surgery Improves the Quality of Total Mesorectal Excision for Rectal Cancer Compared to Laparoscopy: Results of a Case-Controlled Analysis.
abstract: BACKGROUND
  The use of a robotic surgical system is claimed to allow precise traction and counter-traction, especially in a narrow pelvis. Whether this translates to improvement of the quality of the resected specimen is not yet clear. The aim of the study was to compare the quality of the TME and the short-term oncological outcome between robotic and laparoscopic rectal cancer resections.
  
  
  METHODS
  20 consecutive robotic TME performed in a single institution for rectal cancer (Rob group) were matched 1:2 to 40 laparoscopic resections (Lap group) for gender, body mass index (BMI), and distance from anal verge on rigid proctoscopy. The quality of TME was assessed by 2 blinded and independent pathologists and reported according to international standardized guidelines.
  
  
  RESULTS
  Both samples were well matched for gender, BMI (median 25.9 vs. 24.2 kg/m(2), p = 0.24), and level of the tumor (4.1 vs. 4.8 cm, p = 0.20). The quality of the TME was better in the Robotic group (complete TME: 95 vs. 55 %; p = 0.0003, nearly complete TME 5 vs. 37 %; p = 0.04, incomplete TME 0 vs. 8 %, p = 0.09). A trend for lower positive circumferential margin was observed in the Robotic group (10 vs. 25 %, p = 0.1).
  
  
  CONCLUSIONS
  These results suggest that robotic-assisted surgery improves the quality of TME for rectal cancer. Whether this translates to better oncological outcome needs to be further investigated.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Allemann
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Céline
authors.initials: C
authors.lastname: Duvoisin
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Mare
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. dieter.hahnloser@chuv.ch.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D003082:Colectomy / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors