title: Dealing with robot-assisted surgery for rectal cancer: Current status and perspectives.
abstract: The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition three-dimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Luca
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Cenciarelli
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Petz
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Monsellato
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Valvo
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Cossu
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Tiago Leal
authors.initials: TL
authors.lastname: Ghezzi
authors.affiliation: Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Kassem
authors.initials: K
authors.lastname: Shmaissany
mesh_terms: D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D059032:Learning Curve; D011183:Postoperative Complications / Q000209:etiology; D011597:Psychomotor Performance; D012004:Rectal Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
keywords: Circumferential resection margin; Distal resection margin positivity; Lymph node yield; Rectal cancer; Robotic resection; Robotic surgery; Robotic total mesorectal excision
references.citation: Ann Surg Oncol. 2009 Jun;16(6):1480-7
references.pmid: 19290486
references.citation: Cir Esp. 2012 Jun-Jul;90(6):348-54
references.pmid: 22537895
references.citation: J Am Coll Surg. 2012 Jun;214(6):909-18.e1
references.pmid: 22533998
references.citation: Surg Endosc. 2008 Jul;22(7):1601-8
references.pmid: 18270772
references.citation: Tech Coloproctol. 2013 Feb;17 Suppl 1:S47-53
references.pmid: 23307506
references.citation: Ann Surg Oncol. 2012 Aug;19(8):2485-93
references.pmid: 22434245
references.citation: Br J Surg. 1982 Oct;69(10):613-6
references.pmid: 6751457
references.citation: Ann Surg Oncol. 2012 Nov;19(12):3727-36
references.pmid: 22752371
references.citation: Surg Endosc. 2013 Jun;27(6):1887-95
references.pmid: 23292566
references.citation: Medicine (Baltimore). 2015 Mar;94(11):e522
references.pmid: 25789947
references.citation: Ann Surg Oncol. 2007 Nov;14(11):3168-73
references.pmid: 17763911
references.citation: Ann Surg. 2009 Jul;250(1):54-61
references.pmid: 19561481
references.citation: Br J Surg. 1993 Sep;80(9):1194-5
references.pmid: 8402131
references.citation: Int J Med Robot. 2012 Dec;8(4):468-75
references.pmid: 22893623
references.citation: Lancet. 2005 May 14-20;365(9472):1718-26
references.pmid: 15894098
references.citation: Br J Surg. 2010 Nov;97(11):1638-45
references.pmid: 20629110
references.citation: Dis Colon Rectum. 1996 Oct;39(10):1140-5
references.pmid: 8831531
references.citation: Arch Surg. 2012 Aug;147(8):724-31
references.pmid: 22508667
references.citation: Ann Surg Oncol. 2009 May;16(5):1274-8
references.pmid: 19242762
references.citation: J Robot Surg. 2011 Jun;5(2):101-7
references.pmid: 21765876
references.citation: Dis Colon Rectum. 2011 Feb;54(2):151-6
references.pmid: 21228661
references.citation: World J Gastroenterol. 2011 Dec 21;17(47):5214-20
references.pmid: 22215947
references.citation: Ann Surg. 2015 Jan;261(1):129-37
references.pmid: 24662411
references.citation: Lancet. 1986 Jun 28;1(8496):1479-82
references.pmid: 2425199
references.citation: Surg Endosc. 2009 Feb;23(2):447-51
references.pmid: 19057962
references.citation: Int J Colorectal Dis. 2011 Oct;26(10):1317-27
references.pmid: 21750927
references.citation: Ann Surg Oncol. 2013 Aug;20(8):2625-32
references.pmid: 23417433
references.citation: Lancet Oncol. 2010 Jul;11(7):637-45
references.pmid: 20610322
references.citation: Int J Colorectal Dis. 2012 Feb;27(2):233-41
references.pmid: 21912876
references.citation: Ann Surg Oncol. 2012 Jul;19(7):2095-101
references.pmid: 22350601
references.citation: Br J Surg. 2013 Jan;100(1):75-82
references.pmid: 23132548
references.citation: Ann Surg. 2013 Apr;257(4):672-8
references.pmid: 23001075
references.citation: Eur J Surg Oncol. 2014 Sep;40(9):1072-9
references.pmid: 24646748
references.citation: J Surg Res. 2014 May 15;188(2):404-14
references.pmid: 24565506
references.citation: Ann Surg. 2010 May;251(5):882-6
references.pmid: 20395863
references.citation: Ann Surg Oncol. 2010 Jun;17(6):1614-20
references.pmid: 20087780
references.citation: Surg Endosc. 2012 Sep;26(9):2471-6
references.pmid: 22437950
references.citation: Dis Colon Rectum. 2011 Mar;54(3):275-82
references.pmid: 21304296
references.citation: Dis Colon Rectum. 2009 Nov;52(11):1824-30
references.pmid: 19966627
references.citation: Surg Endosc. 2010 Mar;24(3):715-20
references.pmid: 19688388
references.citation: Cancer. 1993 Jul 15;72(2):341-8
references.pmid: 8319167
references.citation: Surg Endosc. 2011 Aug;25(8):2423-40
references.pmid: 21701921
references.citation: Ann Surg. 2014 Jan;259(1):139-47
references.pmid: 23598381
references.citation: World J Surg. 2012 Nov;36(11):2722-9
references.pmid: 22855217
references.citation: Dis Colon Rectum. 2004 Dec;47(12):2162-8
references.pmid: 15657669
references.citation: Surg Endosc. 2011 Mar;25(3):855-60
references.pmid: 20734081
references.citation: Aust N Z J Surg. 1999 Jul;69(7):479-85
references.pmid: 10442917
references.citation: J Am Coll Surg. 2013 Dec;217(6):1063-9.e1
references.pmid: 24041555
references.citation: Lancet Oncol. 2013 Mar;14(3):210-8
references.pmid: 23395398
references.citation: Am J Surg. 2004 Feb;187(2):309-15
references.pmid: 14769327
references.citation: Ann Surg Oncol. 2013 Sep;20(9):2921-8
references.pmid: 23604783
references.citation: JSLS. 2009 Apr-Jun;13(2):176-83
references.pmid: 19660212
references.citation: AORN J. 2013 Oct;98(4):343-52
references.pmid: 24075331
references.citation: Surg Endosc. 2011 Sep;25(9):2972-9
references.pmid: 21512883
references.citation: Colorectal Dis. 2012 Apr;14(4):e134-56
references.pmid: 22151033
references.citation: Surg Endosc. 2009 Apr;23(4):839-46
references.pmid: 19116741
references.citation: Int J Colorectal Dis. 2011 Apr;26(4):415-21
references.pmid: 21174107
references.citation: Surg Endosc. 2011 Jan;25(1):240-8
references.pmid: 20552367
references.citation: Surg Laparosc Endosc Percutan Tech. 2012 Oct;22(5):400-5
references.pmid: 23047381
references.citation: Front Oncol. 2014 May 06;4:98
references.pmid: 24834429
references.citation: Ann Surg. 2013 Jan;257(1):95-101
references.pmid: 23059496
references.citation: J Minim Access Surg. 2015 Jan-Mar;11(1):29-34
references.pmid: 25598596