title: Robotic rectal surgery: State of the art.
abstract: Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words "rectum", "rectal", "cancer", "laparoscopy", "robot". After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Staderini
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Foppa
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Minuzzo
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Badii
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Etleva
authors.initials: E
authors.lastname: Qirici
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Trallori
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lami
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macrì
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonanomi
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Siro
authors.initials: S
authors.lastname: Bagnoli
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Perigli
authors.affiliation: Fabio Staderini, Caterina Foppa, Alessio Minuzzo, Benedetta Badii, Etleva Qirici, Giuliano Perigli, Fabio Cianchi, Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, 50134 Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cianchi
keywords: DaVinci rectal surgery; Robotic rectal cancer; Robotic rectal resection; Robotic rectal surgery; Robotic surgery; Robotics for rectal cancer