title: Evaluation of the robotic approach concerning pitfalls in rectal surgery.
abstract: BACKGROUND
  The feasibility and advantages of robotic rectal surgery (RRS) in comparison to conventional open or laparoscopic rectal resections have been postulated in several reports. But well-known challenges and pitfalls of minimal invasive rectal surgery have not been evaluated by a prospective, multicenter setting so far. Aim of this study was to analyze the perioperative outcome of patients following RRS especially in regard to the pitfalls such as obesity, male patients and low tumors by a European multicenter setting.
  
  
  METHODS
  This prospective study included 348 patients undergoing robotic surgery due to rectal cancer in six major European centers. Clinicopathological parameters, morbidity, perioperative recovery and short-term outcome were analyzed.
  
  
  RESULTS
  A total of 283 restorative surgeries and 65 abdominoperineal resections were carried out. The conversion rate was 4.3%, mean blood loss was 191 ml, and mean operative time was 315 min. Postoperative complications with a Clavien-Dindo score >2 were observed in 13.5%. Obesity and low rectal tumors showed no significant higher rates of major complications or impaired oncological parameters. Male patients had significant higher rates of major complications and anastomotic leakage (p = 0.048 and p = 0.007, respectively).
  
  
  CONCLUSIONS
  RRS is a promising tool for improvement of rectal resections. The well-known pitfalls of minimal-invasive rectal surgery like obesity and low tumors were sufficiently managed by RRS. However, RRS showed significantly higher rates of major complications and anastomotic leakage in male patients, which has to be evaluated by future randomized trials.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: J K
authors.initials: JK
authors.lastname: Baukloh
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reeh
authors.affiliation: Department of General Surgery, Azienda University Hospital, Novara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spinoglio
authors.affiliation: Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Corratti
authors.affiliation: Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Bartolini
authors.affiliation: Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy.
authors.forename: V M
authors.initials: VM
authors.lastname: Mirasolo
authors.affiliation: Department of General and Oncological Surgical, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Priora
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.affiliation: Colorectal Division, Department of Surgery, Hospital Universitario "Marqués de Valdecilla", Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gomez Fleitas
authors.affiliation: Colorectal Division, Department of Surgery, Hospital Universitario "Marqués de Valdecilla", Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gomez Ruiz
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany. Electronic address: d.perez@uke.de.
authors.forename: D R
authors.initials: DR
authors.lastname: Perez
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D009765:Obesity / Q000150:complications; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D012737:Sex Factors
keywords: Rectal cancer; Robotic surgery