Mick Harper

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

PortSmouth TAble Rotation Robotic technique for pan proctocolecotmy using DaVinci Si robotic system; P-STARR technique

Robotic surgery offers a more natural feel and dexterity, a stable optical system and a tridimensional view of the operating field. Because of these technical benefits, robotic surgery has been widely accepted as a standard of care for urological surgery. However, the uptake of robotic colorectal surgery remains limited because of some inherent technical issues related to the setup and access of the target organs including challenges when operating in multiple quadrants of the abdomen. The setup in robotic surgery is relatively fixed as compared to laparoscopic surgery. This rigid configuration of the robotic arms gives an excellent view of a target organ but is confined to a single abdominal quadrant. However, any access beyond the limits of a focused quadrant requires rearrangement of the robotic arms to complete the procedure effectively. This issue has been addressed for robotic rectal cancer surgery in several ways [1, 2]. However, not much has been written on robotic assisted colon surgery. One of the main challenges when considering a robotic surgical approach for proctocolectomy is achieving an optimal docking to access a large target organ in all four quadrants and the pelvis. A single docking of the robotic cart between the legs has previously been described [3]. Whilst that method may work well in selected cases, it limits access to the rectum. Similarly, a double docking requires extra time for complete reconfiguration of the robotic cart and theatre equipment. We present a novel and simple technique of performing robotic proctocolectomy through a left sided docking (P-STARR technique).