Robotic Colon and Rectal Surgery: A Series of 131 Cases

Laparoscopic colorectal surgery has become a mainstay in the treatment of benign and malignant colorectal diseases. There are inherent limitations to conventional laparoscopy which can be overcome by the robot. Here we present our experience with 131 cases of robotic and robot-assisted colon and rectal resections. This is a retrospective review of a prospectively maintained database. From August 2005 through June 2009, we performed a total of 131 totally robotic and robot-assisted colorectal resections. These included 42 right colectomies (RC), 16 anterior resections (AR) for benign disease, 8 AR with rectopexy for prolapse, 7 total proctocolectomies (TPC), 47 low and ultralow anterior resections (LAR) for rectal cancer, and 11 abdominal perineal resections (APR). All LARs were done as a hybrid procedure (laparoscopic splenic flexure mobilization followed by robotic rectal dissection), and all APR specimens were extracted through the perineal incision. All coloanal anastomoses were diverted with a loop ileostomy. There were no intraoperative complications in this series. Postoperative complications included 10 patients with ileus or small bowel obstruction (SBO), 2 patients with anastomotic leaks, 1 patient with an abscess, and 3 patients with temporary peripheral neuropathy that resolved spontaneously. Five patients required reoperation and there were a total of 4 conversions (3.7%) across all case types. Robotic colon and rectal resections are safe and feasible options for the treatment of both benign and malignant disease processes. Further studies comparing oncologic and perioperative outcomes of robotic, laparoscopic, and open techniques are needed to determine the utility and efficacy of this technology in the field of colorectal surgery.