Robotic versus laparoscopic sphincter-preserving total mesorectal excision: A propensity case-matched analysis

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Robotic-assisted surgery is increasingly adopted for complex procedures.
• Robotic total mesorectal excision (R-TME) is hypothesized to offer benefits over laparoscopic total mesorectal excision (L-TME).
• Short-term outcomes of initial R-TME cases require comparison with established L-TME procedures.

Purpose of the Study:

• To compare the short-term outcomes of robotic total mesorectal excision (R-TME) versus laparoscopic total mesorectal excision (L-TME).
• To evaluate the safety and efficacy of initial R-TME procedures in a matched cohort.

Main Methods:

• A cohort of 168 patients undergoing either R-TME or L-TME was analyzed.
• Propensity score matching (1:1) based on eight variables was used to create comparable groups (n=84 each).
• Short-term surgical outcomes were statistically compared between the R-TME and L-TME groups.

Main Results:

• R-TME demonstrated significantly higher rates of inter-sphincteric resection and longer operative times.
• Conversion rates, blood loss, and hospital stay were similar between the R-TME and L-TME groups.
• Anastomotic leak rates and major surgical complications were significantly lower in the R-TME group compared to L-TME.

Conclusions:

• While oncologic quality and overall short-term outcomes were comparable, R-TME resulted in significantly lower rates of anastomotic leaks and major complications.
• For surgeons experienced in laparoscopic techniques, robotic sphincter-saving TME is associated with reduced morbidity.
• R-TME represents a potentially safer alternative for select colorectal procedures.