Current Role of Robotic Surgery in Colorectal Disease

Robot-assisted surgery aims to combine the advantages of open surgery with those of minimally invasive surgery to overcome the previous limitations of laparoscopy. Compared to conventional laparoscopic methods, robot-assisted techniques offer significant advantages, which are currently increasingly employed despite mostly longer operating times and higher costs. The aim of this review was to describe the current role of robotics in the treatment spectrum of colorectal surgery.

A comprehensive literature review was conducted using PubMed, Medline, and Embase to identify studies, systematic reviews, and meta-analyses on robotic surgery for colorectal benign and malignant disease, focusing on studies and meta-analyses comparing the laparoscopic with the robotic approach; articles published between 2004 and 2024 were screened: results of studies on surgical techniques must always be interpreted with caution, taking into account the technical skills and preferences of the participating surgeons. Compared to conventional laparoscopic methods and independent of the indication, robot-assisted techniques offer obvious technical and ergonomic advantages. Most colorectal procedures can safely be conducted via robotic-assisted surgery. Throughout the various indications described in this manuscript, the most evident advantage of robotic surgery remains a lower conversion rate, followed by less blood loss and a shorter hospital stay at the price of a longer operating time. For malignant disease, robotic surgery seems to be additionally associated with a higher lymph node yield in the majority of the studies. In acute or chronic inflammatory colorectal diseases, robotic-assisted surgery may facilitate interventions through improved visibility and a potentially more precise dissection of the correct plane; furthermore, robotic-assisted surgery offers advantages for performing complex intracorporal anastomoses. Last but not least, the surgeon's well-being and preferences make a relevant impact on the utilization of the system in colorectal surgery.

The use of robot-assisted procedures has increased significantly in the last decade across the various surgical specialties, with the largest increase in colorectal surgery. Next to the surgeons' preferences, capacity and costs will define the future role of robotic surgery in colorectal disease. As robotic surgery is becoming a mainstream surgical approach, there is a crying need for implementable training concepts of robotic techniques in colorectal surgery.