Robotic adhesiolysis: current evidence, technical considerations, and future directions

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Adhesiolysis is a complex procedure during abdominal and pelvic reoperations.
• Robotic platforms offer potential advantages for intricate dissections.
• Clinical evidence for robotic adhesiolysis remains limited.

Purpose of the Study:

• To review current evidence on robotic adhesiolysis.
• To discuss technical considerations, rationale, and patient selection for robotic adhesiolysis.
• To identify future research priorities in this field.

Main Methods:

• Targeted narrative review of peer-reviewed literature.
• Literature search focused on adhesion-related morbidity, adhesive small bowel obstruction (ASBO), laparoscopic adhesiolysis, and robotic surgery in patients with adhesions.

Main Results:

• Robotic surgery may decrease conversion to open surgery in selected reoperative abdominal cases, especially in expert hands and colorectal surgery.
• Outcomes such as enterotomy rates, length of stay, and postoperative complications require additional investigation.
• Successful robotic adhesiolysis demands precise technical execution, including safe access, port placement, and instrument choice.

Conclusions:

• Robotic adhesiolysis presents a promising minimally invasive option.
• Cautious use in carefully selected patients is supported by current evidence.
• Standardized reporting, objective adhesion grading, and prospective comparative studies are crucial for future advancements.