Robotic total mesorectal excision for rectal cancer

Robotic TME is an evolution of the classic laparoscopic technique with an aim to overcome the limitations of the non-articulating laparoscopic instruments within the narrow confines of the pelvis. The purpose of this chapter is to share our experience and the experience of others in this constantly evolving field of robotic TME. In the context of pelvic dissection, there are several properties that make the robotic system more advantageous to use as compared to laparoscopic or open techniques. The platform provides very stable optics with the surgeon in control of the camera, allowing for constant adjustments. This, together with simultaneous control of three working, articulating wrist instruments, gives the surgeon the ability to completely control the operating field. This is often essential when working with obese patients, bulky tumors, or within the narrow pelvic confines. Despite many factors that allow for easier completion of this task, it still remains an advanced procedure and is associated with a steep learning curve. Many studies have documented use of the robotic total mesorectal excision technique to be associated with decreased conversion rates, improved mesorectal envelope completeness, and improved genitourinary function. Still, there have been no randomized controlled trials proving unequivocally the superiority of this technique over the other approaches. At the present time, robotic technology should not be treated as a replacement for other techniques, but rather as an available, and powerful tool in a surgeon’s armamentarium. Because of the very high cost of this technology, the most practical option is to select the population of patients that may be best served through use of these surgical techniques