Annals of Coloproctology

Reviews

Minimally invasive surgery

Robotic colorectal surgery training: Portsmouth perspective: Guglielmo Niccolò Piozzi, Sentilnathan Subramaniam, Diana Ronconi Di Giuseppe, Rauand Duhoky, Jim S. Khan; Ann Coloproctol. 2024;40(4):350-362. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00444.0063

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This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Citations

Citations to this article as recorded by

Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
Engeng Chen, Li Chen, Wei Zhang
Frontiers in Oncology.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Colorectal cancer

Essential anatomy for lateral lymph node dissection: Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara; Ann Coloproctol. 2023;39(6):457-466. Published online December 8, 2023; DOI: https://doi.org/10.3393/ac.2023.00164.0023

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Abstract PDF

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by

The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
Gyu-Seog Choi, Hye Jin Kim
Annals of Coloproctology.2024; 40(4): 363. CrossRef
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Annals of Coloproctology.2024; 40(4): 375. CrossRef

Video

Malignant disease, Rectal cancer

Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor: Seung Yoon Yang, Nam Kyu Kim; Ann Coloproctol. 2020;36(6):415-416. Published online December 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.29

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Abstract PDF Supplementary Material

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en-bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Citations

Citations to this article as recorded by

Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Recent advances in functional bismuth chalcogenide nanomaterials: Cancer theranostics, antibacterial and biosensing
Qian Wang, Jun Du, Ruizhuo Ouyang, Baolin Liu, Yuqing Miao, Yuhao Li
Coordination Chemistry Reviews.2023; 492: 215281. CrossRef
Robotic APR with en bloc TAH/BSO and posterior vaginectomy
M. S. Meece, L. P. Horner, S. J. Danker, A. K. Sinno, N. Paluvoi
Techniques in Coloproctology.2023; 27(12): 1381. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Outcomes of robotic partial excision of the levator ani muscle for locally advanced low rectal cancer invading the ipsilateral pelvic floor at the anorectal ring level
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The International Journal of Medical Robotics and Computer Assisted Surgery.2021;[Epub] CrossRef

Original Articles

Comparison of Surgical Skills in Laparoscopic and Robotic Tasks Between Experienced Surgeons and Novices in Laparoscopic Surgery: An Experimental Study: Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park; Ann Coloproctol. 2014;30(2):71-76. Published online April 25, 2014; DOI: https://doi.org/10.3393/ac.2014.30.2.71

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Abstract PDF

Purpose

Robotic surgery is known to provide an improved technical ability as compared to laparoscopic surgery. We aimed to compare the efficiency of surgical skills by performing the same experimental tasks using both laparoscopic and robotic systems in an attempt to determine if a robotic system has an advantage over laparoscopic system.

Methods

Twenty participants without any robotic experience, 10 laparoscopic novices (LN: medical students) and 10 laparoscopically-experienced surgeons (LE: surgical trainees and fellows), performed 3 laparoscopic and robotic training-box-based tasks. This entire set of tasks was performed twice.

Results

Compared with LN, LEs showed significantly better performances in all laparoscopic tasks and in robotic task 3 during the 2 trials. Within the LN group, better performances were shown in all robotic tasks compared with the same laparoscopic tasks. However, in the LE group, compared with the same laparoscopic tasks, significantly better performance was seen only in robotic task 1. When we compared the 2 sets of trials, in the second trial, LN showed better performances in laparoscopic task 2 and robotic task 3; LE showed significantly better performance only in robotic task 3.

Conclusion

Robotic surgery had better performance than laparoscopic surgery in all tasks during the two trials. However, these results were more noticeable for LN. These results suggest that robotic surgery can be easily learned without laparoscopic experience because of its technical advantages. However, further experimental trials are needed to investigate the advantages of robotic surgery in more detail.

Citations

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Cancers.2025; 17(3): 482. CrossRef
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Mona W. Schmidt, Carolyn Fan, Karl F. Köppinger, Leon P. Schmidt, Anna Brechter, Eldrige F. Limen, Johannes A. Vey, Matthes Metz, Beat P. Müller‐Stich, Felix Nickel, Karl‐Friedrich Kowalewski
World Journal of Surgery.2024; 48(1): 14. CrossRef
Transferring laparoscopic skills to robotic-assisted surgery: a systematic review
Karishma Behera, Matthew McKenna, Laurie Smith, Gerard McKnight, James Horwood, Michael M. Davies, Jared Torkington, James Ansell
Journal of Robotic Surgery.2024;[Epub] CrossRef
Looking to the Future; Veterinary Robotic Surgery
Nicole J. Buote
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Carlo Alberto Schena, Andrea-Pierre Luzzi, Vito Laterza, Belinda De Simone, Filippo Aisoni, Paschalis Gavriilidis, Fausto Catena, Federico Coccolini, Francesca Morciano, Fausto Rosa, Francesco Marchegiani, Nicola de’Angelis
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Pedja Cuk, Mohamad Jawhara, Issam Al-Najami, Per Helligsø, Andreas Kristian Pedersen, Mark Bremholm Ellebæk
Techniques in Coloproctology.2023; 27(3): 171. CrossRef
Force-based assessment of tissue handling skills in simulation training for robot-assisted surgery
A. Masie Rahimi, Sem F. Hardon, E. Willuth, F. Lang, Caelan M. Haney, Eleni A. Felinska, Karl-Friedrich Kowalewski, Beat P. Müller-Stich, Tim Horeman, F. Nickel, Freek Daams
Surgical Endoscopy.2023; 37(6): 4414. CrossRef
The future of robotics in the treatment of abdominal wall hernias: A narrative review
Estella Y Huang, Daniel Chung, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan, Ryan C Broderick
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Transfer of skills between laparoscopic and robot-assisted surgery: a systematic review
Pia Iben Pietersen, Peter Hertz, Rikke Groth Olsen, Louise Birch Møller, Lars Konge, Flemming Bjerrum
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Short-term and long-term efficacy in robot-assisted treatment for mid and low rectal cancer: a systematic review and meta-analysis
Huiming Wu, Renkai Guo, Huiyu Li
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Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study
E. Willuth, S. F. Hardon, F. Lang, C. M. Haney, E. A. Felinska, K. F. Kowalewski, B. P. Müller-Stich, T. Horeman, F. Nickel
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Rebecca Karkia, Anil Tailor, Patricia Ellis, Thumuluru Madhuri, Andrea Scala, James Read, Matthew Perry, Krishna Patil, Adam Blackburn, Simon Butler-Manuel, Jayanta Chatterjee
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Julie Flynn, Jose T. Larach, Joseph C.H. Kong, Peadar S. Waters, Jacob J. McCormick, Satish K. Warrier, Alexander Heriot
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Arnav Gupta, Bishoy Lawendy, Mitchell G. Goldenberg, Ethan Grober, Jason Y. Lee, Nathan Perlis
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Andrew J. Holcomb, Jeremy D. Richmon
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Hersha Patel, Kavitha Madhuri, Thomas Rockell, Rugaia Montaser, Patricia Ellis, Jayanta Chatterjee, Simon Butler‐Manuel, Anil Tailor
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Daniel J. Wong, Michelle J. Wong, Gi Hong Choi, Yao Ming Wu, Paul B. Lai, Brian K. P. Goh
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Initial Clinical Experience with Robotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer: Ju-A Park, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park; J Korean Soc Coloproctol. 2012;28(5):265-270. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.265

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35 Citations

Abstract PDF

Purpose

This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer.

Methods

A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed.

Results

In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days).

Conclusion

Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.

Citations

Citations to this article as recorded by

Learning curve analysis for prophylactic bilateral robot-assisted lateral lymph node dissection for lower rectal cancer: a retrospective study
T. Sueda, M. Yasui, J. Nishimura, Y. Kagawa, M. Kitakaze, R. Mori, C. Matsuda, Y. Ushimaru, T. Sugase, Y. Mukai, H. Komatsu, Y. Yanagimoto, T. Kanemura, K. Yamamoto, H. Wada, K. Goto, H. Miyata, M. Ohue
Techniques in Coloproctology.2025;[Epub] CrossRef
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Tarek A. Awad, Eslam Hassan, Safa Baqar, Hugh Mackenzie, Sebastian Smolarek
Colorectal Disease.2025;[Epub] CrossRef
Short-term Outcomes of Robotic Lateral Pelvic Lymph Node Dissection for Lower Rectal Cancer
Wataru Sakamoto, Satoshi Fukai, Takahiro Sato, Misato Ito, Takuro Matsumoto, Mai Ashizawa, Shun Chida, Hisashi Onozawa, Hirokazu Okayama, Hisahito Endo, Motonobu Saito, Zenichiro Saze, Tomoyuki Momma, Koji Kono
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Robotic versus laparoscopic total mesorectal excision with lateral lymph node dissection for advanced rectal cancer: A systematic review and meta-analysis
Mohamed Ali Chaouch, Mohammad Iqbal Hussain, Adriano Carneiro da Costa, Alessandro Mazzotta, Bassem Krimi, Amine Gouader, Eddy Cotte, Jim Khan, Hani Oweira, Tsutomu Kumamoto
PLOS ONE.2024; 19(5): e0304031. CrossRef
The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
Gyu-Seog Choi, Hye Jin Kim
Annals of Coloproctology.2024; 40(4): 363. CrossRef
Robotic-assisted versus laparoscopic-assisted extended mesorectal excision: a comprehensive meta-analysis and systematic review of perioperative and long-term outcomes
Ahmed Abdelsamad, Mohammed Khaled Mohammed, Aya Sayed Ahmed Said Serour, Ibrahim Khalil, Zeyad M. Wesh, Laila Rashidi, Mike Ralf Langenbach, Florian Gebauer, Khaled Ashraf Mohamed
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Xiajuan Xue, Shuijie Lin, Qunzhang Zeng, Yincong Guo
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Robot-assisted lateral pelvic lymph node dissection in patients with advanced rectal cancer: a single-center experience of 65 cases
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Naradha Lokuhetty, José Tomás Larach, Amrish K. S. Rajkomar, Helen Mohan, Peadar S. Waters, Alexander G. Heriot, Satish K. Warrier
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Se-Jin Baek, Guglielmo Niccolò Piozzi, Seon-Hahn Kim
Surgical Oncology.2022; 43: 101786. CrossRef
Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection
Jung Hoon Bae, Wooree Koh, Hyun Ho Kim, Yoon Suk Lee
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Se-Jin Baek, Guglielmo Niccolò Piozzi, Seon-Hahn Kim
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Long-term clinical outcomes of total mesorectal excision and selective lateral pelvic lymph node dissection for advanced low rectal cancer: a comparative study of a robotic versus laparoscopic approach
S. H. Song, G.-S. Choi, H. J. Kim, J. S. Park, S. Y. Park, S.-M. Lee, J. A. Choi, H. A. Seok
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Min Chul Kim, Jae Hwan Oh
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Hidetoshi Katsuno, Tsunekazu Hanai, Koji Masumori, Yoshikazu Koide, Keigo Ashida, Hiroshi Matsuoka, Yosuke Tajima, Tomoyoshi Endo, Masahiro Mizuno, Yeongcheol Cheong, Kotaro Maeda, Ichiro Uyama
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Mootaz Elhusseini, Emad H. Aly
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Radiation Therapy Dose Escalation to Clinically Involved Pelvic Sidewall Lymph Nodes in Locally Advanced Rectal Cancer
Pehr E. Hartvigson, Smith Apisarnthanarax, Stephanie Schaub, Stacey Cohen, Greta Bernier, Wui-Jin Koh, Edward Y. Kim
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Robotic rectal surgery in Korea: Analysis of a nationwide registry
Se‐Jin Baek, Jung‐Myun Kwak, Jin Kim, Seon‐Hahn Kim, Sungsoo Park
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Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach
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Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer
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Kazushige Kawai, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Kensuke Otani, Koji Murono, Kazuhito Sasaki, Manabu Kaneko, Shigenobu Emoto, Hiroaki Nozawa
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Dae Ro Lim, Sung Uk Bae, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim
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Tomohiro Yamaguchi, Yusuke Kinugasa, Akio Shiomi, Hiroyuki Tomioka, Hiroyasu Kagawa
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Mahdi H. Albandar, Min Soo Cho, Sung Uk Bae, Nam Kyu Kim
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