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Original Article

Minimally invasive surgery

Robotic versus laparoscopic surgery for mid and low rectal cancer: a propensity score–matched analysis of short-term outcomes and costs: Aaron Seah Wei Ming, Isaac Seow-En, Koo Chee Hoe, Lionel Raphael Chen Hui, Yvonne Ng Ying Ru, Ngo Nye Thane, Ivan Tan En-Howe, Rachel Lee Shi Yi, Emile Kwong Wei Tan; Ann Coloproctol. 2026;42(3):355-363. Published online June 16, 2026; DOI: https://doi.org/10.3393/ac.2025.01508.0215

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Purpose
Robotic and laparoscopic approaches to rectal cancer surgery yield comparable short-term outcomes; however, comparative inpatient costs, particularly when stratified by tumor level, remain insufficiently characterized. This study compared short-term clinical and pathological outcomes, as well as index hospitalization costs, for minimally invasive surgery in patients with mid and low rectal cancer.
Methods
All consecutive patients with mid (5–10 cm from the anal verge) and low (<5 cm from the anal verge) rectal cancer who underwent elective minimally invasive surgery between January 2018 and December 2023 were identified. One-to-one propensity score matching was performed using the following covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, tumor level, receipt of neoadjuvant therapy, and presence of a defunctioning stoma. Outcomes and cost components were compared overall and stratified by tumor level.
Results
After matching, 282 patients were included (laparoscopic surgery, n=141; robotic surgery, n=141). Median operative time was longer in the robotic group (368 minutes vs. 325 minutes, P=0.007), whereas the median postoperative length of stay was similar between groups (6.0 days vs. 6.0 days, P=0.255). Rates of conversion to open surgery, anastomotic leak, 30-day mortality, and 30-day readmission did not differ significantly. Histopathological indicators of resection quality, including lymph node yield, margin clearance, and completeness of total mesorectal excision, were comparable. Mean index hospitalization cost was higher in the robotic group (SGD 37,436 vs. SGD 31,724; difference, SGD 5,713; P=0.008), with a greater difference observed in mid rectal cancer (SGD 8,606; P=0.008) than in low rectal cancer (SGD 1,811; P=0.465).
Conclusion
Robotic and laparoscopic surgery yielded comparable short-term clinical and pathological outcomes. Although costs were higher with robotic surgery, the cost differential was smaller for low rectal cancer, identifying this subgroup as a priority for prospective evaluation of clinical and economic value.

Citations

Citations to this article as recorded by

Comment On: “Robotic versus laparoscopic surgery for mid and low rectal cancer: a propensity score–matched analysis of short-term outcomes and costs”
Zhibin Liu, Linfeng Liu, Xueqing Yao
Updates in Surgery.2026;[Epub] CrossRef

Review

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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10 Citations

Abstract PDF

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

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Shih-Feng Huang, Yung-Lin Tan, Chao-Wen Hsu, Hsin-Ping Tseng, Danilo Miskovic, Chih-Chien Wu
International Journal of Colorectal Disease.2026;[Epub] CrossRef
Learning curve for Da Vinci Single-Port robotic colorectal cancer surgery: impact of prior robotic experience
Soo Young Lee, Chang Hyun Kim, Jaram Lee, Hyeung-min Park, Hyeong Rok Kim
Surgical Endoscopy.2026; 40(6): 4742. CrossRef
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Lorenzo Spirito, Carmine Sciorio, Vittorio Imperatore, Antonio Di Girolamo, Giuseppe Romeo, Riccardo Giannella, Antonio Ruffo, Fabio Esposito, Lorenzo Romano, Paola Coppola, Luigi Napolitano, Antonio D’Ambrosio, Roberta Siciliano, Guido De Sena
Journal of Robotic Surgery.2026;[Epub] CrossRef
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Michael Devine, Carolyn Cullinane, Helen Mohan, Dara O. Kavanagh, Dara O’Keeffe, Barry B. McGuire, Christina A. Fleming
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Engeng Chen, Li Chen, Wei Zhang
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Sarah Englert, Natascha Tschukewitsch, Alexa Wölfl, Christoph Justinger
Die Chirurgie.2025; 96(9): 765. CrossRef
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R. Smyth, N. Francis, S. Vasudevan
Journal of Robotic Surgery.2025;[Epub] CrossRef
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Chi Zhang, Jinwan Wang
Journal of Robotic Surgery.2025;[Epub] CrossRef
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Anna K. Kieslich, Ruari Jardine, Hussain Ibrahim, Areeg Calvert, Kenneth G. Walker, Kim A. Walker, Angus J. M. Watson
Journal of Robotic Surgery.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

Original Article

Comparison of Short-term Surgical Outcomes between a Robotic Colectomy and a Laparoscopic Colectomy during Early Experience: Jin Yong Shin; J Korean Soc Coloproctol. 2012;28(1):19-26. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.19

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46 Citations

Abstract PDF

Purpose

Although robotic surgery was invented to overcome the technical limitations of laparoscopic surgery, the role of a robotic (procto)colectomy (RC) for the treatment of colorectal cancer compared to that of a laparoscopic (procto)colectomy (LC) was not well defined during the initial adoption periods of both procedures. This study aimed to evaluate the efficacy and the safety of a RC for the treatment of colorectal cancer by comparing the authors' initial experiences with both a RC and a LC.

Methods

The first 30 patients treated by using a RC for colorectal cancer from July 2010 to March 2011 were compared with the first 30 patients treated by using a LC for colorectal cancer from December 2006 to June 2007 by the same surgeon. Perioperative variables and short-term outcomes were analyzed. In addition, the 30 RC and the 30 LC cases involved were divided into rectal cancer (n = 17 and n = 12, respectively), left-sided colon cancer (n = 7 and n = 12, respectively) and right-sided colon cancer (n = 6 and n = 6, respectively) for subgroup analyses.

Results

The mean operating times for RC and LC were significantly different at 371.8 and 275.5 minutes, respectively, but other perioperative parameters (rates of open conversion, numbers of retrieved lymph node, estimated blood losses, times to first flatus, maximal pain scores before discharge and postoperative hospital stays) were not significantly different in the two groups. Subgroup analyses showed that the mean operative times for a robotic proctectomy and a laparoscopic proctectomy were 396.5 and 298.8 minutes, respectively (P < 0.000). Postoperative complications occurred in five patients in the RC group and in six patients in the LC group (P = 0.739).

Conclusion

Although the short-term outcomes of a RC during its initial use were better than those of a LC (with the exception of operating time), differences were not found to be significantly different. On the other hand, the longer operation time of a robotic proctectomy compared to that of a laparoscopic proctectomy during the early period may be problematic.

Citations

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Review

Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Robotic Surgery from an Expert's View: Nam-Kyu Kim, Jeonghyun Kang; J Korean Soc Coloproctol. 2010;26(6):377-387. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.377

9,156 View
44 Download
67 Citations

Abstract PDF

Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.

Citations

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Medicine.2017; 96(40): e8171. CrossRef
Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®
Luca Morelli, Simone Guadagni, Gregorio Di Franco, Matteo Palmeri, Giovanni Caprili, Cristiano D'Isidoro, Luigi Cobuccio, Emanuele Marciano, Giulio Di Candio, Franco Mosca
The International Journal of Medical Robotics and Computer Assisted Surgery.2017; 13(1): e1728. CrossRef
Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid–low rectal cancer following neoadjuvant chemoradiation therapy
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Surgical Endoscopy.2017; 31(4): 1728. CrossRef
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International Journal of Colorectal Disease.2016; 31(4): 869. CrossRef
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Surgical Endoscopy.2016; 30(1): 307. CrossRef
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Cancer Research and Treatment.2016; 48(1): 225. CrossRef
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International Journal of Clinical Oncology.2015; 20(4): 633. CrossRef
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Annals of Surgical Treatment and Research.2014; 86(2): 76. CrossRef
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Colorectal Disease.2012;[Epub] CrossRef
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