Chirurgia robotica colorettale: esperienza iniziale

Introduction Robotc surgery was performed at the Department "Pietro Valdoni" of the "Umberto I" University Hospital of Rome since 2019. The aim of the current study is to present a retrospective review of the collected data of patients undergoing robotic surgery for colorectal diseases. Materials and methods From October 2020 to September 2022, 35 patients underwent to robotic colorectal surgery with da Vinci X IS4200 system. Surgery team was the same for all the procedures. Indications for surgery included both benign and malignant colorectal diseases: colorectal cancer, endoscopically unresectable adenomas and complicated diverticular disease. Data about patients demographics, perioperative outcomes, pathological analysis have been prospectively recorded in the Department database and were subsequently analysed. All procedures were performed with five ports, three robotic and two laparoscopic, respectively. Results Thirty-five patients (14 males and 21 females) were included. Mean age was 70 years (range 52-90), BMI 24kg/m2. Indications for surgery were cancer (82,8% of cases), complicated diverticular disease (8,6%), benign adenomas (8,6%). The most frequent operation was right hemicolectomy (45,5%) followed by low anterior resection (21,2%) and left hemicolectomy (33,3%). Median operative time was 259 minutes (range 180-390), 25 minutes (range 10-35) were necessary for the preoperative robot preparation (docking). There were two conversions to laparotomy. All patients operated for colorectal cancer underwent an appropriate oncological procedure. The median time to discharge was 7 days (range: 6-11). Four patients (12,1%) experienced postoperative complications (Clavien-Dindo I, two patients; Clavien Dindo II/III one patient, respectively). Conclusions In our experience colorectal robotic surgery is feasible and safe. The magnified 3-D vision and the enhanced robotic freedom of movements compared to laparoscopic surgery increases the precision of basic surgical gestures such as traction, counter-traction and improves anatomic dissection. Operating times are still longer than laparoscopic surgery, especially at the start of the learning curve, and their significance is a topic of discussion. However, the experience in robotic surgery can lead to a significant improvement in operating times. Furthermore, low complication rate and consequently a reduced lenght of stay can decrease overall costs. It is necessary to continue gathering data.