Comparison of Robotic-Assisted Resection Alone and with Natural Orifice Specimen Extraction for Rectal Cancer by Using Da Vinci Xi.

OBJECTIVE:The aim of our study is to compare the results of robotic surgery-assisted Low Anterior Resection (LAR) and Natural Orifice Specimen Extraction (NOSE) for Rectal Cancer (RC).PATIENTS AND METHODS:From November 2015 to June 2021, patients receiving robotic NOSES and robotic surgery assisted resection (RSAR) were retrospectively enrolled in the study. All robotic-assisted LAR of the rectum, NOSE, colorectal anastomosis and loop ileostomies were performed using the Da Vinci Xi system.RESULTS:A total of 57 patients with robotic NOSES and 93 with robotic RC resection were enrolled. Total mesorectal excision of the rectum, trans-anal or transvaginal specimen extraction (TVSE), anastomoses and protective ileostomy were conducted in all patients. ASA, BMI, tumor histology, stage, nodal stage, mean operative time, estimated blood loss, tumor size, lymph nodes removal, hospital stay morbidity and mortality were evaluated. No patient required conversion to conventional surgery. NOSE has less morbidity and significantly reduces postoperative pain and hospital stay (5.0 vs. 5.5). The two groups were similar in long-term survival.CONCLUSIONS:According to our literature search, this is the first study to compare RSAR and NOSE for RC using the Da Vinci Xi system. NOSE can be performed safely and successfully on selected patients, providing excellent good results.