Portal de Periódicos da CAPES

Robotic surgery in the treatment of rectal cancer - implementation in Bulgaria and early clinical results

2015; Volume: 47; Linguagem: Inglês

10.14748/ssm.v47i0.1361

1314-6408

Tashko S. Deliyski, Dobromir Dimitrov, Sergey Iliev, Ts. Ivanov, E Filipov, Hyuliya Feradova, K. Nedyalkov, С Томов, Grigor Gortchev,

Surgical Simulation and Training

At present, the standard treatment of rectal cancer requires a multimodality approach. It includes preoperative radiotherapy, surgical removal of the tumor with total mesorectal excision (TME), and postoperative chemotherapy. Conventional open surgery is the most frequent surgical approach. Laparoscopic surgery is not a standard surgical procedure for the treatment of rectal cancer (1). The difficult anatomy of the pelvis, the two dimensional view to the surgical field, unstable camera, loss of eye-hand coordination and the enhancement of the physiological tremor lead to a number of technical difficulties, a long learning curve and a high conversion rate in treatment of rectal cancer (2). Minimally invasive surgery has dramatically changed since the introduction of the robotic surgical systems into the practice (3). This type of a system was created for precise dissection in narrow spaces like the pelvis. Three dimensional view of the operative field, instruments with high level of mobility, recreating the wrist s movements, a filter for the physiological tremor and better ergonomics are a part of the advantages of robotic surgery over laparoscopic surgery (4-5). Better visualization and high degree of instruments movements can lead to better dissection during TME (6). Currently some comparative studies have demonstrated a lower conversion rate for robotic surgery compared to conventional laparoscopic surgery in the treatment of rectal cancer (7-8). Other studies report faster recovery of sexual and urinary function after robotic surgery (9). This is the reason for many authors to believe that robotic surgery can overcome the limitations of conventional laparoscopic surgery in the treatment of rectal cancer. Robotic surgery can also significantly increase the percentage of minimally invasive procedures and improve the quality of rectal cancer surgery.