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Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to 10 November 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was 2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD = −0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs. LG group varied and amounted to 8.0 ± 5.3 vs. 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.

Colorectal cancer (CRC) is the third most common type of cancer worldwide and a leading cause of cancer death. Surgery represents the mainstay of treatment in early cases but often patients are primarily diagnosed in an advanced stage of disease and sometimes also distant metastases are present. Neoadjuvant therapy is therefore needed but drug resistance may influence response and concur to recurrent disease. At molecular level, it is a very heterogeneous group of diseases with about 30% of hereditary or familial cases. During colorectal adenocarcinomas development, epithelial cells from gastrointestinal trait acquire sequential genetic and epigenetic mutations in specific oncogenes and/or tumour suppressor genes, causing CRC onset, progression and metastasis. Molecular characterization of cancer associated mutations gives valuable information about disease prognosis and response to the therapy. Very early diagnosis and personalized care, as well as a better knowledge of molecular basis of its onset and progression, are therefore crucial to obtain a cure of CRC. In this review, we describe updated genetics, current diagnosis and management of CRC pointing out the extreme need for a multidisciplinary approach to achieve the best results in patient outcomes.

Background Robotic surgery for the treatment of gastric cancer has been reported, but the technique is not yet established. The objective of this study was to assess the feasibility and safety of our novel integrated procedure for robotic suprapancreatic D2 nodal dissection during distal gastrectomy. Methods At our hospital from January 2009 to December 2010, a total of 25 consecutive cases of gastric cancer were treated by robotic distal gastrectomy with intracorporeal Billroth I reconstruction. These patients were enrolled in a prospective study to assess the safety and feasibility of robotic distal gastrectomy with nodal dissection by our novel integrated approach, which consists of three elements: arm formation, the surgical approach, a cutting device. To evaluate the learning curves involved in this approach, clinicopathologic features and surgical outcomes were compared between the initial ( n  = 12) and late ( n  = 13) phases. Results All operations were completed without the need for open or conventional laparoscopic surgery. The mean operating time was 361 ± 58.1 min (range 258–419 min), and blood loss recorded was 51.8 ± 38.2 ml (range 4–123 ml). The median number of retrieved lymph nodes was 44.3 ± 18.4 (range 26–95). R0 resection was accomplished in all cases. There were no deaths or complications related to pancreatic damage. Operating time and surgeon console time for the late phase were significantly shorter than those for the initial phase. Conclusions Our novel robotic approach for D2 nodal dissection in gastric cancer is feasible and safe.

Although the removal of the adnexa technically removes more tissue, it may require less fine manipulation and dissection than cystectomy. Secondary to this, we sought to measure the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy (CLS). We search six databases to find studies comparing LESS and CLS for ovarian lesions where removal of the entire ovary, with or without the fallopian tube, is necessary. Criteria used for study eligibility: both controlled trials and observational studies were included in this analysis. Study appraisal and synthesis methods: we used the Cochrane risk of bias assessment tool for the randomized clinical trials and the national heart, lung, and blood quality assessment tools for the observational studies. The statistical analysis was done using the review manager software. LESS showed a significantly longer operative time [mean difference (MD)=2.96 (-1.97, 7.90), p=0.24], but with moderate heterogeneity. Estimated blood loss was significantly lower for LESS [MD=-18.62 (-33.83, -3.42), p=0.02]. The length of patient hospital stay was comparable [MD=-0.02 (-0.50, 0.47), p=0.95]. Visual analog scale (VAS) pain scores at 24 hours [MD=0.23 (-0.09, 0.56), p=0.16] and 6 hours postoperatively [MD=0.15 (-0.04, 0.33), p=0.12] were similar. The LESS group required less postoperative analgesia [risk ratios (RR)=0.47 (0.32, 0.68), p=0.001]. The change in hemoglobin was comparable [MD=-0.11 (-0.26, 0.03), p=0.14]. Perioperative complications were higher in the LESS group [RR=2.236 (1.031, 4.851), p=0.04]. Compared with CLS, LESS required more operative time but resulted in significantly less blood loss and lower postoperative analgesic use. Hospital stays and VAS pain scores were similar. LESS had a higher incidence of perioperative complications, which questions the feasibility of its use in some situations.

Background Single-incision plus one-port laparoscopic surgery (SILS + 1) has been demonstrated to be minimally invasive while possessing better cosmesis and less pain compared with conventional laparoscopic surgery (CLS). However, SILS + 1 as an alternative to CLS for colorectal cancer is still controversial. Methods A total of 1071 patients who underwent curative laparoscopic surgery for colon cancer between 2015 and 2018 were included. Of these patients, 258 SILS + 1 cases and 516 CLS cases were analyzed using propensity score matching. The baseline characteristics, surgical outcomes, pathologic findings and recovery course, morbidity and mortality within postoperative 30 days and 3-year disease-free and overall survival were compared. Results Baseline characteristics were balanced between the groups. The mean operating time was significantly shorter in SILS + 1 group, with less estimated blood loss. Tumor size, tumor differentiation, number of harvested lymph nodes, resection margin and pathologic T, N, TNM stage was similar between the groups. There was no significant difference in overall perioperative complications. Uni- and multivariate analyses revealed that SILS + 1 was not a risk factor for complications. Postoperatively, SILS + 1 group showed faster recovery than CLS group in terms of ambulation, bowel function, oral intake and discharge. The 3-year disease-free survival rates of SILS + 1 and CLS groups were 90.1% and 87.3%(p = 0.59), respectively and the 3-year overall survival rates were 93.3% vs. 89.8%(p = 0.172). Discussion Our study revealed that SILS + 1 is safe, feasible, oncologically efficient, and may be considered as a surgical option for selected patients with colorectal cancer.

Purpose Scientific evidence supporting robotic-assisted laparoscopic surgery (RALS) for rectal cancer remains inconclusive because most previous reports were retrospective case series or case-control studies, with few reports focusing on long-term oncological outcomes with a large volume of patients. The aim of this study was to clarify the short- and long-term outcomes of a large number of consecutive patients with rectal cancer who underwent RALS in a single high-volume center. Methods The records of 551 consecutive patients who underwent RALS for rectal adenocarcinoma between December 2011 and March 2017 were examined to reveal the short-term outcomes. The oncological outcomes of the 204 patients who underwent surgery between December 2011 and March 2014 were evaluated. Results Most patients had tumors located in the lower or mid-rectum (86.0%). Only 7.6% of patients underwent neoadjuvant chemoradiotherapy. Lateral lymph node dissection was performed for 191 patients (34.7%). The median operative time was 257 min, median blood loss was 10 mL, and no transfusions were needed. No conversion to open surgery was necessary. Eighteen patients (3.3%) had Clavien-Dindo grade III postoperative complications. Six patients (1.1%) had positive resection margins. The mean follow-up duration of the 204 patients was 43.6 ± 9.8 (months). The 5-year cancer-specific survival rate for stage I/II/III/IV was 100%/100%/100%/not reached, respectively. The 5-year relapse-free survival rate for stage I/II/III/IV was 93.6%/75.0%/77.6%/ not reached, respectively. The rate of local recurrence was 0.5%. Conclusions Our results suggest that RALS is technically feasible for rectal cancer and has good short- and long-term outcomes.

The objective of this study was to compare the oncologic outcomes between those who underwent robotic surgery or conventional laparoscopic surgery for endometrial cancer. We performed a retrospective review of patients from a single institution who underwent either laparoscopic or robotic surgery for the treatment of endometrial cancer between January 2010 and December 2020. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Among the 268 patients included in this study, 95 underwent robotic surgery (35.4%) and 173 underwent laparoscopic surgery (64.6%). The median follow-up durations were 51 and 59 months for the robotic surgery and laparoscopic surgery groups, respectively ( = 0.085). The recurrence rate did not differ significantly between the two groups. ( = 0.371). Disease-free survival ( = 0.721) and overall survival ( = 0.453) were similar between the two groups. In both univariate and multivariate analyses, the type of surgery was not related to disease-free survival. The median total cost per admission was significantly higher for RS than for LS (12,123 vs. 6,884 USD, < 0.0001). With consistently greater costs and similar survival outcomes, robotic systems have few advantages compared with laparoscopy.

Background Comparative studies between robotic-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) primarily focus on surgical outcomes, with limited emphasis on the anesthesiologist's perspective. This study aimed to compare anesthesia-related Enhanced Recovery After Surgery (ERAS) outcomes to inform surgical decision-making. Methods This retrospective study included 831 patients who underwent partial nephrectomy or radical prostatectomy for renal or prostate cancer between September 2021 and October 2023. Propensity score matching (PSM) was performed in a 1:1 ratio based on age, gender, BMI, surgery type, and comorbidities. Primary outcomes included anesthesia time, surgical time, recovery time, and resting/activity VAS scores on postoperative day one (POD1). Secondary outcomes comprised ambulation status, nausea/vomiting, dizziness, and anxiety incidence. Safety indicators were pharyngeal pain, respiratory depression, and oxygen requirement. Results After PSM, 252 patients were allocated to each group. The RALS group demonstrated significantly longer anesthesia and surgical times compared to the CLS group ( P < 0.05). PACU recovery time showed no significant difference. While Rest-VAS on POD1 was similar, Act-VAS was significantly higher in the RALS group ( P <0.05). The proportion of patients achieving autonomous mobilization (Grade 1) was significantly lower in the RALS group( P <0.01). Incidences of nausea/vomiting and dizziness were significantly higher in the RALS group ( P <0.05). Anxiety incidence was significantly lower in the RALS group ( P <0.05). No significant differences were found in sore throat, respiratory depression, or oxygen requirement rates. Conclusions These findings suggest that from an anesthesiological perspective, RALS is associated with longer surgical and anesthesia time. The observed differences in postoperative recovery indicators highlight the importance of considering patient physiological reserve when selecting a surgical approach. However, given the observational nature of this study, these findings should be considered hypothesis-generating and warrant prospective validation.

Three-port (trocar) laparoscopic appendectomy is the standard treatment for acute appendicitis and previous studies have compared to single-incision approach, however, they often include both pediatric and adult patients and fail to account for surgeons’ experience, leading to variability in outcomes. This systematic review and meta-analysis aims to address these literature gaps by focusing on adult patients and controlling for surgeon expertise. We conducted a comprehensive search of randomized controlled trials comparing single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) up to November 2024. We assessed the length of hospitalization, operative duration, postoperative complications, and surgical wound infections. Data were synthesized using random-effects models to account for variability among studies. The meta-analysis included four studies with a total of 408 patients, comprising 202 in the single-incision laparoscopic appendectomy (SILA) group and 206 in the conventional laparoscopic appendectomy (CLA) group. For the length of hospitalization, no statistically significant difference was observed, with a weighted mean difference (WMD) of 0.07 days (95% CI  − 0.32 to 0.47, I 2  = 0%, p  = 0.72). Similarly, the operative duration showed no significant difference, with a WMD of 4.49 min (95% CI  − 7.02 to 16.00, I 2  = 89%, p  = 0.44). The analysis of postoperative complications also revealed no significant difference between the groups, with an odds ratio (OR) of 1.32 (95% CI 0.69 to 2.51, I 2  = 0%, p  = 0.40). Surgical wound infections were found to be comparable, with an OR of 1.14 (95% CI 0.46 to 2.83, I 2  = 0%, p  = 0.78). Sensitivity analysis indicated that the results were statistically significant regarding operative duration when Kim et al. was excluded from the analysis. SILA and CLA yield comparable outcomes in terms of hospitalization length, operative duration, and complications, suggesting that both techniques are viable options for the management of acute appendicitis in adults. Further studies investigating overall cosmesis, patient satisfaction, and postoperative pain are warranted to optimize surgical approaches. PROSPERO registration: CRD42024612596.

BackgroundSingle-incision laparoscopic surgery (SILS) for right colon cancer is going to be considered as a new option. The potential benefits, clinical, and oncologic outcomes are still controversial. The aim of this study was to investigate clinical and oncologic outcomes of single-incision laparoscopic surgery (SILS) compared to conventional laparoscopic surgery (CLS) for right colon cancer using propensity score matching analysis.MethodsFrom December 2013 to June 2017, 174 patients underwent laparoscopic radical right hemicolectomy through a single-incision (n = 32) or a conventional (n = 142) approach. The data were prospectively collected and the patients were matched at a radio of 1:1 according to age, sex, body mass index (BMI), previous abdominal surgeries, comorbidities, ASA score (≤ 2/> 2), and pathologic stage.ResultsNo significant differences were observed in estimated blood loss, time to diet, postoperative pain score, length of hospital stay between the SILS and CLS groups. However, the SILS group showed longer operation time (175 (40) vs 145 (52.5), p = 0.011) and shorter incision length (4 (1.4) vs 7 (1.9), p < 0.001). There were 2 (6.3%) postoperative complications in the SILS group and 5 (15.6%) in the CLS group (p = 0.426). The pathologic outcomes were similar between two groups. The median follow-up period was 26.5 months in the SILS group and 34.9 months in the CLS group (p = 0.002). There were 3 recurrences (9.4%) in the SILS group and 3 (9.4%) in the CLS group. The 3-year disease-free survival rates were 92.4 and 93.8% (p = 0.984), and overall survival rates were 92.3 and 93.0% (p = 0.884) in the SILS and the CLS groups, respectively. No incisional hernia was observed during the follow-up period.ConclusionsThough single-incision laparoscopic surgery for right colon cancer showed longer operation time in this study, it appears to be a safe and feasible option with comparable clinical and oncologic outcomes to conventional laparoscopic surgery.