结直肠癌是最常见的消化道恶性肿瘤之一，严重威胁着患者的身体健康。外科手术是治疗结直肠癌的有效方法。目前，微创手术因创伤小、恢复快等优点，成为许多患者的首选。传统腹腔镜手术在技术上存在一定的难度，它需要外科医生拥有丰富的腹腔镜操作经验。而达芬奇机器人拥有高清的 3D 镜头、灵活的机械臂以及更符合人体工程学的操作方式，在设计上优于腹腔镜。但多项研究结果显示，机器人结直肠手术的围手术期结果、远期结果与传统腹腔镜相比未见明显优势，而费用却明显增加。目前，机器人结直肠手术已被证实是安全可行的，其便于进行体内肠吻合，并可以缩短学习曲线。达芬奇机器人可在术空间狭小、解剖复杂的盆腔内操作。在面对内脏肥胖、骨盆狭窄、低位肿瘤等病例时，它的视觉系统也有助于辨识解剖层次，更好的保留盆腔自主神经，可能会促进泌尿与性功能的术后恢复。随着各领域的新技术不断发展和融合，以及外科医生机器人手术经验的积累，相信机器人手术在未来会拥有更广阔的应用前景。

Colorectal cancer is one of the most common digestive tract malignancies, which is a severe threat to human health. Surgery is an effective treatment for colorectal cancer. At present, minimally invasive surgery has become the first choice  of many patients since its advantages of minor injury and quick recovery. Laparoscopic surgery is technically difficult, which requires rich experience of surgeons. The Da Vinci robot-assisted surgical system is equipped with high-definition 3D view, flexible robotic arm and good ergonomics, which is superior to laparoscopy. According to latest studies, the perioperative results and long-term results of robot-assisted colorectal surgery showed no obvious advantages over traditional laparoscopy, but the cost is significantly increased. However, robotic colorectal surgery is safe and feasible to perform intestinal anastomosis, which also has a shorter learning curve. Robotic surgery is more suitable for pelvic operation, which has narrow surgical space and complex anatomy. When dealing with visceral obesity, male pelvis and low tumor location, the visual system of robotic surgery system can identify the anatomical level, which may help to preserve pelvic autonomic nerve better during operation and accelerate the recovery of urinary and sexual function after surgery. With the continuous combination of new technologies in various fields and the accumulation of robotic surgery experience for surgeons, it is believed that the robotic surgery will be widely used in the near future.

收稿日期：2020-10-28  录用日期：2021-02-23

Received Date: 2020-10-28  Accepted Date: 2021-02-23

基金项目：2019 年海军军医大学校级“思政课程”、“课程思政”专项课题

Foundation Item: Educational Reform Program of Naval Medical University in 2019

通讯作者：楼征，Email：louzhengpro@126.com

Corresponding Author: LOU Zheng, Email: louzhengpro@126.com

引用格式：李书原，楼征，张卫 . 机器人辅助腹腔镜与传统腹腔镜行结直肠癌手术的安全性和有效性比较 [J]. 机器人外科学杂志（中英文），2021，2（4）：277-286.

Citation: LI S Y, LOU Z, ZHANG W. Comparison of safety and efficacy between robotic and conventional laparoscopic surgeryfor colorectal cancer[J]. Chinese Journal of Robotic Surgery, 2021, 2 (4): 277-286.

[1]Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA: A Cancer Journal for Clinicians, 2018, 68(6): 394-424.

[2]Jacobs M, Verdeja J C, Goldstein H S. Minimally invasive colon resection (Laparoscopic Colectomy)[J]. Surgical Laparoscopy & Endoscopy, 1991, 1(3): 144-150.

[3]Nelson H, Sargent D J, Wieand S, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer[J]. The New England Journal of Medicine, 2004,350(20): 2050-2059.

[4]Guillou P J, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC Trial): multicentre, randomised controlled trial[J]. Lancet (London, England), 2005, 365(9472):1718-1726.

[5]MA Y, YANG Z, QIN H, et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer[J]. Medical Oncology (Northwood,London, England), 2011, 28(4): 925-933.

[6]CHEN K, CAO G, CHEN B, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 Years[J]. International Journal of Surgery (London, England),2017, 39: 1-10.

[7]Toritani K, Watanabe J, Nakagawa K, et al. Randomized controlled trial to evaluate laparoscopic versus open surgery in transverse and descending colon cancer patients[J]. International Journal of Colorectal Disease, 2019, 34(7): 1211-1220.

[8]Uhrich M L, Underwood R A, Standeven J W, et al. Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery[J]. Surgical Endoscopy, 2002, 16(4): 635-639.

[9]Lanfranco A R, Castellanos A E, Desai J P, et al. Robotic surgery: a current perspective[J]. Annals of Surgery, 2004, 239(1): 14-21.

[10] Weber P A, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J]. Diseases of the Colon and Rectum, 2002, 45(12): 1689-1694; discussion 1695-1696.

[11] Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system[J].Surgical Endoscopy, 2002, 16(8): 1187-1191.

[12] D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases[J]. Diseases of the Colon and Rectum, 2004,47(12): 2162-2168.

[13] Park J S, Kang H, Park S Y, et al. Long-term oncologic after robotic versus laparoscopic right colectomy: a prospective randomized study[J]. Surgical Endoscopy,2019, 33(9): 2975-2981.

[14] Polat F, Willems L H, Dogan K, et al. The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study[J]. Surgical Endoscopy, 2019, 33(11): 3644-3655.

[15] ZHU X L, YAN P J, YAO L, et al. Comparison of short-term outcomes between robotic-assisted and laparoscopic surgery in colorectal cancer[J]. Surgical Innovation, 2019, 26(1): 57-65.

[16] Gerbaud F, Valverde A, Danoussou D, et al. Experience with transitioning from laparoscopic to robotic right colectomy[J]. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 2019. DOI: 10.4293/JSLS.2019.00044.

[17] Yozgatli T K, Aytac E, Ozben V, et al. Robotic complete mesocolic excision versus conventional laparoscopic hemicolectomy for right-sided colon cancer[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques.Part A, 2019, 29(5): 671-676.

[18] Kim J C, Lee J L, Yoon Y S, et al. Robotic left colectomy with complete mesocolectomy for splenic flexure and descending colon cancer, compared with a laparoscopic procedure[J]. The International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS, 2018,14(5): e1918.

[19] Spinoglio G, Bianchi P P, Marano A, et al. Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 Patients[J]. Annals of Surgical Oncology, 2018, 25(12): 3580-3586.

[20] Vasudevan V, Reusche R, Wallace H, et al. Clinical outcomes and cost-benefit analysis comparing laparoscopic and robotic colorectal surgeries[J]. Surgical Endoscopy, 2016, 30(12): 5490-5493.

[21] De’Angelis N, Lizzi V, Azoulay D, et al. Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 2016, 26(11): 882-892.

[22] Kang J, Park Y A, Baik S H, et al. A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer[J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2016, 26(6):497-502.

[23] Solaini L, Bazzocchi F, Cavaliere D, et al. Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis[J]. Surgical Endoscopy, 2018, 32(3): 1104-1110.

[24] Park J S, Choi G S, Park S Y, et al. Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy[J]. The British Journal of Surgery, 2012,99(9): 1219-1226.

[25] Spinoglio G, Summa M, Priora F, et al, Robotic colorectal surgery: first 50 cases experience[J]. Diseases of the Colon and Rectum, 2008, 51(11): 1627-1632.

[26] Zarak A, Castillo A, Kichler K, et al. Robotic versus laparoscopic surgery for colonic disease: a meta-analysis of postoperative variables[J]. Surgical Endoscopy, 2015,29(6): 1341-1347.

[27] Lee S D, Lim S B. D3 Lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer[J]. International Journal of Colorectal Disease,2009, 24(3): 295-300.

[28] Mckenzie S, Baek J-H, Wakabayashi M, et al. Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience[J]. Surgical Endoscopy, 2010, 24(8): 2048-2052.

[29] Trastulli S, Coratti A, Guarino S, et al. Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study[J]. Surgical Endoscopy, 2015, 29(6):1512-1521.

[30] Trastulli S, Cirocchi R, Desiderio J, et al. Robotic versus laparoscopic approach in colonic resections for cancer and benign diseases: systematic review and meta-analysis[J]. PLOS ONE, 2015, 10(7): e0134062.DOI: 10.1371/journal.pone.0134062.

[31] Mirkin K A, Kulaylat A S, Hollenbeak C S, et al.Robotic versus laparoscopic colectomy for stage i-iii colon cancer: oncologic and long-term survival outcomes[J]. Surgical Endoscopy, 2018, 32(6): 2894-

2901.

[32] Salman M, Bell T, Martin J, et al. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database[J]. The American Surgeon, 2013, 79(6): 553-560.

[33] Kim M J, Park S C, Park J W, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase ii open label prospective randomized controlled trial[J].Annals of Surgery, 2018, 267(2): 243-251.

[34] Debakey Y, Zaghloul A, Farag A, et al. Robotic-assisted versus conventional laparoscopic approach for rectal cancer surgery, first egyptian academic center experience, RCT[J]. Minimally Invasive Surgery, 2018.DOI: 10.1155/2018/5836562.

[35] Tolstrup R, Funder J A, Lundbech L, et al. Perioperative pain after robot-assisted versus laparoscopic rectal resection[J]. International Journal of Colorectal Disease,2018, 33(3): 285-289.

[36] Jayne D, Pigazzi A, Marshall H, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the rolarr randomized clinical trial[J]. JAMA, 2017, 318(16):1569.

[37] Galata C, Vassilev G, Haas F, et al. Clinical, oncological, and functional outcomes of Da Vinci (Xi)- assisted versus conventional laparoscopic resection for rectal cancer: a prospective, controlled cohort study of 51 consecutive cases[J]. International Journal of Colorectal Disease, 2019, 34(11): 1907-1914.

[38] Crippa J, Grass F, Dozois E J, et al. Robotic surgeryfor rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort[J]. Annals of Surgery, 2020. DOI: 10.1097/SLA.0000000000003805.

[39] Crolla R M P H, Mulder P G, van der Schelling G P. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? an observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections[J]. Surgical Endoscopy, 2018, 32(11): 4562-4570.

[40] Feroci F, Vannucchi A, Bianchi P P, et al. Total mesorectal excision for mid and low rectal cancer:laparoscopic vs robotic surgery[J]. World Journal ofGastroenterology, 2016, 22(13): 3602-3610.

[41] Shiomi A, Kinugasa Y, Yamaguchi T, et al. Robot assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes[J]. International Journal of Colorectal Disease,2016, 31(10): 1701-1710.

[42] Morelli L, Guadagni S, Lorenzoni V, et al. Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysiscovering the initial 50 robotic cases with the Da VinciSi[J]. International Journal of Colorectal Disease, 2016, 31(9): 1639-1648.

[43] D’Annibale A, Pernazza G, Monsellato I, et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer[J]. Surgical Endoscopy, 2013,27(6): 1887-1895.

[44] Barnajian M, Pettet D, Kazi E, et al. Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic Cases[J]. Colorectal Disease, 2014, 16(8): 603-609.

[45] Fransgaard T, Pinar I, Thygesen L C, et al. Association between robot-assisted surgery and resection quality in patients with colorectal cancer[J]. Surgical Oncology, 2018, 27(2): 177-184.

[46] Kim J Y, Kim N-K, Lee K Y, et al. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery[J]. Annals of Surgical Oncology, 2012, 19(8): 2485-2493.

[47] Park S Y, Choi G-S, Park J S, et al. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison[J]. World Journal of Surgery, 2014, 38(7): 1834-1842.

[48] Broholm M, Pommergaard H-C, G-genür I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis[J]. Colorectal Disease, 2015, 17(5):375-381.

[49] Byrn J C, Hrabe J E, Charlton M E. An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience[J]. Surgical Endoscopy, 2014, 28(11):3101-3107.

[50] Bianchini M, Guadagni S, Morelli L. Costs-benefits of robot-assisted colorectal surgery: a different perspective[J]. Journal of Robotic Surgery, 2019, 13(4): 607-608.

[51] Ozben V, Cengiz T B, Atasoy D, et al. Is Da Vinci Xi better than Da Vinci Si in robotic rectal cancer surgery? comparison of the 2 generations of da vinci systems [J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2016, 26(5): 417-423.

[52] Morelli L, Di Franco G, Guadagni S, et al. Robot-assisted total mesorectal excision for rectal cancer:case-matched comparison of short-term surgical and functional outcomes between the Da Vinci Xi and Si[J].Surgical Endoscopy, 2018, 32(2): 589-600.

[53] Best S L, Donnally C, Mir S A, et al. Complications during the initial experience with laparoendoscopic single-site pyeloplasty[J]. BJU International, 2011,108(8): 1326-1329.

[54] Autorino R, Kaouk J H, Stolzenburg J-U, et al. Current status and future directions of robotic single-site surgery: a systematic review[J]. European Urology,2013, 63(2): 266-280.

[55] Kaouk J, Garisto J, Eltemamy M, et al. Pure single-site robot-assisted partial nephrectomy using the sp surgical system: initial clinical experience[J]. Urology, 2019,124: 282-285.

[56] Spinelli A, David G, Gidaro S, et al. First experience in colorectal surgery with a new robotic platform with haptic feedback[J]. Colorectal Disease, 2018, 20(3):228-235.