Robotic Versus Laparoscopic Low Anterior Resection: Comparison of Peri-Operative Outcomes at United Lincolnshire Teaching Hospitals NHS Trust

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Aim The aim of this study was to compare the intra-operative and post-operative outcomes of robotic-assisted low anterior resection (LAR) and laparoscopic LAR. Materials and methods The study was a retrospective one, with the study period being January 2021 to December 2024. It was conducted across three hospitals of the United Lincolnshire Teaching Hospitals NHS Trust, United Kingdom. All patients diagnosed with an operable rectal cancer were included in this study. Data was collected from the case records of all patients. Besides demographic data, the pre-operative parameter considered was whether the patient received neoadjuvant chemoradiation. Intra-operative parameters analysed were operative duration, whether the procedure was converted to open, if a stoma was created, and the presence of any specific intra-operative complications. Length of stay in hospital and incidence of post-surgical complications, such as paralytic ileus, small bowel obstruction, anastomotic leak, bowel perforation, repeat surgery, hemorrhage or hematoma formation, sizable intra-abdominal collections, etc., were documented and analysed. Lastly, histopathological outcomes, the number of lymph nodes harvested, and the circumferential resection margins were analysed. Results Group A comprised 37 patients who underwent robotic LAR, and Group B comprised 48 patients who underwent laparoscopic LAR. The mean intra-operative duration (475±20.96 minutes for Group A versus 447.29±29 minutes for Group B) between the two groups showed a statistically significant difference (p value = 0.001). The chi square test showed better intra-operative and post-operative outcomes for Group A patients, with statistically significant differences, in the number of patients needing a de-functioning ileostomy (p = 0.001), rates of conversion to open surgery (p = 0.041), average lymph nodes harvest (p = 0.05), anastomotic leak (p = 0.03), paralytic ileus (p = 0.02), and re-laparotomy (p = 0.03). The unpaired t-test showed a significant difference between the average circumferential resection margins between Group A and Group B (degree of freedom (df) = 83, critical value = 1.99, and t = 5.1272) and the average duration of hospital stay (df = 82, critical value = 1.99, t = 2.97, further highlighting improved outcomes in Group A patients. Conclusion The three-dimensional magnified vision of the robotic platform, precise instrumentation, and the enhanced dexterity of the robotic arms help perform a precise dissection in the mesorectal fascial plane, achieve better tumor-free resection margins, and complete resection of the disease. The improved vision allows for resection of the disease while preserving the blood supply of the anastomotic ends, thus facilitating better clinical outcomes and early discharge from the hospital.

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