Comment on “Early results of novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using Da Vinci XI: initial clinical experience”

Dear Editor,

We are pleased to read the article entitled “Early results of novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using Da Vinci XI: initial clinical experience” by Çakır et al.¹. In this study, the authors evaluated the early outcomes of robotic surgery-assisted anterior resection for low rectal cancer and transvaginal specimen extraction (TVSE). The authors explained the importance of TVSE for women in two aspects: it can bring good cosmetic effect and effectively reduce the complications related to additional skin incision. However, there are still some problems that need our further thinking and exploration.

Both transvaginal extraction and transanal extraction belong to natural orifice specimen extraction (NOSE). In this article, TVSE was used, and the research object was limited to women. As we know, different genders have different human structures. The rectum is the last segment of the bowel, which is connected with the sigmoid colon on the upper part and the anus on the lower part. In female, the uterus and vagina are located in the front of rectum, and in male, the bladder, seminal vesicle, and prostate lie in front of the rectum. In clinical practice, many studies²,³ used transanal specimen extraction. Comparing the two methods of NOSE, transanal specimen extraction technology is more applicable to a wide range of people (both men and women). To the best of our knowledge, the authors illustrates the importance of TVSE for women, but we suggest comparing the two methods of NOSE in terms of operation time, operation and early postoperative complications, hospital stay, blood loss, etc. to highlight the disadvantages and advantages of TVSE.

Vagina is very important for women and it is closely related to some diseases and sexual life⁴ of women. The complications of some TVSE (e.g., sexual intercourse difficulties, infection, infertility, pelvic structural trauma⁵) may have a significant impact on the postoperative life of some special women. Therefore, when using TVSE, patients should be carefully screened to avoid unexpected injury. In addition, further studies on which women (e.g., sexual dysfunction, difficulty in pregnancy) are not suitable for TVSE are also needed.

Compared with traditional laparoscopic methods (unstable view, enlarged hand tremor, uncomfortable ergonomic position of the surgeon⁶), the robot method has some advantages to help rectal cancer surgery, including three-dimensional vision, less fatigue, tremor filtering, and seven degrees of wrist-like motion⁷,⁸. However, the robot can only act as a more advanced technology and means in the current stage of surgery, and, in essence, it still needs human operation ideas and arrangements.

• Funding: none.

REFERENCES

• ¹ Çakır T, Aslaner A. Early results of novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using Da Vinci XI: initial clinical experience. Rev Assoc Med Bras (1992). 2021;67(7):971-4. https://doi.org/10.1590/1806-9282.20210325
  » https://doi.org/10.1590/1806-9282.20210325
• ² D'Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a natural orifice specimen extraction (NOSE) technique. Colorectal Dis. 2011;13(Suppl. 7):28-31. https://doi.org/10.1111/j.1463-1318.2011.02773.x
  » https://doi.org/10.1111/j.1463-1318.2011.02773.x
• ³ Zhang J, Li W, Li Y, Amin B, Zhang N, Sun Z, et al. Short- and long-term outcomes as well as anal function of transanal natural orifice specimen extraction surgery versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection: a retrospective study with over 5-year follow-up. Wideochir Inne Tech Maloinwazyjne. 2022;17(2):344-51. https://doi.org/10.5114/wiitm.2022.113567
  » https://doi.org/10.5114/wiitm.2022.113567
• ⁴ Schober JM, Alguacil NM, Cooper RS, Pfaff DW, Meyer-Bahlburg HF. Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina. Clin Anat. 2015;28(3):355-62. https://doi.org/10.1002/ca.22503
  » https://doi.org/10.1002/ca.22503
• ⁵ Bayraktar O, Esen E, Bengür FB, Erenler Bayraktar İ, Aytaç E, Bilgin İA, et al. Transvaginal specimen extraction in minimally invasive colorectal resections: initial experience of a tertiary referral hospital. ACU Saglik Bil Derg. 2019;10(2):231-5. https://doi.org/10.31067/0.2019.130
  » https://doi.org/10.31067/0.2019.130
• ⁶ Cui B, Lei S, Liu K, Yao H. Robotic low anterior resection plus transanal natural orifice specimen extraction in a patient with situs inversus totalis. BMC Surg. 2018;18(1):64. https://doi.org/10.1186/s12893-018-0394-3
  » https://doi.org/10.1186/s12893-018-0394-3
• ⁷ Xiong B, Ma L, Zhang C, Cheng Y. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res. 2014;188(2):404-14. https://doi.org/10.1016/j.jss.2014.01.027
  » https://doi.org/10.1016/j.jss.2014.01.027
• ⁸ Watanabe T, Hata K. Robotic surgery for rectal cancer with lateral lymph node dissection. Br J Surg. 2016;103(13):1755-7. https://doi.org/10.1002/bjs.10412
  » https://doi.org/10.1002/bjs.10412

Publication Dates

• Publication in this collection
  10 Mar 2023
• Date of issue
  2023

History

• Received
  30 Nov 2022
• Accepted
  03 Dec 2022