The Miracle Machine

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We read with interest the recent article by Kim et al1 in Diseases of the Colon & Rectum. Although we appreciate the reviewers’ good intention to provide timely contributions to the literature, we are puzzled by the authors’ conclusions.
Claiming that robotic resection, per se (without supporting data), can lead to improved cancer-specific survival rates does not represent a constructive contribution to the contemporary debate surrounding the role of robotic proctectomy for rectal cancer. Authors should focus on histopathology data such as the quality of total mesorectal excision (TME), the width of circumferential resection margins (CRMs), and/or any other validated metrics to evaluate which approach to proctectomy is most beneficial to patients.
Although the total absence of tactile feedback may potentially have a negative impact on the quality of TME during a surgeon’s learning curve, there is currently very limited literature assessing the quality of TME in robotic proctectomy (not reported by Kim et al1).2 Dissimilarly, robotic EndoWrist technology may increase the width of CRMs overcoming the fulcrum effect in the pelvis. In fact, a previous study reported a wider CRM in robotic proctectomy as compared with its conventional and laparoscopic counterparts.3 A significantly decreased rate of CRM involvement would constitute a major oncologic benefit of robotic proctectomy, because CRM is a predictor of cancer-specific survival.
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