Steep Learning Curve

Laparoscopic colorectal resection is a technically demanding procedure with a steep learning curve [22]. New surgical skills need to be learned and many colorectal surgeons do not have such specific training. Laparoscopic instruments are straight, with no articulation at their tips. In addition, the surgeon must learn to operate watching on a two-dimensional monitor. These disadvantages may be overcome, however, by the recent introduction of robotic technology in the operating room (OR). The robotic device is designed to transfer the movements directly from the surgeon's hand to articulated instruments driven by robotic arms and, at the same time, to allow a real three-dimensional view of the surgical field. It has been demonstrated that an equally valid oncological resection and comparable surgical results can be obtained by standard laparoscopy and using the robotic approach [23].

Based on this evidence, it is now clear that the laparoscopic approach can be offered to patients for the treatment of colorectal cancer, providing the procedure is performed by surgeons with plenty of experience in this field.

The laparoscopic technique differs in several ways from the standard open technique. The differences include not only a technically different approach to the colon, but also a different and particular preparation of the patient for surgery, a different position of the patient on the OR table, and a completely different set of equipment. Surgeons willing to perform this type of surgery need to have an in-depth understanding of the technology used in laparoscopy.

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