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Slawomir Marecik, MD, FACS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA

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Are here to stay One of the available tools in our armamentarium Powerful tool Massive potential

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Technically challenging Tumor location Anatomic structures Difficult retraction Unstable camera Poor ergonomics for surgeon UK MRC CLASICC

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Advanced lesion Obese, low (male) APR

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1 Quality Of Dissection 2 Minimally Invasive 3 Comfort For Surgeon

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Quality Of Dissection

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Robotic n=56 Mesorectal grade Complete 52 Nearly complete 4 Incomplete 0 Laparoscopic n=57 Mesorectal Grade Complete 43 Nearly complete 12 Incomplete 2 p=0.033p=0.033 Baik SH. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of prospective comparative study. Ann Surg Oncol. 2009 Quality Of Dissection

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Pigazzi, Baek O.7 % CRM143 pts Kim 1.6 % CRM59 pts Prasad, Marecik 1 % CRM82 pts ROLLAR ACOSOG Can we reduce preoperative radiation? Improved urogenital function? Randomized Studies To Compare Laparoscopic vs. Robotic Resection

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The robot is more useful in certain areas Laparoscopy is more useful in other areas A Hybrid Approach Is The Most Practical Solution At This Time

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Laparoscopic TME challenging Difficulties with advanced disease An increase in obese patient population

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Source: Behavioral Risk Factor Surveillance System, CDC. 2000 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 54 person) 2010 1990 No Data