Current status and future of minimally invasive surgery for colorectal cancer

Regarding colorectal cancer surgery, around 60% are performed by laparoscopic surgery(LS) in Japan. As for minimally invasiveness, reduced port surgery and incision-less surgery with/without total laparoscopic approach have been reported. To safely accomplish LS for transverse colon cancer, 3D-CT imaging could be helpful to expedite safe and meticulous lymph-node dissection . For rectal cancer, LS could be beneficial for precise dissection and mobilization of rectum under telescopic and magnified view. Additionally, we have demonstrated that systematic and step-by-step approach could lead to its safe anastomosis . Regarding robotic surgery (RS). It seems to be advantageous to the patients with fatty narrow pelvis, ISR and some other demanding cases like lateral lymphadenectomy. However, In Japan, RS has not been applied so much yet, because of its high cost , no national health insurance coverage, no tactile sensation, etc. We have started to apply 3D laparoscope to the colorectal cancer surgeries since 2013. As with the advancement of our techniques and supporting devices like smart scope holder, we have realized the unexpected tactile sensation with stable 3D high vision imaging which could make our operation simple with reducing the operative time and cost. Moreover, combination with TAMIS could be very good option for upgrading ISR. We believe that surgeons' creative mind must be the key to advance future innovations of MIS.