Background: Articulating laparoscopic instruments, ArtiSential, designed to mimic the multi-directional angulating motion of robotic arms, may enhance surgical precision. Unlike robotic platforms, they can be immediately implemented in conventional laparoscopic settings without requiring costly infrastructure. However, no direct comparisons between these instruments and robotic systems have been reported. The aim of this study is to compare short-term operative outcomes and cost-effectiveness between articulating laparoscopic and robotic low anterior resection (LAR) for rectal cancer. Materials and methods: We conducted a multicenter prospective parallel-arm cohort study of rectal cancer patients who underwent LAR at seven tertiary referral centers in Korea between August 2022 and July 2024. Outcomes were evaluated using propensity score matching. The primary outcome was short-term morbidity; secondary outcomes included operative details and medical costs. Results: A total of 740 patients were included: 289 (39. 1%) underwent articulating laparoscopic LAR and 451 (60. 9%) underwent robotic LAR. After matching, the articulating laparoscopic group had significantly shorter operative times (median, 126 vs 153 min; P < 0. 001). Postoperative complications and pathologic outcomes were comparable between groups. Median out-of-pocket medical expenses were markedly lower in the articulating laparoscopic group (2475 vs 11 378; P < 0. 001). Conclusion: In this multicenter prospective study, articulating laparoscopic LAR demonstrated similar perioperative outcomes to robotic LAR, with substantially reduced patient costs. Although long-term oncologic outcomes require further investigation, articulating laparoscopic LAR may offer a cost-effective alternative to robotic surgery, particularly in resource-constrained settings.
Pyo et al. (Wed,) studied this question.