Table 1. Comparison between open, laparoscopic, and robotic surgery for the management of CRC.

Procedure	Advantages	Disadvantages
Open surgery
1	Better approach to manage complications such as obstruction, perforation, and hemorrhage in CRC [68].	Open surgery typically requires larger incisions than minimally invasive techniques, which can result in more tissue damage, scarring, and longer healing times. A larger incision size leaves a permanent scar at the site of the incision. Incision size correlates with the intensity of postoperative pain at the site [69].
2	Direct visualization: Open surgery provides a direct line of sight to the surgical site, allowing the surgeon to see and assess the area in real time. This can be particularly useful in complex surgeries or cases where there are unexpected findings [69].	Open surgery typically requires recovery from open surgery which can take longer than minimally invasive techniques due to the larger incisions, increased pain, and longer hospital stay in regards to managing wound health and postoperative surgical site infections [68,69].
3	Open surgery allows for greater access to the surgical site, which can be important in cases where there are large tumors, extensive scarring, or other factors that make it difficult to reach the area with minimally invasive techniques.	Because open surgery involves larger incisions and more tissue manipulation, there is a higher risk of infection compared to minimally invasive techniques.
4	Open surgeries are preferred in patients with a history of multiple surgeries as extensive intra-abdominal adhesions limit access in conventional laparoscopic surgery [70].	Open surgery can carry a higher risk of complications such as blood clots, pneumonia, and other surgical site infections. Longer duration of postoperative ileus even with early ambulation as compared to laparoscopic surgeries [71].
5	Surgeons performing open surgery can feel the tissue and organs they are operating on, which can provide valuable tactile feedback to guide their movements and ensure accuracy.	Open surgery can result in greater blood loss during the procedure, which may require blood transfusions or other interventions to manage.
Laparoscopic
1	Laparoscopic surgery involves making smaller incisions than open surgery, which results in less tissue damage, reduced scarring, faster healing times, and better cosmetic outcome [72].	The surgical field is converted to a two-dimensional image on a monitor, devoid of a three-dimensional view compared to open or robotic surgery [73].
2	Patients who undergo laparoscopic surgery typically experience a faster recovery time due to the smaller incisions and reduced tissue damage, resulting in less postoperative pain which allows for early mobilization, minimal use of analgesics, and shorter hospital stay.	Difficulty in controlling intraoperative hemorrhage and inadvertent injury to adjacent structures(Injury to the left ureter and bladder in sigmoid colectomy) [74].
3	Laparoscopic surgery uses a camera to provide high-quality, magnified images of the surgical site, which can improve surgical precision and reduce the risk of complications [71].	Pneumoperitoneum used in laparoscopic surgeries can cause shoulder pain due to referred pain from the diaphragm, which can be particularly bothersome in patients who are awake during the procedure.
4	Laparoscopic surgery uses a camera to provide high-quality, magnified images of the surgical site, which can improve surgical precision and reduce the risk of complications.	Carbon dioxide used during pneumoperitoneum can be absorbed into the bloodstream, leading to carbon dioxide retention and acid-base disturbances, particularly in patients with impaired ventilation. Increased risk of venous thromboembolism: pneumoperitoneum can increase the risk of venous thromboembolism, particularly in patients with a history of blood clots or other risk factors [75].
5	Early return of functional status postoperatively. (Early return of bowel function post colectomy) [76].	Pneumoperitoneum can lead to insufflation-related injuries, such as puncture of blood vessels or organs, particularly if the procedure is performed by an inexperienced surgeon or if there is an underlying anatomical abnormality. Pneumoperitoneum-induced stretching of the parasympathetic nerve (vagus) can lead to bradycardia and subsequent hypotension.
6		Selective patient eligibility (lack of extensive intra-abdominal adhesions, tolerance of pneumoperitoneum)
Robotic
1	Robotic-assisted surgery combines the advantages of laparoscopic surgery (less postoperative pain and faster recovery) with those of open surgery (high-quality three-dimensional view, restoration of eye-hand-target axis) [70].	Robotic surgery is often more expensive than traditional laparoscopic and open surgery due to the high cost of robotic technology and specialized training required for the surgeons and operating room staff [70].
2	Robotic surgery allows for greater precision and control of surgical instruments, which can be particularly important in complex surgeries.	Robotic surgery provides less tactile feedback to the surgeon than open surgery, which may impact surgical precision and increase the risk of complications.
3	Robotic surgery allows for a more ergonomic working environment for the surgeon, reducing the risk of fatigue and repetitive strain injuries.	Robotic surgery requires specialized training for surgeons and operating room staff, which can be time-consuming and may result in a steep learning curve [77].
4	The robotic arms used in robotic surgery are more dexterous than traditional laparoscopic instruments, allowing for more precise movements and greater surgical accuracy.	Robotic surgery may require greater reliance on robotic technology, which may reduce the surgeon's autonomy and control during the procedure.
5	Robotic instruments can move in a greater range of motion than traditional laparoscopic instruments, allowing for better access to hard-to-reach areas and more precise movements [78].	Limited use for instrumentation as each da Vinci instrument is limited to 10 uses [79].