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Bae SU. Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy: Standardization of surgical technique. World J Gastrointest Surg 2025; 17:103704. [DOI: 10.4240/wjgs.v17.i4.103704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 01/26/2025] [Accepted: 02/24/2025] [Indexed: 03/29/2025] Open
Abstract
Surgical advancements have transformed colorectal cancer treatment, with complete mesocolic excision (CME) becoming a crucial method to guarantee oncological safety and effectiveness. The article by Yadav emphasized the significance of CME in attaining optimal resection margins, thorough lymph node dissection, and enhanced long-term survival rates. The adjunctive function of D3 lymphadenectomy, emphasizing the clearance of lymphatic drainage along the supplying vessels, was also addressed. CME with central vascular ligation, based on the principles of total mesorectal excision for rectal cancer, entails en bloc tumor resection and precise dissection along the embryological planes, thus diminishing recurrence and improving survival rates. The viability and safety of minimally invasive techniques, such as laparoscopic CME, have been confirmed; however, technical difficulties remain owing to the intricate vascular anatomy. Robotic-assisted surgery presents potential benefits, including accurate lymphatic dissection and intracorporeal anastomosis. However, evidence demonstrating its superiority over laparoscopic techniques is scarce owing to high costs and prolonged duration. This study promotes the global standardization of CME as an essential element of modern colorectal cancer surgery. CME epitomizes contemporary oncological practices, requiring widespread adoption to achieve superiority in colon cancer management.
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Affiliation(s)
- Sung Uk Bae
- Department of Surgery, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu KS002, South Korea
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2
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Barzola E, Planellas P, Cornejo L, Gómez N, Julià D, Bobb KA, Farrés R, Gómez M. Impact of team experience on robot-assisted surgery for rectal cancer: A comparative study. Cir Esp 2025; 103:75-83. [PMID: 39675672 DOI: 10.1016/j.cireng.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 10/28/2024] [Indexed: 12/17/2024]
Abstract
INTRODUCTION The robotic surgical team in the operating room plays an important role in determining the outcome of a robotic approach. This study aimed to compare the outcomes of 2 hospitals with different levels of expertise in robot-assisted rectal cancer surgery. METHODS This retrospective study analyzed 195 patients who underwent robot-assisted rectal resection at 2 referral centers for the treatment of rectal cancer between March 2018 and December 2021. RESULTS In total, 195 patients had undergone robotic rectal cancer surgery: 95 performed by an expert team, and 100 by a novel team. The expert team performed more low anterior resections (55.8%) than the novel team (33%) (P = 0.001), and the total operative time varied significantly between the groups (P < 0.001). The novel team's operative time was 135 min longer than the expert team's. The expert team had no conversions to open surgery, while the novel team had an 8% conversion rate (P = 0.007). In this study, overall morbidity was 45.3% among patients treated by the expert team versus 38% among those treated by the novice team (P = 0.304). Severe complications (Clavien-Dindo grade >IIIB) occurred at a rate of 10% in both groups. Incomplete mesorectal excision was observed in 3.2% of the expert team's patients versus 4.2% of the novice team's (P = 0.65). CONCLUSION The expert team achieved a shorter operative time and less conversion to open surgery. However, the morbidity and pathological outcomes were comparable between the teams. The introduction of robotic surgery in a team with early-stage surgical experience was safe.
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Affiliation(s)
- Ernesto Barzola
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain; General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain; General and Digestive Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain.
| | - Pere Planellas
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain; General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Lidia Cornejo
- General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Nuria Gómez
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain; General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - David Julià
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain; General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Kelly-Ann Bobb
- Eric Williams Medical Sciences Complex, Mount Hope, West Indies, Trinidad and Tobago
| | - Ramón Farrés
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain; General and Digestive Surgery Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Marcos Gómez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, Santander, Spain; Surgery Research and Innovation Group, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
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Taha A, Taha-Mehlitz S, Bach L, Ochs V, Bardakcioglu O, Honaker MD, Cattin PC. Robotic colorectal surgery: quality assessment of patient information available on the internet using webscraping. Comput Assist Surg (Abingdon) 2023; 28:2187275. [PMID: 36905397 DOI: 10.1080/24699322.2023.2187275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
The primary goal of this study is to assess current patient information available on the internet concerning robotic colorectal surgery. Acquiring this information will aid in patients understanding of robotic colorectal surgery. Data was acquired through a web-scraping algorithm. The algorithm used two Python packages: Beautiful Soup and Selenium. The long-chain keywords incorporated into Google, Bing and Yahoo search engines were 'Da Vinci Colon-Rectal Surgery', 'Colorectal Robotic Surgery' and 'Robotic Bowel Surgery'. 207 websites resulted, were sorted and evaluated according to the ensuring quality information for patients (EQIP) score. Of the 207 websites visited, 49 belonged to the subgroup of hospital websites (23.6%), 46 to medical centers (22.2%), 45 to practitioners (21.7%), 42 to health care systems (20,2%), 11 to news services (5.3%), 7 to web portals (3.3%), 5 to industry (2.4%), and 2 to patient groups (0.9%). Only 52 of the 207 websites received a high rating. The quality of available information on the internet concerning robotic colorectal surgery is low. The majority of information was inaccurate. Medical facilities involved in robotic colorectal surgery, robotic bowel surgery and related robotic procedures should develop websites with credible information to guide patient decisions.
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Affiliation(s)
- Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Stephanie Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Laura Bach
- Faculty of Medicine, University of Erlangen, Erlangen, Germany
| | - Vincent Ochs
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | | | - Michael D Honaker
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Philippe C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
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Ravendran K, Abiola E, Balagumar K, Raja AZ, Flaih M, Vaja SP, Muhidin AO, Madouros N. A Review of Robotic Surgery in Colorectal Surgery. Cureus 2023; 15:e37337. [PMID: 37182014 PMCID: PMC10169093 DOI: 10.7759/cureus.37337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Colorectal surgery is a treatment for colorectal lesions. Technological advancements have given the rise to robotic colorectal surgery, a procedure that limits excessive blood loss via 3D pin-point precision capabilities during surgeries. The aim of this study is to review robotic surgery in colorectal treatment procedures in order to dictate its ultimate merits. This is a literature review utilising PubMed and Google Scholar; it only includes case studies and case reviews related to robotic colorectal surgeries. Literature reviews are excluded. We incorporated abstracts from all articles and full publications were examined to compare the benefits of robotic surgery in colorectal treatments. The number of articles reviewed was 41 literature spanning from 2003 to 2022. We found that robotic surgeries yielded finer marginal resections, greater amounts of lymph node resections and earlier recovery of bowel functions. The patients also spent less time in hospital after surgery. The obstacles on the other hand are it costs longer operative hours and further training, which is expensive. Studies show robotic approach is a choice for treating rectal cancer. However further studies would be needed to conclude the best approach. This is especially true with patients treated for anterior colorectal resections. Based on the evidence it's safe to say that the upsides outweigh the downsides, but advancements and further research in robotic colorectal surgeries are still necessary to reduce operative hours and cost. Surgical societies should also take the initiative and set up effective training programmes for colorectal robotic surgeries, as trained physicians result in better treatment outcomes.
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Saqib SU, Raza MZ, Evans C, Bajwa AA. The robotic learning curve for a newly appointed colorectal surgeon. J Robot Surg 2023; 17:73-78. [PMID: 35325433 DOI: 10.1007/s11701-022-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022]
Abstract
Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies. However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formalized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve. Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3 to 2.5 h, while total operative time dropped from 6 h to 5.5 h as the surgeon became more experienced; however, this was not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after 30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.
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Affiliation(s)
- Sabah Uddin Saqib
- Clinical Fellow Colorectal Surgery, University Hospital Coventry, Coventry, UK.
| | - Muhammad Zeeshan Raza
- Robotic Research Fellow in Robotic Colorectal Surgery, University Hospital Coventry, Coventry, UK
| | - Charles Evans
- Consultant Colorectal Surgeon, University Hospital Coventry, Coventry, UK
| | - Adeel Ahmad Bajwa
- Consultant Colorectal Surgeon, University Hospital Coventry, Coventry, UK
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Yuanyuan W, Shiyin H, Lei H, Ding D. Pelvic floor muscle exercises alleviate symptoms and improve mental health and rectal function in patients with low anterior resection syndrome. Front Oncol 2023; 13:1168807. [PMID: 37152027 PMCID: PMC10158794 DOI: 10.3389/fonc.2023.1168807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Background Pelvic floor rehabilitation has been reported to be effective in improving fecal incontinence. The aim of this study was to prospectively evaluate the effectiveness of combined pelvic floor muscle exercises (PFMEs) and loperamide treatment on rectal function and mental health for low anterior resection syndrome (LARS) patients after sphincter-saving operation (SSO) for rectal cancer. Methods A total of 60 inpatients diagnosed with LARS were enrolled and randomly assigned to one of two groups: patients in Group A (n = 30) were treated with a PFME intervention and those in Group B (n = 30) with a control intervention for 4 weeks. High-resolution anorectal manometry (HRAM) was performed for all LARS patients. Demographic information was collected for all patients, and they subsequently also completed several questionnaires, including the Hospital Anxiety and Depression Scale (HADS), a measure of Wexner score, a measure of stool frequency per day, and the Bristol Stool Form Scale (BSFS). Results No significant differences between the groups were observed in baseline data. With regard to rectal function, we found significant improvements at week 4 in maximal resting pressure (MRP) (39.93 ± 5.02 vs. 28.70 ± 5.40 mmH2O, p < 0.001) and maximal squeeze pressure (MSP) (132.43 ± 8.16 mmH2O vs. 113.33 ± 9.87 mmH2O, p < 0.001) among Group A patients compared to Group B patients. Additionally, Wexner scores were significantly lower in Group A than in Group B at week 4 (8.10 ± 1.24 vs. 9.87 ± 1.29 ml, p = 0.018), as were stool frequency (6.47 ± 0.90 vs. 7.83 ± 0.93, p < 0.001) and BSFS scores (5.17 ± 0.65 vs. 6.10 ± 0.80, p = 0.020). Notably, HADS scores were also significantly lower in Group A than in Group B at week 4 (8.25 ± 2.36 vs. 10.48 ± 3.01, p < 0.001). Additionally, both anxiety scores (4.16 ± 1.38 vs. 5.33 ± 1.69, p < 0.001) and depression scores (4.09 ± 1.56 vs. 5.15 ± 1.89, p < 0.001) were significantly lower in Group A than in Group B at week 4. Conclusion Pelvic floor muscle exercises are an effective treatment that can alleviate symptoms and improve rectal function and mental health in patients with low anterior resection syndrome.
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Affiliation(s)
| | | | | | - Ding Ding
- *Correspondence: Wu Yuanyuan, ; Ding Ding,
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Baek SK. Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:91-96. [PMID: 36177372 PMCID: PMC9494010 DOI: 10.7602/jmis.2022.25.3.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Laparoscopic right colectomy is currently considered the standard treatment for right colon cancer. After excision of the right colon, minimally invasive options for ileocolonic anastomosis include extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). However, the choice of anastomotic technique remains debated. As the entire IA is performed in the abdominal cavity, it is known for its advantages of a faster intestinal recovery and small incision. However, IA is time-consuming and technically difficult, limiting its widespread use. Recently, the robotic approach has increased the adoption of intracorporeal anastomotic techniques owing to the benefits of endowrist-articulated instruments and staplers. Except for a small incision and faster bowel recovery, the outcomes of the two anastomoses methods are inconsistent. To date, there has been no clear conclusion regarding whether IA or EA should be used to treat right colon cancer. This review aimed to investigate the current evidence relating to intraoperative outcomes and short-term postoperative results between both anastomotic approaches.
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Affiliation(s)
- Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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8
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Segev L, Schtrechman G, Kalady MF, Liska D, Gorgun IE, Valente MA, Nissan A, Steele SR. Long-term Outcomes of Minimally Invasive Versus Open Abdominoperineal Resection for Rectal Cancer: A Single Specialized Center Experience. Dis Colon Rectum 2022; 65:361-372. [PMID: 34784318 DOI: 10.1097/dcr.0000000000002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Randomized studies have validated laparoscopic proctectomy for the treatment of rectal cancer as noninferior to an open proctectomy, but most of those studies have included sphincter-preserving resections along with abdominoperineal resection. OBJECTIVE This study aimed to compare perioperative and long-term oncological outcomes between minimally invasive and open abdominoperineal resection. DESIGN This study is a retrospective analysis of a prospectively maintained database. SETTINGS The study was conducted in a single specialized colorectal surgery department. PATIENTS All patients who underwent abdominoperineal resection for primary rectal cancer between 2000 and 2016 were included. MAIN OUTCOME MEASURES The primary outcomes measured were the perioperative and long-term oncological outcomes. RESULTS We included 452 patients, 372 in the open group and 80 in the minimally invasive group, with a median follow-up time of 74 months. There were significant differences between the groups in terms of neoadjuvant radiation treatment (67.5% of the open versus 81.3% of the minimally invasive group, p = 0.01), operative time (mean of 200 minutes versus 287 minutes, p < 0.0001), and mean length of stay (9.5 days versus 6.6 days, p < 0.0001). Overall complication rates were similar between the groups (34.5% versus 27.5%, p = 0.177). There were no significant differences in the mean number of lymph nodes harvested (21.7 versus 22.2 nodes, p = 0.7), circumferential radial margins (1.48 cm versus 1.37 cm, p = 0.4), or in the rate of involved radial margins (10.8% versus 6.3%, p = 0.37). Five-year overall survival was 70% in the open group versus 80% in the minimally invasive group (p = 0.344), whereas the 5-year disease-free survival rate in the open group was 63.2% versus 77.6% in the minimally invasive group (p = 0.09). LIMITATIONS This study was limited because it describes a single referral institution experience. CONCLUSIONS Although both approaches have similar perioperative outcomes, the minimally invasive approach benefits the patients with a shorter length of stay and a lower risk for surgical wound infections. Both approaches yield similar oncological technical quality in terms of the lymph nodes harvested and margins status, and they have comparable long-term oncological outcomes. See Video Abstract at http://links.lww.com/DCR/B754.RESULTADOS A LARGO PLAZO DE LA RESECCIÓN ABDOMINOPERINEAL MÍNIMAMENTE INVASIVA VERSUS ABIERTA PARA EL CÁNCER DE RECTO: EXPERIENCIA DE UN SOLO CENTRO ESPECIALIZADOANTECEDENTES:Estudios aleatorizados han validado la proctectomía laparoscópica para el tratamiento del cáncer de recto igual a la proctectomía abierta, pero la mayoría de esos estudios han incluido resecciones con preservación del esfínter junto con resección abdominoperineal.OBJETIVO:Comparar los resultados oncológicos perioperatorios y a largo plazo entre la resección abdominoperineal abierta y mínimamente invasiva.DISEÑO:Análisis retrospectivo de una base de datos mantenida de forma prospectiva.ENTORNO CLINICO:Servicio único especializado en cirugía colorrectal.PACIENTES:Todos los pacientes que se sometieron a resección abdominoperineal por cáncer de recto primario entre 2000 y 2016.PRINCIPALES MEDIDAS DE VALORACION:Resultados oncológicos perioperatorios y a largo plazo.RESULTADOS:Se incluyeron 452 pacientes, 372 en el grupo abierto y 80 en el grupo mínimamente invasivo, con una mediana de seguimiento de 74 meses. Hubo diferencias significativas entre los grupos en términos de tratamiento con radiación neoadyuvante (67,5% del grupo abierto versus 81,3% del grupo mínimamente invasivo, p = 0,01), tiempo operatorio (media de 200 minutos versus 287 minutos, p < 0,0001) y la duración media de la estancia (9,5 días frente a 6,6 días, p < 0,0001). Las tasas generales de complicaciones fueron similares entre los grupos (34,5% versus 27,5%, p = 0,177). No hubo diferencias significativas en el número medio de ganglios linfáticos extraídos (21,7 versus 22,2 ganglios, p = 0,7), márgenes radiales circunferenciales (1,48 cm y 1,37 cm, p = 0,4), ni en la tasa de márgenes radiales afectados (10,8 cm). % versus 6,3%, p = 0,37). La supervivencia general a 5 años fue del 70% en el grupo abierto frente al 80% en el grupo mínimamente invasivo (p = 0,344), mientras que la tasa de supervivencia libre de enfermedad a 5 años en el grupo abierto fue del 63,2% frente al 77,6% en el grupo mínimamente invasivo (p = 0,09).LIMITACIONES:Experiencia en una institución de referencia única.CONCLUSIONES:Si bien ambos tienen resultados perioperatorios similares, el enfoque mínimamente invasivo, beneficia a los pacientes con estadía más corta y menor riesgo de infecciones de la herida quirúrgica. Ambos enfoques, producen una calidad técnica oncológica similar en términos de ganglios linfáticos extraídos y estado de los márgenes, y tienen resultados oncológicos comparables a largo plazo. Consulte Video Resumen en http://links.lww.com/DCR/B754. (Traducción - Dr. Fidel Ruiz Healy).
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Affiliation(s)
- Lior Segev
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Surgical Oncology - Surgery C, Sheba Medical center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Schtrechman
- Department of Surgical Oncology - Surgery C, Sheba Medical center, Tel Hashomer, Israel
| | - Matthew F Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Liska
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - I Emre Gorgun
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Aviram Nissan
- Department of Surgical Oncology - Surgery C, Sheba Medical center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Scott R Steele
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
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Navarrete-Arellano M. Robotic-Assisted Minimally Invasive Surgery in Children. LATEST DEVELOPMENTS IN MEDICAL ROBOTICS SYSTEMS 2021. [DOI: 10.5772/intechopen.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.
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Keller DS, Jenkins CN. Safety with Innovation in Colon and Rectal Robotic Surgery. Clin Colon Rectal Surg 2021; 34:273-279. [PMID: 34504400 PMCID: PMC8416332 DOI: 10.1055/s-0041-1726352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Robotic colorectal surgery has been touted as a possible way to overcome the limitations of laparoscopic surgery and has shown promise in rectal resections, thus shifting traditional open surgeons to a minimally invasive approach. The safety, efficacy, and learning curve have been established for most colorectal applications. With this and a robust sales and marketing model, utilization of the robot for colorectal surgery continues to grow steadily. However, this disruptive technology still requires standards for training, privileging and credentialing, and safe implementation into clinical practice.
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Affiliation(s)
- Deborah S. Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento, California
| | - Christina N. Jenkins
- Division of Colorectal Surgery, Department of General and Trauma Surgery, Loma Linda University Medical Center, Loma Linda, California
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Hannan E, Feeney G, Ullah MF, Ryan C, McNamara E, Waldron D, Condon E, Coffey JC, Peirce C. Robotic versus laparoscopic right hemicolectomy: a case-matched study. J Robot Surg 2021; 16:641-647. [PMID: 34338996 PMCID: PMC9135878 DOI: 10.1007/s11701-021-01286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022]
Abstract
The current gold standard surgical treatment for right colonic malignancy is the laparoscopic right hemicolectomy (LRH). However, laparoscopic surgery has limitations which can be overcome by robotic surgery. The benefits of robotics for rectal cancer are widely accepted but its use for right hemicolectomy remains controversial. The aim of this study was to compare outcomes in patients undergoing robotic right hemicolectomy (RRH) and LRH in a university teaching hospital. Demographic, perioperative and postoperative data along with early oncological outcomes of patients who underwent RRH and LRH with extracorporeal anastomosis (ECA) were identified from a prospectively maintained database. A total of 70 patients (35 RRH, 35 LRH) were identified over a 4-year period. No statistically significant differences in estimated blood loss, conversion to open surgery, postoperative complications, anastomotic leak, 30-day reoperation, 30-day mortality, surgical site infection or lengths of stay were demonstrated. Surgical specimen quality in both groups was favourable. The mean duration of surgery was longer in RRH (p < < 0.00001). A statistically significant proportion of RRH patients had a higher BMI and ASA grade. The results demonstrate that RRH is safe and feasible when compared to LRH, with no statistical difference in postoperative morbidity, mortality and early oncological outcomes. A difference was noted in operating time, however was influenced by training residents in docking the robot and a technically challenging cohort of patients. Operative time has shortened with further experience. Incorporating an intracorporeal anastomosis technique in RRH offers the potential to improve outcomes compared to LRH.
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Affiliation(s)
- Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.
| | - Gerard Feeney
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Mohammad Fahad Ullah
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Claire Ryan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Emma McNamara
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - David Waldron
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Eoghan Condon
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - John Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
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12
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Donlon NE, Nugent TS, Free R, Hafeez A, Kalbassi R, Neary PC, O'Riordain DS. Robotic versus laparoscopic anterior resections for rectal and rectosigmoid cancer: an institutional experience. Ir J Med Sci 2021; 191:845-851. [PMID: 33846946 DOI: 10.1007/s11845-021-02625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Colorectal surgery has evolved with the advent of laparoscopic techniques and now robotic-assisted surgery. There is significant literature supporting the use of laparoscopic techniques over open surgery with evidence of enhanced post-operative recovery, reduced use of opioids, smaller incisions and equivalent oncological outcomes. Robotic minimally invasive surgery addresses some of the limitations of laparoscopic surgery, providing surgical precision and improvements in perception and dexterity with a resulting decrease in tissue damage. METHODS We retrospectively reviewed the medical records of patients who underwent robotic-assisted anterior resection for cancer of the rectum or rectosigmoid junction in our institution since our robotic programme began in 2017. Patient demographics were identified via electronic databases and patient charts. A matched cohort of laparoscopic cases was identified. RESULTS A total of 51 consecutive robotic-assisted anterior resections were identified and case matched with laparoscopic resections for comparison. Robotic-assisted surgery was associated with a shorter length of stay (p = 0.04), reduced initial post-operative analgesia requirements (p < 0.01) and no significant difference in time to bowel movement or stoma functioning (p = 0.84). All patients had an R0 resection, and there was no statistical difference in lymph node yield between the groups (p = 0.14). Robotic surgery was associated with a longer operative duration (p < 0.001). CONCLUSION In this early experience, robotic surgery has proven feasible and safe and is comparable to laparoscopic surgery in terms of completeness of resection and recovery. As costs and operating times decline and as technology progresses, robotic surgery may one day replace traditional laparoscopic techniques.
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Affiliation(s)
- Noel E Donlon
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland.
| | - Tim S Nugent
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Ross Free
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Adnan Hafeez
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Resa Kalbassi
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Paul C Neary
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
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13
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GÖMCELİ İ, ARAS O. Clinical and oncological outcomes of the low ligation of the inferior mesenteric artery with robotic surgery in patients with rectal cancer following neoadjuvant chemoradiotherapy. Turk J Med Sci 2021; 51:111-123. [PMID: 32777903 PMCID: PMC7991877 DOI: 10.3906/sag-2003-178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background/aim The aim of this study is to compare clinical and oncologic outcomes of the high and low ligation techniques of the inferior mesenteric artery (IMA) in rectal cancer patients treated with robotic surgery after neoadjuvant chemoradiotherapy (nCRT). Materials and methods In this retrospective study, 77 patients with T3/T4-node negative rectal cancer with tumor penetration through the muscle wall (Stage 2) or node positive disease without distant metastases (Stage 3) who were treated electively with robotic surgical resection following nCRT at a single institution between January 2014 and January 2018 were analyzed. Patients were divided into 2 groups (38 patients were included in the low ligation group and 39 patients in the high ligation group). Results There was no statistical difference between the high ligation group and low ligation group in univariate analysis for 2-year overall survival and disease-free survival (OR = 1.146; 95% CI = 0.274 to 4.797; P = 0.950, and OR = 1.141; 95% CI = 0.564 to 2.308; P = 0.713, respectively). There was no significant difference between the 2 groups in the mean number of harvested lymph nodes and mean number of metastatic lymph nodes (P = 0.980 and P = 0.124, respectively). Anastomosis stricture was observed significantly less frequently in the low ligation group versus the high ligation group (2.6% and 28.2%, respectively) (P = 0.002). Also, the difference for the median length of hospital stay for the high and low ligation groups was statistically significant in favor of the low ligation group (P = 0.011). Conclusion In robotic rectal surgery, the low ligation technique of the IMA can reduce the rate of anastomosis stricture and provide similar oncological results as the high ligation technique.
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Affiliation(s)
- İsmail GÖMCELİ
- Department of Gastrointestinal Surgery, Antalya Training and Research Hospital, Health Sciences University, AntalyaTurkey
| | - Orhan ARAS
- Department of Gastrointestinal Surgery, Antalya Training and Research Hospital, Health Sciences University, AntalyaTurkey
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14
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Petz W, Bertani E, Borin S, Fiori G, Ribero D, Spinoglio G. Fluorescence-guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision. Int J Med Robot 2021; 17:e2217. [PMID: 33372413 DOI: 10.1002/rcs.2217] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND In robotic right hemicolectomy for cancer, appropriate lymphadenectomy is essential. Visualization of draining lymph nodes and blood flow with near-infrared (NIR) fluorescence DaVinci® imaging system is a recent development. We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) endoscopic submucosal injection to intraoperatively identify tumour lymphatic basin. METHODS The day before surgery, in patients scheduled for robotic right colectomy an endoscopic submucosal injection of 3 mg of ICG solution around the tumor is realized. Robotic right hemicolectomy is performed with suprapubic trocars layout and "bottom to up dissection", realizing a CME with central vessel ligation and D3 lymphadenectomy. Site of primary tumor and lymphatic basin are visible with the FireflyTM camera modality. RESULTS From July 2016 to July 2020, 85 patients received a robotic right colectomy with CME and D3 lymphadenectomy. In 50 patients, ICG submucosal injection was performed: visualisation of the site of primary tumour and of LN in the D3 area was possible in all cases; in 17/50 patients (34%), LN out from anatomical lymphatic basin were identified. No side effects were observed. CONCLUSIONS In this series, submucosal ICG injection showed to be feasible and safe. The accuracy in identification of D3 lymphatic basin was high, thus permitting an image-guided radical lymphadenectomy. Fluorescent technology represents an interesting innovation to ameliorate surgery of colon cancer.
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Affiliation(s)
- Wanda Petz
- Division of Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Emilio Bertani
- Division of Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Simona Borin
- Division of Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Giancarla Fiori
- Division of Endoscopy, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Ribero
- Division of Hepatobiliary and Colorectal Surgery, Candiolo Cancer Institute IRCCS, Candiolo, Italy
| | - Giuseppe Spinoglio
- Division of Hepatobiliary and Colorectal Surgery, Candiolo Cancer Institute IRCCS, Candiolo, Italy
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15
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Kong JC, Prabhakaran S, Choy KT, Larach JT, Heriot A, Warrier SK. Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis. ANZ J Surg 2021; 91:124-131. [PMID: 33400369 DOI: 10.1111/ans.16518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra-abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. RESULTS A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3- or 5-year disease-free survival, pooled 5-year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). CONCLUSION Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.
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Affiliation(s)
- Joseph C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Swetha Prabhakaran
- Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kay T Choy
- Department of Colorectal Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - José T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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16
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Somashekhar SP, Deshpande AY, Ashwin KR, Gangasani R, Kumar R, Shetty S. Comparative Evaluation of the Short-Term Treatment Outcomes Between Open, Laparoscopic- and Robotic-Assisted Surgical Approaches for Rectal Cancer Treatment. Indian J Surg Oncol 2020; 11:649-652. [PMID: 33299282 PMCID: PMC7714866 DOI: 10.1007/s13193-020-01137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/17/2020] [Indexed: 12/18/2022] Open
Abstract
The open surgeries and more recently minimal invasive surgeries aided by laparoscopic or robotic approaches are employed for rectal cancer treatment procedures. The open approach is the most commonly opted technique, but recent studies have also shown that laparoscopic total mesorectal excision (TME) has become the standard of care. There are certain shortcomings of laparoscopic surgery such as long learning curve, inadequate counter traction, limited dexterity, lack of tactile feedback and limited two-dimensional visions. Robotic surgery also offers several benefits to overcome the drawbacks of laparoscopic procedures, such as providing better dexterity and a more stable visualization. This study aims to analyse the surgical results in terms of completion of TME, short-term surgical outcomes and hospital stay in after open, laparoscopic- and robotic-assisted rectal resections respectively. A retrospective review of prospectively maintained database of patients operated for carcinoma rectum between January 2013 and August 2018 at Manipal Comprehensive Cancer Centre, Manipal-Vattikuti Institute of Robotic Surgery, Bangalore, was analysed in this study. The surgical parameters like completion of total mesorectal excision; proximal, distal and circumferential resection margins; number of nodes retrieved; and total post operative hospital stay were analysed in the open, laparoscopic-assisted and robotic-assisted groups. A total of 100 patients were included in the study consisting of 25, 25 and 50 patients each in the open, laparoscopic and robotic arms respectively. In case the desired results were not obtained using the advanced technique the procedure was converted and open technique was adopted. The conversion rate to open procedure was 8% (2of 25) in the laparoscopic-assisted group and 2% (1/50) in the robotic-assisted group. The average post operative hospital stay was 7.4, 7.36 and 6 days in the open, laparoscopic- and robotic-assisted group (p = 0.01) respectively. Robotic rectal resections show a trend towards better surgical results in the form of improved circumferential resection margins, completeness of TME and lower conversion rates.
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Affiliation(s)
- S. P. Somashekhar
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
| | - Abhinav Y. Deshpande
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
- Nagpur, India
| | - K. R. Ashwin
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
| | - R. Gangasani
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
| | - Rohit Kumar
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
| | - Sushrut Shetty
- Depatment of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bangalore, India
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17
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Trends in utilization, conversion rates, and outcomes for minimally invasive approaches to non-metastatic rectal cancer: a national cancer database analysis. Surg Endosc 2020; 35:3154-3165. [PMID: 32601761 DOI: 10.1007/s00464-020-07756-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/22/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study examined utilization and conversion rates for robotic and laparoscopic approaches to non-metastatic rectal cancer. Secondary aims were to examine short- and long-term outcomes of patients who underwent conversion to laparotomy from each approach. METHODS The National Cancer Database (NCDB) was reviewed for all cases of non-metastatic adenocarcinoma of the rectum or rectosigmoid junction who underwent surgical resection from 2010 to 2016. Utilization rates of robotic, laparoscopic, and open approaches were examined. Patients were split into cohorts by approach. Subgroup analyses were performed by primary tumor site and surgical procedure. Multivariable analysis was performed by multivariable logistic regression for binary outcomes and multivariable general linear models for continuous outcomes. Survival analysis was performed by Kaplan-Meier and multivariable cox-proportional hazards regression. RESULTS From 2010 to 2016, there was a statistically significant increase in utilization of the robotic and laparoscopic approaches over the study period and a statistically significant decrease in utilization of the open approach. The conversion rates for robotic and laparoscopic cohorts were 7.0% and 15.7%, p < 0.0001. Subgroup analysis revealed statistically lower conversion rates between robotic and laparoscopic approaches for rectosigmoid and rectal tumors and for LAR and APR. Converted cohorts had statistically significant higher odds of short term mortality than the non-converted cohorts (p < 0.05).Laparoscopic conversion had statistically higher odds of positive margins (p < 0.0001) and 30-day unplanned readmission (p < 0.0001) than the laparoscopic non-conversion. Increased adjusted mortality hazard was seen for converted laparoscopy relative to non-converted laparoscopy (p = 0.0019). CONCLUSION From 2010 to 2016, there was a significant increase in utilization of minimally invasive approaches to surgical management of non-metastatic rectal cancer. A robotic approach demonstrated decreased conversion rates than a laparoscopic approach at the rectosigmoid junction and rectum and for LAR and APR. Improved outcomes were seen in the minimally invasive cohorts compared to those that converted to laparotomy.
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18
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Kaleem SZ, Parikh S, Yang K, Poggio JL. Industry Payments in Colon and Rectal Surgery: A Cross-Sectional Analysis of Open Payments Data. J Surg Res 2020; 254:369-377. [PMID: 32534234 DOI: 10.1016/j.jss.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Physician Payments Sunshine Act of 2010 mandated publication of all financial relationships between companies and physicians on the Centers for Medicare and Medicaid Services' Open Payments Data to elucidate potential conflicts of interest. This study seeks to illuminate the financial relationships that the pharmaceutical, medical device, biologics, and medical supply industries maintained with colon and rectal surgeons across the United States from 2014 to 2018. MATERIALS AND METHODS We extracted and analyzed all colon and rectal surgeon data from the Open Payments Data for 2014-2018 using Microsoft Excel 2018 and JMP PRO 13.2.0 (SAS Institute). We calculated descriptive statistics and displayed prominent trends in the data. RESULTS From 2014 to 2018, totals of $26,841,274 in general payments and $7,492,822 in research payments were made to 1935 and 150 colorectal surgeons, respectively. Intuitive Surgical, Inc paid the most money in general payments every year, ranging from 39.0% to 58.8% of the total payment amount. Intuitive Surgical, Inc's product, da Vinci Surgical System, had the greatest number of payments, totaling 21,191 general payments. The year with the highest amount paid for research was 2017, in which a total of $2,810,558 was paid to colorectal surgeons. CONCLUSIONS Companies across industries paid millions of dollars to colorectal surgeons from 2014 to 2018. However, further research is required to determine the causal effects of these surgeons' financial relationships with the industry on research, prescription, and technology adoption practices.
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Affiliation(s)
- Syed Z Kaleem
- Drexel University College of Medicine, Philadelphia, Pennsylvania.
| | - Sachin Parikh
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kevin Yang
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Juan L Poggio
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Colon and Rectal Surgery, Temple University Hospital and Jeanes Hospital, Philadelphia, Pennsylvania.
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19
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Fleming CA, Westby D, Ullah MF, Mohan HM, Sehgal R, Bolger JC, O’Leary DP, McNamara E, Korpanty G, El Bassiouni M, Condon E, Coffey JC, Peirce C. A review of clinical and oncological outcomes following the introduction of the first robotic colorectal surgery programme to a university teaching hospital in Ireland using a dual console training platform. J Robot Surg 2020; 14:889-896. [DOI: 10.1007/s11701-020-01073-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
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20
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Laparoscopic Versus Robotic-assisted Suturing Performance Among Novice Surgeons: A Blinded, Cross-Over Study. Surg Laparosc Endosc Percutan Tech 2020; 30:117-122. [PMID: 32039938 DOI: 10.1097/sle.0000000000000766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Robotic-assisted laparoscopy (RAL) presents several advantages over 3-dimensional conventional laparoscopy (3D-CL) that may facilitate laparoscopic suturing especially with novice surgeons. This study compares novice surgeons' suturing performance by 3D-CL and RAL using Objective Structured Assessment of Technical Skill (OSATS), an objective, validated scoring tool. Twenty-two surgeons with no robotic experience completed a standardized suturing task in an experimental setup by both 3D-CL and RAL in a randomized, cross-over design. Two experienced surgeons blindly assessed their performance using OSATS. Median (interquartile range) OSATS scores for 3D-CL and RAL were, respectively, 22.8 (17.4 to 25.8) versus 25.0 (21.9 to 26.5), P=0.032. There was no association between laparoscopic experience and robotic-assisted suturing performance. Thus, this study is, to our knowledge, the first to compare novice surgeons' suturing performance by 3D-CL and RAL using an objective, validated scoring tool and to show better suturing performance when assisted by the robot regardless of experience level.
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21
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Crippa J, Grass F, Achilli P, Mathis KL, Kelley SR, Merchea A, Colibaseanu DT, Larson DW. Risk factors for conversion in laparoscopic and robotic rectal cancer surgery. Br J Surg 2020; 107:560-566. [PMID: 31976558 DOI: 10.1002/bjs.11435] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. METHODS A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m2 or more) was performed. RESULTS A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non-obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71). CONCLUSION Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non-obese patients.
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Affiliation(s)
- J Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - F Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - P Achilli
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - D T Colibaseanu
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Yin M, Cai Y, Zhou L. Identifying the superior surgical procedure for endometrial cancer: A protocol of network meta-analysis. Medicine (Baltimore) 2019; 98:e16855. [PMID: 31415417 PMCID: PMC6831278 DOI: 10.1097/md.0000000000016855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endometrial cancer (EC) is one of the most common gynecologic tumors, with a high incidence in developed countries. Although the overall prognosis is good, some women have invasive tumors, the risk of recurrence, and death is high. The common surgical methods used in EC are total-abdominal hysterectomy (TAH), total-vaginal hysterectomy (TVH), laparoscopic-assisted vaginal hysterectomy (LAVH), and total-laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. METHODS The literature search was performed in The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, and Embase. The randomized controlled trials (RCTs) will be included. The search date is until June 2019. The risk of bias of included RCTs was assessed by 2 investigators according to the Cochrane Collaboration's tool. Network meta-analysis will be conducted by R software. RESULTS This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. CONCLUSION This network meta-analysis will provide clinical staff with current and reliable information on the best surgical approach for EC. Ethical approval is not applicable, since this is a network mate-analysis based on published articles. The protocol has been registered on PROSPERO under the number CRD42019128094.
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Affiliation(s)
- Min Yin
- The First Hospital of Lanzhou University
| | | | - Li Zhou
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
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23
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Bae SU, Yang SY, Min BS. Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes. Int J Colorectal Dis 2019; 34:471-479. [PMID: 30560354 DOI: 10.1007/s00384-018-3208-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently, an operative strategy involving complete mesocolic excision (CME) and central vascular ligation (CVL) for colonic cancer has been introduced. We aimed to describe our initial experience and assess the long-term outcomes of robotic modified CME (mCME) and CVL (mCME+CVL) for right-sided colon cancer. METHODS Of the 677 patients with histologically confirmed, right-sided colon adenocarcinoma who underwent curative mCME+CVL between February 2008 and October 2016, 43 who were treated entirely using the robotic approach were included in this retrospective study. Survival rates were determined using the Kaplan-Meier method, and P values of < 0.05 indicated statistically significant differences. RESULTS The total operation and docking times were 293 (180-644) min and 5 (3-19) min, respectively, with an estimated blood loss of 50 (10-400) mL. The time to soft diet was 4 (1-16) days and the length of hospitalization was 8 (4-48) days. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IV complications were noted in 3 (7.0%), 5 (11.7%), 2 (4.7%), 1 (2.3%), and 0 (0%) patients, respectively. The proximal and distal resection margins were 14 (4-54) and 19 (4-48) cm, respectively, and 29 (6-157) lymph nodes were harvested per patient. The patients were followed-up for a median of 55 (2-109) months, during which the overall survival rate, median disease-free period, disease-free survival rate, and tumor recurrence rate were 93.6%, 38 (2-109) months, 81.1%, and 16.3% (7 patients), respectively. CONCLUSIONS Robotic mCME and CVL for right-sided colon cancer was feasible and safe. It can be added to the surgeon's toolbox as an optional strategy for the management of colon cancer patients.
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Affiliation(s)
- Sung Uk Bae
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, South Korea.,Department of Surgery, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, South Korea
| | - Seung Yoon Yang
- Department of Surgery, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, South Korea
| | - Byung Soh Min
- Department of Surgery, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, South Korea.
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Short-term Results After Totally Robotic Restorative Total Proctocolectomy With Ileal Pouch Anal Anastomosis for Ulcerative Colitis. Surg Laparosc Endosc Percutan Tech 2019; 30:40-44. [DOI: 10.1097/sle.0000000000000645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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25
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Hoshino N, Sakamoto T, Hida K, Sakai Y. Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence. Surg Today 2019; 49:556-570. [DOI: 10.1007/s00595-019-1763-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
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Peng W, Xing Y, Liu R, Li J, Zhang Z. An automatic skill evaluation framework for robotic surgery training. Int J Med Robot 2018; 15:e1964. [PMID: 30281892 DOI: 10.1002/rcs.1964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/22/2018] [Accepted: 09/24/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND To provide feedback to surgeons in robotic surgery training, many surgical skill evaluation methods have been developed. However, they hardly focus on the performance of the surgical motion segments. This paper proposes a method of specifying a trainee's skill weakness in the surgical training. METHODS This paper proposed an automatic skill evaluation framework by comparing the trainees' operations with the template operation in each surgical motion segment, which is mainly based on dynamic time warping (DTW) and continuous hidden Markov model (CHMM). RESULTS The feasibility of this proposed framework has been preliminarily verified. For specifying the skill weakness in instrument handling and efficiency, the result of this proposed framework was significantly correlated with that of manual scoring. CONCLUSION The automatic skill evaluation framework has shown its superiority in efficiency, objectivity, and being targeted, which can be used in robotic surgery training.
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Affiliation(s)
- Wenjia Peng
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Yuan Xing
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Ruida Liu
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Jinhua Li
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Zemin Zhang
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
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Hovgaard LH, Andersen SAW, Konge L, Dalsgaard T, Larsen CR. Validity evidence for procedural competency in virtual reality robotic simulation, establishing a credible pass/fail standard for the vaginal cuff closure procedure. Surg Endosc 2018; 32:4200-4208. [PMID: 29603003 DOI: 10.1007/s00464-018-6165-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of robotic surgery for minimally invasive procedures has increased considerably over the last decade. Robotic surgery has potential advantages compared to laparoscopic surgery but also requires new skills. Using virtual reality (VR) simulation to facilitate the acquisition of these new skills could potentially benefit training of robotic surgical skills and also be a crucial step in developing a robotic surgical training curriculum. The study's objective was to establish validity evidence for a simulation-based test for procedural competency for the vaginal cuff closure procedure that can be used in a future simulation-based, mastery learning training curriculum. METHODS Eleven novice gynaecological surgeons without prior robotic experience and 11 experienced gynaecological robotic surgeons (> 30 robotic procedures) were recruited. After familiarization with the VR simulator, participants completed the module 'Guided Vaginal Cuff Closure' six times. Validity evidence was investigated for 18 preselected simulator metrics. The internal consistency was assessed using Cronbach's alpha and a composite score was calculated based on metrics with significant discriminative ability between the two groups. Finally, a pass/fail standard was established using the contrasting groups' method. RESULTS The experienced surgeons significantly outperformed the novice surgeons on 6 of the 18 metrics. The internal consistency was 0.58 (Cronbach's alpha). The experienced surgeons' mean composite score for all six repetitions were significantly better than the novice surgeons' (76.1 vs. 63.0, respectively, p < 0.001). A pass/fail standard of 75/100 was established. Four novice surgeons passed this standard (false positives) and three experienced surgeons failed (false negatives). CONCLUSION Our study has gathered validity evidence for a simulation-based test for procedural robotic surgical competency in the vaginal cuff closure procedure and established a credible pass/fail standard for future proficiency-based training.
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Affiliation(s)
- Lisette Hvid Hovgaard
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Steven Arild Wuyts Andersen
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Lars Konge
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
| | - Torur Dalsgaard
- Endometriosis Team and Robotic Surgery Section, Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Christian Rifbjerg Larsen
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Felder SI, Ramanathan R, Russo AE, Jimenez-Rodriguez RM, Hogg ME, Zureikat AH, Strong VE, Zeh HJ, Weiser MR. Robotic gastrointestinal surgery. Curr Probl Surg 2018; 55:198-246. [PMID: 30470267 DOI: 10.1067/j.cpsurg.2018.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Seth I Felder
- Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, Florida
| | - Rajesh Ramanathan
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashley E Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Melissa E Hogg
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Totally Robotic Versus Totally Laparoscopic Surgery for Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2018; 28:245-249. [DOI: 10.1097/sle.0000000000000552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Jimenez-Rodriguez RM, Weiser MR. In Brief. Curr Probl Surg 2018; 55:194-195. [PMID: 30470266 DOI: 10.1067/j.cpsurg.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2025]
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31
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Petz W, Ribero D, Bertani E, Borin S, Formisano G, Esposito S, Spinoglio G, Bianchi P. Suprapubic approach for robotic complete mesocolic excision in right colectomy: Oncologic safety and short-term outcomes of an original technique. Eur J Surg Oncol 2017; 43:2060-2066. [PMID: 28912072 DOI: 10.1016/j.ejso.2017.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 02/06/2023] Open
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32
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Hagen ME, Balaphas A, Podetta M, Rohner P, Jung MK, Buchs NC, Buehler L, Mendoza JM, Morel P. Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs. Surg Endosc 2017; 32:1550-1555. [PMID: 29052069 DOI: 10.1007/s00464-017-5843-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/22/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Multiport laparoscopy is the gold-standard approach for cholecystectomy, and single-port laparoscopy has been developed to further reduce its invasiveness. A specific robotic single-port platform (da Vinci single-site, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2011, which could technically facilitate single-site cholecystectomy. Current data show its feasibility; however, detailed short- and long-term analyses of costs and comparisons relative to multiport laparoscopy are not available to date. METHODS Patients who underwent robotic single-site cholecystectomy for benign, clinically noninflammatory disease between 2011 and 2015 were matched for disease, age, gender, BMI, ASA classification, diagnosis, and elapsed year of surgery to a cohort of multiport cholecystectomies. Demographic, perioperative, and long-term data were collected retrospectively and analyzed. Perioperative and long-term costs including re-operations due to the primary procedure until February 2017 were compared across both cohorts. RESULTS 99 patients who underwent robotic single-site cholecystectomy were matched to 99 patients with multiport cholecystectomy. A higher rate of outpatient procedures in the robotic cohort (31.3 vs. 17.2%, p = 0.0305) was found, and demographic parameters and perioperative clinical outcomes were similar. Perioperative costs were significantly higher for the robotic single-site patients (6158.0 vs. 4288.0 USD, p < 0.0001). With similar follow-up times of 59.0 and 58.9 months, respectively (p = 0.9552), significantly more patients of the robotic Single-Site cohort underwent follow-up surgery (7.1 vs. 0.0%, p = 0.0140), and follow-up costs were significantly higher for the robotic cohort (694.7 vs. 0.0 USD, p = 0.0145). CONCLUSION With similar early postoperative clinical results and a higher rate of re-operations, perioperative and long-term costs are significantly higher with robotic Single-Site cholecystectomy compared with multiport cholecystectomy. Considering the unclear clinical value of robotic single-site cholecystectomy and the significant short- and long-term costs, a call for further research and a debate as to who should bear the costs beyond the ones of the gold-standard treatment appear reasonable.
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Affiliation(s)
- Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Alexandre Balaphas
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Michele Podetta
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Peter Rohner
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Minoa K Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Leo Buehler
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Jona M Mendoza
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Philippe Morel
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
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Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2017; 32:24-38. [PMID: 28812154 DOI: 10.1007/s00464-017-5796-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 12/28/2022]
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Robotic Versus Laparoscopic Gastric Resection for Primary Gastrointestinal Stromal Tumors >5 cm: A Size-Matched and Location-Matched Comparison. Surg Laparosc Endosc Percutan Tech 2017; 27:65-71. [PMID: 28079762 DOI: 10.1097/sle.0000000000000371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study compared robotic (RR) and laparoscopic resection (LR) for primary gastrointestinal stromal tumors (GISTs) of the stomach >5 cm. Twelve consecutive patients who underwent RR from 2012 to 2015 were matched for tumor size and location with 24 patients who underwent LR from 2000 to 2012. The median tumor size was 7.1 cm (range, 5.5 to 11.5). GISTs were resected by wedge resection (91.7%) or distal gastrectomy. The median RR operative time was longer than that of LR (162.5 vs. 130 min, respectively; P=0.004). Only 1 LR patient required conversion. The time to flatus and hospital stay were similar between groups. Overall, 3 patients developed minor postoperative complications that were medically treated. Mortality was nil. All resections were R0. No difference was observed in the incidence of recurrence. RR was significantly more expensive (+21.6%) than LR. RR appears to be safe and feasible for GISTs>5 cm, but is associated with longer operative times and greater costs.
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Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature. Int J Surg Case Rep 2017; 37:13-16. [PMID: 28618350 PMCID: PMC5472142 DOI: 10.1016/j.ijscr.2017.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/23/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Appendiceal mucoceles encompass neoplastic and non-neoplastic causes of a distended Appendix filled with mucus. Appendectomy is recommended when an appendiceal mucocele is identified, incidentally or otherwise, in the event it is secondary to a malignancy. For an intact mucocele, it is critically important to avoid rupturing the mucocele during resection, as rupture of a neoplastic mucocele can result in pseudomyxoma peritonei, or mucin deposits in the peritoneum, which is associated with long-term morbidity and mortality. For this reason, laparotomy is the traditionally recommended surgical approach for treatment. PRESENTATION OF CASES In our case series, we describe two patients, a 49-year-old woman and a 79-year-old man, with incidentally identified appendiceal mucoceles. These patients were successfully treated with minimally invasive approaches to appendectomy, one with a robotic approach and one with a hand-assisted laparoscopic approach. The mucoceles were removed without rupture, and both patients recovered well postoperatively without complication. DISCUSSION While laparotomy is the traditionally recommended surgical approach for resection of appendiceal mucoceles, certain minimally invasive techniques allow for safe removal of the mucoceles while minimizing the morbidity of laparotomy. CONCLUSION Minimally invasive approaches to appendenctomy, specifically the robotic-assisted approach and the hand-assisted laparoscopic approach, can be considered for safe resection of appendiceal mucoceles.
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36
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Is right colectomy a complete learning procedure for a robotic surgical program? J Robot Surg 2017; 12:147-155. [PMID: 28500580 DOI: 10.1007/s11701-017-0711-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/27/2017] [Indexed: 02/08/2023]
Abstract
This study analyses the utility of right colectomy as a learning procedure at the beginning of a robotic surgical program. The hypothesis is that right colectomy contains all the technical steps necessary to acquire basic abilities in robotics surgery. The first 23 consecutive robotic right colectomy performed at the beginning of a robotic program were analysed. All surgical times were recorded in the operating room and second checked on a dedicated video-database. Specific robotic times were analysed using CUSUM method to evaluate the learning curve. CUSUM-derived learning phases were compared. Fourteen males and nine females with a mean age of 68.7 (46-84) underwent robotic right colectomy. The mean overall time was 265.3 min (180-320 min), docking time was 7 min (5-12 min), console time was 205.9 min (145-260 min), and anastomotic time was 43.6 (25-60 min). CUSUM analyses identified two learning phases: "starting phase" and "consolidation phase". Interphase comparison confirmed the significant (p < 0.05) differences between the two phases. Robotic technology facilitates the training process in minimally invasive colorectal surgery. At the beginning of the learning curve, right colectomy could represent a complete procedure to be proficient in robotic colorectal surgery.
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37
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Bravo R, Trépanier JS, Arroyave MC, Fernández-Hevia M, Pigazzi A, Lacy AM. Combined transanal total mesorectal excision (taTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer. Tech Coloproctol 2017; 21:233-235. [PMID: 28265766 DOI: 10.1007/s10151-017-1597-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/21/2017] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery for rectal cancer can be technically challenging. We describe a hybrid technique combining abdominal robotic dissection and transanal total mesorectal excision. This procedure was performed in a 50-year-old man with rectal adenocarcinoma at 5 cm from the dentate lane. Preoperative staging was T2N0M0. Surgery went well without complications, and estimated blood loss was less than 50 mL. Robotic surgical time was 90 min, and total operative time was 160 min. The patient was discharged on postoperative day 3. Pathology analysis revealed an intact mesorectum (TME grade 3) and a T2N0 tumor with negative margins. Hybrid surgery with pelvic robotic dissection and transanal total mesorectal excision was feasible, quick and safe in this patient and may be a method that can be developed further.
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Affiliation(s)
- R Bravo
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - J-S Trépanier
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - M C Arroyave
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Clínica Somer, Rionegro, Antioquia, Colombia
| | - M Fernández-Hevia
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - A Pigazzi
- Irvine Medical Center, University of California, Orange, CA, USA
| | - A M Lacy
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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A novel approach for robotic mobilization of the splenic flexure. Tech Coloproctol 2017; 21:53-57. [PMID: 28058512 DOI: 10.1007/s10151-016-1572-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The techniques of robotic splenic flexure mobilization in the colorectal surgery setting are not well defined and have been challenging due to limited range of motion of the second-generation robotic platform in multiple quadrants. METHODS This report describes a novel technique for robotic splenic flexure mobilization with medial-to-lateral approach without a need for robotic cart repositioning during left-sided colon and rectal surgery. The dissection is started with ligation of the inferior mesenteric artery and vein. Unique in this approach, entering the lesser sac is accomplished by extension of the dissection cranially by lifting up the mesocolon from the anterior surface of the pancreatic body toward the stomach. RESULTS This technique presented in the video allows the mobilization of the splenic flexure without excessive tractions and avoidance of potential splenic injuries. CONCLUSIONS The described novel approach demonstrates total robotic splenic flexure takedown without excessive traction, with improved visualization, and reduction of potential risk of splenic injury. This approach provides totally robotic mobilization of the splenic flexure at single docking without changing the patient's position.
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Hagen ME, Jung MK, Ris F, Fakhro J, Buchs NC, Buehler L, Morel P. Early clinical experience with the da Vinci Xi Surgical System in general surgery. J Robot Surg 2016; 11:347-353. [PMID: 28028750 DOI: 10.1007/s11701-016-0662-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 11/24/2022]
Abstract
The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6 month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6 min, p = 0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1 min, p = 0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.
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Affiliation(s)
- Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Minoa K Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Frederic Ris
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Jassim Fakhro
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Leo Buehler
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Philippe Morel
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
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Bae SU, Jeong WK, Baek SK. Robot-Assisted Colectomy for Left-Sided Colon Cancer: Comparison of Reduced-Port and Conventional Multi-Port Robotic Surgery. J Laparoendosc Adv Surg Tech A 2016; 27:398-403. [PMID: 27870592 DOI: 10.1089/lap.2016.0427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The robotic single-port access plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colon cancer, can enable lymphovascular dissection using the wristed instrumentation and safe rectal transection through an additional port maintaining the cosmetic advantage of the single-port surgery. The aim of this study is to compare the clinicopathological outcomes between reduced-port and conventional multi-port robotic colectomy for left-sided colon cancer. METHODS The study group included 23 patients who underwent an RPRS and 16 patients who underwent a multi-PRS (MPRS) for left-sided colon cancer between August 2013 and January 2016. RESULTS The operative time was significantly shorter in the RPRS group than in the MPRS group (mean time 258 ± 67 vs. 319 ± 66 minutes, P = .009). There were no apparent differences in tolerance of diet, postoperative pain score, length of hospital stay, the rate of postoperative complications, and the mean number of harvested lymph node, but the RPRS group had a significantly smaller total incision length (38 ± 12 mm vs. 83 ± 6 mm, P = .013). CONCLUSIONS This study shows the feasibility and safety of the RPRS, with clinicopathological outcomes that is comparable with that of the MPRS for left-sided colon cancer.
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Affiliation(s)
- Sung Uk Bae
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
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Abstract
BACKGROUND Debate exists regarding the role of robotic-assisted surgery in colorectal cancer. Robotic-assisted surgery has been promoted as a strategy to increase the availability of minimally invasive surgery, which is associated with improved short-term morbidity; however, robotic-assisted surgery is much more expensive than laparoscopic surgery. OBJECTIVE We aimed to understand hospital and patient trends in the adoption of robotic-assisted surgery. DESIGN The study used cross-sectional and longitudinal designs. SETTINGS The study included 2010 and 2012 American Hospital Association surveys, as well as the 2010-2012 Nationwide Inpatient Sample. PATIENTS US hospitals responding to the American Hospital Association survey were included to measure patients with colorectal cancer who were undergoing elective minimally invasive surgery or open resection. MAIN OUTCOME MEASURES Robotic-assisted surgery adoption by US hospitals was measured, regarding specifically patients with colorectal cancer who were treated with robotic surgery. RESULTS In 2010, 20.1% of hospitals adopted robotic-assisted surgery, increasing to 27.4% by 2012. Hospitals more likely to adopt robotic-assisted surgery included teaching hospitals, those with more advanced imaging services, those in metropolitan rather than rural areas, and those performing the highest inpatient surgery volume. Robotic-assisted surgery only accounted for 1.3% of colorectal cancer operations during 2010-2012, but patient probability of robotic-assisted surgery ranged from 0.1% to 15.2%. The percentage of patients with colorectal cancer who were treated robotically among those undergoing minimally invasive surgery increased over time (2010, 1.5%; 2012, 3.6%). Robotic-assisted surgery is increasing more rapidly for patients with rectal cancer with minimally invasive surgery (2010, 5.5%; 2012, 13.3%) versus patients with colon cancer treated with minimally invasive surgery (2010, 1.3%; 2012, 3.3%). LIMITATIONS The study was limited by its observational study design. CONCLUSIONS Robotic-assisted surgery uptake remains low for colon cancer but higher for rectal cancer surgery, suggesting a more thoughtful adoption of robotic-assisted surgery for colorectal cancer by focusing its use on more technically challenging cases.
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De Rosa M, Rega D, Costabile V, Duraturo F, Niglio A, Izzo P, Pace U, Delrio P. The biological complexity of colorectal cancer: insights into biomarkers for early detection and personalized care. Therap Adv Gastroenterol 2016; 9:861-886. [PMID: 27803741 PMCID: PMC5076770 DOI: 10.1177/1756283x16659790] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer has been ranked the third and second most prevalent of all cancers in men and women, respectively, and it represents the fourth most common cause of cancer deaths. In 2012, there were 1.4 million estimated cases of colorectal cancer worldwide, and 700,000 estimated deaths, which implies significant impact on public health, especially in economically-developed countries. In recent years, there has been an increase in the number of tumors, although this has been accompanied by decreased mortality, due to more appropriate and available information, earlier diagnosis, and improvements in treatment. Colorectal cancers are characterized by great genotypic and phenotypic heterogeneity, including tumor microenvironment and interactions between healthy and cancer cells. All of these traits confer a unique peculiarity to each tumor, which can thus be considered as an individual disease. Well conducted molecular and clinical characterization of each colorectal cancer is essential with a view to the implementation of precision oncology, and thus personalized care. This last aims at standardization of therapeutic plans chosen according to the genetic background of each specific neoplasm, to increase overall survival and reduce treatment side effects. Thus, prognostic and predictive molecular biomarkers assume a critical role in the characterization of colorectal cancer and in the determination of the most appropriate therapy.
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Affiliation(s)
- Marina De Rosa
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Valeria Costabile
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Francesca Duraturo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Antonello Niglio
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Paola Izzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II ’, I-80131 Naples, Italy
| | - Ugo Pace
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology-Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale’ IRCCS, I-80131 Naples, Italy
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Benlice C, Aytac E, Costedio M, Kessler H, Abbas MA, Remzi FH, Gorgun E. Robotic, laparoscopic, and open colectomy: a case-matched comparison from the ACS-NSQIP. Int J Med Robot 2016; 13. [PMID: 27766727 DOI: 10.1002/rcs.1783] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to compare perioperative outcomes of patients undergoing robotic, laparoscopic, and open colectomy using a procedure-targeted database. METHODS Retrospective review of patients undergoing elective colectomy in 2013 was conducted using the procedure-targeted database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Robotic, laparoscopic, and open groups were matched (1:1:1) based on age, gender, body mass index, surgical procedure, diagnosis and ASA classification. Demographics, comorbidities, and short-term (30 day) outcomes were compared. RESULTS Out of 12 790 patients, 387 fulfilled criteria per group after matching. Univariate comparison showed operating time was longer (P < 0.001) and hospital stay was shorter (P < 0.001) in the robotic group. Morbidity (P < 0.001), superficial SSI (P < 0.001), bleeding requiring transfusion (P < 0.001), ventilator dependency (P = 0.003), and ileus (P < 0.001) rates were lower in the robotic group. After adjusting for confounders, outcomes were comparable between the groups except hospital stay which was shorter in the robotic group (P < 0.001). CONCLUSIONS ACS-NSQIP data demonstrated several short-term advantages of robotic surgery compared with laparoscopic and open surgery.
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Affiliation(s)
- Cigdem Benlice
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Erman Aytac
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Maher A Abbas
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
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Foo CC, Law WL. The Learning Curve of Robotic-Assisted Low Rectal Resection of a Novice Rectal Surgeon. World J Surg 2016; 40:456-62. [PMID: 26423674 DOI: 10.1007/s00268-015-3251-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increasing availability of the surgical robotic system, the young generation colorectal surgeons may learn robotic-assisted rectal surgery upfront. There are currently very limited studies evaluating the learning curve of novice rectal surgeons. OBJECTIVE This study aimed to evaluate the learning curve of a surgeon who had limited experience in open and laparoscopic rectal surgery. METHODS Thirty-nine consecutive robotic-assisted total mesorectal excisions were performed from March 2013 to October 2014. All cases were performed by a single surgeon whose prior experience in open or laparoscopic low rectal cancer resections was <5 cases. The learning curve was analyzed using the cumulative sum method. RESULTS Thirty-four low anterior resections, four abdomino-perineal resections, and one Hartmann's operation were performed. The mean total operating time was 397.2 ± 184.3 min. There was no conversion. The major complication rate was 10.3 %. When total operating time was analyzed with the CUSUM method, three phases could be identified. They are the initial eight cases, middle 17 cases, and the final 14 cases. The first phase consisted of more proximal tumors (86.3 ± 20.7 vs. 58.0 ± 34.9 mm from anal verge, p = 0.04) and was associated with a shorter total operating time (243.5 ± 38.0 vs. 540.9 ± 133.4 min, p = 0.000) and less estimated blood loss (81.3 ± 25.9 vs. 168.8 ± 99.5 ml, p = 0.02) compared to the second phase. When the third phase is compared with the first and second phase, it has shorter total operating time (310.6 ± 164.5 vs. 44 5.7 ± 179.8 min, p = 0.03). Complications rate were 12.5, 17.6, and 0 % for phase one, two, and three respectively. CONCLUSIONS In this study, the learning curve for a novice rectal surgeon was 25 cases. This is comparable to those who have already mastered the technique with laparoscopic or open approach. Surgical robotic system may have a role in shortening the learning curve for low rectal resection.
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Affiliation(s)
- Chi Chung Foo
- Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
| | - Wai Lun Law
- Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Comparison of Open, Laparoscopic, and Robotic Colectomies Using a Large National Database: Outcomes and Trends Related to Surgery Center Volume. Dis Colon Rectum 2016; 59:535-42. [PMID: 27145311 DOI: 10.1097/dcr.0000000000000580] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have shown that high-volume centers and laparoscopic techniques improve outcomes of colectomy. These evidence-based measures have been slow to be accepted, and current trends are unknown. In addition, the current rates and outcomes of robotic surgery are unknown. OBJECTIVE The purpose of this study was to examine current national trends in the use of minimally invasive surgery and to evaluate hospital volume trends over time. DESIGN This was a retrospective study. SETTINGS This study was conducted in a tertiary referral hospital. PATIENTS Using the National Inpatient Sample, we evaluated trends in patients undergoing elective open, laparoscopic, and robotic colectomies from 2009 to 2012. Patient and institutional characteristics were evaluated and outcomes compared between groups using multivariate hierarchical-logistic regression and nonparametric tests. The National Inpatient Sample includes patient and hospital demographics, admission and treating diagnoses, inpatient procedures, in-hospital mortality, length of hospital stay, hospital charges, and discharge status. MAIN OUTCOME MEASURES In-hospital mortality and postoperative complications of surgery were measured. RESULTS A total of 509,029 patients underwent elective colectomy from 2009 to 2012. Of those 266,263 (52.3%) were open, 235,080 (46.2%) laparoscopic, and 7686 (1.5%) robotic colectomies. The majority of minimal access surgery is still being performed at high-volume compared with low-volume centers (37.5% vs 28.0% and 44.0% vs 23.0%; p < 0.001). A total of 36% of colectomies were for cancer. The number of robotic colectomies has quadrupled from 702 in 2009 to 3390 (1.1%) in 2012. After adjustment, the rate of iatrogenic complications was higher for robotic surgery (OR = 1.73 (95% CI, 1.20-2.47)), and the median cost of robotic surgery was higher, at $15,649 (interquartile range, $11,840-$20,183) vs $12,071 (interquartile range, $9338-$16,203; p < 0.001 for laparoscopic). LIMITATIONS This study may be limited by selection bias by surgeons regarding the choice of patient management. In addition, there are limitations in the measures of disease severity and, because the database relies on billing codes, there may be inaccuracies such as underreporting. CONCLUSIONS Our results show that the majority of colectomies in the United States are still performed open, although rates of laparoscopy continue to increase. There is a trend toward increased volume of laparoscopic procedures at specialty centers. The role of robotics is still being defined, in light of higher cost, lack of clinical benefit, and increased iatrogenic complications, albeit comparable overall complications, as compared with laparoscopic colectomy.
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Kim CN, Bae SU, Lee SG, Yang SH, Hyun IG, Jang JH, Cho BS, Park JS. Clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer: initial results in a center for minimally invasive surgery. Int J Colorectal Dis 2016; 31:843-52. [PMID: 26956581 DOI: 10.1007/s00384-016-2544-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE A robotic system was mainly designed to allow precise dissection in deep and narrow spaces. We report the clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer. METHODS Between July 2009 and January 2012, 60 consecutive patients undergoing robotic surgery for rectal cancer at the Eulji University Hospital were included. RESULTS The mean total operation time, docking time, and surgeon console time were 466.8 ± 115.6, 7.5 ± 6.7, and 261 ± 87.5 min, respectively. Oral intake of diet was started at 3.3 ± 0.9 days and the mean hospital stay was 8.6 ± 2.4 days. All 60 procedures were technically successful without the need for conversion to open or laparoscopic surgery. Complications included anastomotic leakage, anastomotic stricture, postoperative bleeding, ileus, and perineal wound infection in 3 (5 %), 1 (1.7 %), 2 (3.3 %), 2 (3.3 %), and 1 (1.7 %) patient, respectively. The mean distal resection margin and total number of lymph nodes harvested was 3.1 ± 1.7 cm and 20.1 ± 11.5, respectively. During the mean follow-up period of 48.5 months (range, 7-75), the 4-year overall and disease-free survival rates were 87.7 and 72.8 %, respectively. CONCLUSIONS A totally robotic approach for rectal cancer operations was a time-consuming procedure, although we already had a lot experience in laparoscopic colorectal surgery. However, the dexterity of the robotic surgery could enable the surgeon to expand the choice of surgical methods according to the condition of the rectal cancer without the need for conversion.
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Affiliation(s)
- Chang-Nam Kim
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea.
| | - Sung Uk Bae
- Department of Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Seul-Gi Lee
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Seung Hyun Yang
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - In Gun Hyun
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Je Ho Jang
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Byung Sun Cho
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Joo Seung Park
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
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Luca F, Valvo M, Guerra-Cogorno M, Simo D, Blesa-Sierra E, Biffi R, Garberoglio C. Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis. Eur J Surg Oncol 2016; 42:841-7. [PMID: 27050311 DOI: 10.1016/j.ejso.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/01/2016] [Accepted: 03/01/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In recent decades there has been an increasing trend toward sphincter-preserving procedures for the treatment of low rectal cancer. Robotic surgery is considered to be particularly beneficial when operating in the deep pelvis, where laparoscopy presents technical limitations. The aim of this study was to prospectively evaluate the functional outcomes in patients affected by rectal cancer after robotic total intersphincteric resection (ISR) with hand-sewn coloanal anastomosis. METHODS AND PROCEDURES From March 2008 to October 2012, 23 consecutive patients affected by distal rectal adenocarcinoma underwent robotic ISR. Operative, clinical, pathological and functional data regarding continence or presence of a low anterior resection syndrome (LARS) were prospectively collected in a database. RESULTS Twenty-three consecutive patients were included in the study: 8 men and 15 women. The mean age was 60.2 years (range 28-73). Eighteen (78.3%) had neoadjuvant radiochemotherapy. Conversion rate was nil. The mean operative time was 296.01 min and the mean postoperative hospital stay was 7.43 ± 1.73 days. According to Kirwan's incontinence score, good fecal continence was shown in 85.7% of patients (Grade 1 and 2) and none required a colostomy (Grade 4). Concerning LARS score, the results were as follows: 57.1% patients had no LARS; 19% minor LARS and 23.8% major LARS. CONCLUSIONS Robotic total ISR for low rectal cancer is an acceptable alternative to traditional procedures. Extensive discussion with the patient about the risk of poor functional outcomes or LARS syndrome is mandatory when considering an ISR for treatment of low rectal cancer.
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Affiliation(s)
- F Luca
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy.
| | - M Valvo
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy
| | - M Guerra-Cogorno
- Department of General Surgery, Centro Médico "Dr. Rafael Guerra Méndez" Valencia, Venezuela
| | - D Simo
- Unità Operativa di Patologia Chirurgica, Ospedale SS. Annunziata, Chieti, Italy
| | - E Blesa-Sierra
- Servicio de Cirugia General y Aparato Digestivo, Hospital Clinico San Carlos, Madrid, Spain
| | - R Biffi
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy
| | - C Garberoglio
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Effect of BMI on Short-Term Outcomes with Robotic-Assisted Laparoscopic Surgery: a Case-Matched Study. J Gastrointest Surg 2016; 20:488-93. [PMID: 26704536 DOI: 10.1007/s11605-015-3016-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many benefits of minimally invasive surgery are lost in the obese, but robotic-assisted laparoscopic surgery (RALS) may offer advantages in this population. Our goal was to compare outcomes for RALS in obese and non-obese patients. METHODS A prospective database was reviewed for colorectal resections using RALS. Patients were stratified into obese (BMI > 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)), then case-matched for comparability. The main outcome measures were operative time, conversion rate, length of stay and complication, readmission, and reoperation rates between groups. RESULTS Forty-five patients were evaluated in each cohort. The BMI was significantly different (p < 0.01). All other demographics were well matched. There were no significant differences in operative time (p = 0.86), blood loss (p = 0.38), intraoperative complications (p = 0.54), or conversion rates (p = 0.91) across cohorts. Length of stay was comparable between groups (p = 0.45). Postoperatively, the complication (p = 0.87), readmission (p = 1.00), and reoperation rates (p = 0.95) were similar. There were no mortalities. For malignant cases (37.8 %), the lymph node yield (p = 0.48) and positive margins (p = 1.00) were similar and acceptable in both cohorts. CONCLUSIONS In our matched RALS series, perioperative and postoperative outcomes were similar between obese and non-obese patients undergoing colorectal surgery. RALS is a feasible option in the surgical setting of the obese patient. Further controlled studies are warranted to explore the full benefits.
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Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol 2016; 22:704-717. [PMID: 26811618 PMCID: PMC4716070 DOI: 10.3748/wjg.v22.i2.704] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
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