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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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Palmeri M, Gianardi D, Guadagni S, Di Franco G, Bastiani L, Furbetta N, Simoncini T, Zirafa C, Melfi F, Buccianti P, Moglia A, Cuschieri A, Mosca F, Morelli L. Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study. Surg Innov 2018; 25:251-257. [PMID: 29577830 DOI: 10.1177/1553350618765540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM. METHODS Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group). RESULTS Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024). CONCLUSIONS In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.
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Affiliation(s)
- Matteo Palmeri
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Luca Bastiani
- 2 Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Niccolò Furbetta
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- 3 Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Zirafa
- 4 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Franca Melfi
- 4 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Piero Buccianti
- 5 General Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Moglia
- 6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Alfred Cuschieri
- 7 Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland
| | - Franco Mosca
- 6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Luca Morelli
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
- 6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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Morelli L, Di Franco G, Guadagni S, Rossi L, Palmeri M, Furbetta N, Gianardi D, Bianchini M, Caprili G, D'Isidoro C, Mosca F, Moglia A, Cuschieri A. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 2018; 32:589-600. [PMID: 28733738 DOI: 10.1007/s00464-017-5708-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/05/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Robotic rectal resection with da Vinci Si has some technical limitations, which could be overcome by the new da Vinci Xi. We compare short-term surgical and functional outcomes following robotic rectal resection with total mesorectal excision for cancer, with the da Vinci Xi (Xi-RobTME group) and the da Vinci Si (Si-RobTME group). METHODS The first consecutive 30 Xi-RobTME were compared with a Si-RobTME control group of 30 patients, selected using a one-to-one case-matched methodology from our prospectively collected Institutional database, comprising all cases performed between April 2010 and September 2016 by a single surgeon. Perioperative outcomes were compared. The impact of minimally invasive TME on autonomic function and quality of life was analyzed with specific questionnaires. RESULTS The docking and overall operative time were shorter in the Xi-RobTME group (p < 0.001 and p < 0.05 respectively). The mean differences of overall operative time and docking time were -33.8 min (95% CI -5.1 to -64.5) and -6 min (95% CI -4.1 to -7.9), respectively. A fully-robotic approach with complete splenic flexure mobilization was used in 30/30 (100%) of the Xi-RobTME cases and in 7/30 (23%) of the Si-RobTME group (p < 0.001). The hybrid approach in males and patients with BMI > 25 kg/m2 was necessary in ten patients (45 vs. 0%, p < 0.001) and in six patients (37 vs. 0%, p < 0.05), in the Si-RobTME and Xi-RobTME groups, respectively. There were no differences in conversion rate, mean hospital stay, pathological data, and in functional outcomes between the two groups before and at 1 year after surgery. CONCLUSION The technical advantages offered by the da Vinci Xi seem to be mainly associated with a shorter docking and operative time and with superior ability to perform a fully-robotic approach. Clinical and functional outcomes seem not to be improved, with the introduction of the new Xi platform.
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Affiliation(s)
- Luca Morelli
- General Surgery Unit, University of Pisa, Pisa, Italy.
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
- General Surgery Unit, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Andrea Moglia
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Alfred Cuschieri
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK
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Davis CH, Shirkey BA, Moore LW, Gaglani T, Du XL, Bailey HR, Cusick MV. Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database. J Surg Res 2017; 223:16-21. [PMID: 29433869 DOI: 10.1016/j.jss.2017.09.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/24/2017] [Accepted: 09/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopy, originally pioneered by gynecologists, was first adopted by general surgeons in the late 1980s. Since then, laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant disease. Formal laparoscopic training became a required component of surgery residency programs as validated by the Fundamentals of Laparoscopic Surgery curriculum; however, some surgeons may be more apprehensive of widespread adoption of minimally invasive techniques. Although an overall increase in the use of laparoscopy in colorectal surgery is anticipated over a 10-year period, it is unknown if a similar increase will be seen in higher risk or more acutely ill patients. METHODS Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2005-2014, colorectal procedures were identified by Current Procedural Terminology codes and categorized to open or laparoscopic surgery. The proportion of colorectal surgeries performed laparoscopically was calculated for each year. Separate descriptive statistics was performed and categorized by age and body mass index (BMI). American Society of Anesthesiology (ASA) classification and emergency case status variables were added to the project to help assess complexity of cases. RESULTS During the 10-year study period, the number of colorectal cases increased from 3114 in 2005 to 51,611 in 2014 as more hospitals joined NSQIP. A total of 277,376 colorectal cases were identified; of which, 114,359 (41.2%) were performed laparoscopically. The use of laparoscopy gradually increased each year, from 22.7% in 2005 to 49.8% in 2014. Laparoscopic procedures were most commonly performed in the youngest age group (18-49 years), overweight and obese patients (BMI 25-34.9), and in ASA class 1-2 patients. Over the 10-year period, there was a noted increase in the use of laparoscopy in every age, BMI, and ASA category, except ASA 5. The percent of emergency cases receiving laparoscopic surgery also doubled from 5.5% in 2005 to 11.5% in 2014. CONCLUSIONS Over a 10-year period, there was a gradual increase in the use of laparoscopy in colorectal surgery. Further, there was a consistent increase of laparoscopic surgery in all age groups, including the elderly, in all BMI classes, including the obese and morbidly obese, and in most ASA classes, including ASA 3-4, as well as in emergency surgeries. These trends suggest that minimally invasive colorectal surgery appears to be widely adopted and performed on more complex or higher risk patients.
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Affiliation(s)
- Catherine H Davis
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Epidemiology, The University of Texas School of Public Health, Houston, Texas
| | - Beverly A Shirkey
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Tanmay Gaglani
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Xianglin L Du
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - H Randolph Bailey
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Marianne V Cusick
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas.
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Morelli L, Di Franco G, Guadagni S, Palmeri M, Gianardi D, Bianchini M, Moglia A, Ferrari V, Caprili G, D'Isidoro C, Melfi F, Di Candio G, Mosca F. Full Robotic Colorectal Resections for Cancer Combined With Other Major Surgical Procedures: Early Experience With the da Vinci Xi. Surg Innov 2017; 24:321-327. [PMID: 28498018 DOI: 10.1177/1553350617697183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. METHODS Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for "left lower quadrant," with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure. RESULTS All procedures were completed with the full robotic technique. Simultaneous procedures in same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-targeting operation. No external collisions or problems related to trocar positions were noted. No patient experienced postoperative surgical complications and the mean hospital stay was 6 days. CONCLUSIONS The high success rate of full robotic colorectal resection combined with other surgical interventions for synchronous tumors, suggest the efficacy of the da Vinci Xi in this setting.
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Affiliation(s)
- Luca Morelli
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Vincenzo Ferrari
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Giovanni Caprili
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Cristiano D'Isidoro
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Franca Melfi
- 3 Multidisciplinary Center of Robotic Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Di Candio
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Franco Mosca
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
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Morelli L, Guadagni S, Di Franco G, Palmeri M, Caprili G, D'Isidoro C, Cobuccio L, Marciano E, Di Candio G, Mosca F. Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®. Int J Med Robot 2017; 13:e1728. [PMID: 26804716 DOI: 10.1002/rcs.1728] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/13/2015] [Accepted: 12/07/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to compare the short-term outcomes of robotic rectal resection with total mesorectal excision (TME) for rectal cancer, with the use of the new da Vinci Xi® (Xi-RobTME group) and the da Vinci Si® (Si-RobTME group). METHODS Ten patients with histologically confirmed rectal cancer underwent robot-assisted TME with the use of the new da Vinci Xi. The outcomes of Xi-RobTME group were compared with a Si-RobTME group selected using a case-matched methodology. RESULTS Overall operative times and mean hospital stays were shorter in the Xi-RobTME group. Surgeries were fully robotic with a complete take-down of the splenic flexure in all Xi-RobTME cases, while only four cases of the Si-RobTME group were fully robotic, with two cases of complete take-down of the splenic flexure. CONCLUSIONS The new da Vinci Xi could offer some advantages with respect to the da Vinci Si in rectal resection for cancer. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luca Morelli
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
- Centre for Computer-assisted Surgery (EndoCAS), University of Pisa, Italy
| | - Simone Guadagni
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Gregorio Di Franco
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Matteo Palmeri
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Giovanni Caprili
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Cristiano D'Isidoro
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Luigi Cobuccio
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Emanuele Marciano
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Giulio Di Candio
- General Surgery, Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Franco Mosca
- Centre for Computer-assisted Surgery (EndoCAS), University of Pisa, Italy
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Robotic right hemicolectomy: Analysis of 108 consecutive procedures and multidimensional assessment of the learning curve. Surg Oncol 2016; 26:28-36. [PMID: 28317582 DOI: 10.1016/j.suronc.2016.12.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE Surgeons tend to view the robotic right colectomy (RRC) as an ideal beginning procedure to gain proficiency in robotic general and colorectal surgery. Nevertheless, oncological RRC, especially if performed with intracorporeal ileocolic anastomosis confectioning, cannot be considered a technically easier procedure. The aim of this study was to assess the learning curve of the RRC performed for oncological purposes and to evaluate its safety and efficacy investigating the perioperative and pathology outcomes in the different learning phases. METHODS Data on a consecutive series of 108 patients undergoing RRC with intracorporeal anastomosis between June 2011 and September 2015 at our institution were prospectively collected to evaluate surgical and short-term oncological outcomes. CUSUM (Cumulative Sum) and Risk-Adjusted (RA) CUSUM analysis were performed in order to perform a multidimensional assessment of the learning curve for the RRC surgical procedure. Intraoperative, postoperative and pathological outcomes were compared among the learning curve phases. RESULTS Based on the CUSUM and RA-CUSUM analyses, the learning curve for RRC could be divided into 3 different phases: phase 1, the initial learning period (1st-44th case); phase 2, the consolidation period (45th-90th case); and phase 3, the mastery period (91th-108th case). Operation time, conversion to open surgery rate and the number of harvested lymph nodes significantly improve through the three learning phases. CONCLUSIONS The learning curve for oncological RRC with intracorporeal anastomosis is composed of 3 phases. Our data indicate that the performance of RRC is safe from an oncological point of view in all of the three phases of the learning curve. However, the technical skills necessary to significantly reduce operative time, conversion to open surgery rate and to significantly improve the number of harvested lymph nodes were achieved after 44 procedures. These data suggest that it might be prudent to start the RRC learning curve by treating only benign diseases and to reserve the performance of oncological resection to when at least the initial learning phase has been completed.
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Guerrieri M, Campagnacci R, Sperti P, Belfiori G, Gesuita R, Ghiselli R. Totally robotic vs 3D laparoscopic colectomy: A single centers preliminary experience. World J Gastroenterol 2015; 21:13152-13159. [PMID: 26674518 PMCID: PMC4674734 DOI: 10.3748/wjg.v21.i46.13152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/09/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare robotic and three-dimensional (3D) laparoscopic colectomy based on the literature and our preliminary experience.
METHODS: This retrospective observational study compared operative measures and postoperative outcomes between laparoscopic 3D and robotic colectomy for cancer. From September 2013 to September 2014, 24 robotic colectomies and 23 3D laparoscopic colectomy were performed at our Department. Data were analyzed and reported both by approach and by colectomy side. Robotic left colectomy (RL) vs laparoscopic 3D left colectomy (LL 3D) and Robotic right colectomy (RR) vs laparoscopic 3D (LR 3D). Rectal cancer procedures were not included.
RESULTS: There were 18 RR and 11 LR 3D, 6 RL and 12 LL 3D. As regards LR 3D, extracorporeal anastomosis (EA) was performed in 7 patients and intracorporeal anastomosis (IA) in 4; the RR group included 14 IA and 4 EA. There was no mortality. Median operative time was higher for the robotic group while conversion rate (12.5% vs 13%) and lymph nodes removed (14 vs 13) were similar for both. First flatus time was 1 d for RR and 2 d the other patient groups. Oral intake was resumed in 1 d by LR and in 2 d by the other patients (P = 0.012). Overall cost was €4950 and €1950 for RL and LL 3D, and €4450 and €1450 for RR and LR 3D, respectively.
CONCLUSION: There were no differences between RR and LR 3D, except that IA was easier with RR, and probably contributed with the learning curve to the longer operative time recorded. Both techniques offer similar advantages for the patient with significantly different costs. In left colectomies robotic colectomy provided better outcomes, especially in resections approaching the rectum.
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Bourgeois AC, Faulkner AR, Pasciak AS, Bradley YC. The evolution of image-guided lumbosacral spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:69. [PMID: 25992368 PMCID: PMC4402607 DOI: 10.3978/j.issn.2305-5839.2015.02.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/26/2015] [Indexed: 12/19/2022]
Abstract
Techniques and approaches of spinal fusion have considerably evolved since their first description in the early 1900s. The incorporation of pedicle screw constructs into lumbosacral spine surgery is among the most significant advances in the field, offering immediate stability and decreased rates of pseudarthrosis compared to previously described methods. However, early studies describing pedicle screw fixation and numerous studies thereafter have demonstrated clinically significant sequelae of inaccurate surgical fusion hardware placement. A number of image guidance systems have been developed to reduce morbidity from hardware malposition in increasingly complex spine surgeries. Advanced image guidance systems such as intraoperative stereotaxis improve the accuracy of pedicle screw placement using a variety of surgical approaches, however their clinical indications and clinical impact remain debated. Beginning with intraoperative fluoroscopy, this article describes the evolution of image guided lumbosacral spinal fusion, emphasizing two-dimensional (2D) and three-dimensional (3D) navigational methods.
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Affiliation(s)
- Austin C Bourgeois
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Austin R Faulkner
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Alexander S Pasciak
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Yong C Bradley
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
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10
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Xu JM, Wei Y, Wang XY, Fan H, Chang WJ, Ren L, Jiang W, Fan J, Qin XY. Robot-assisted one-stage resection of rectal cancer with liver and lung metastases. World J Gastroenterol 2015; 21:2848-2853. [PMID: 25759560 PMCID: PMC4351242 DOI: 10.3748/wjg.v21.i9.2848] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/18/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
The Da Vinci Surgical System may help to overcome some of the difficulties of laparoscopy for complicated abdominal surgery. The authors of this article present a case of robot-assisted, one-stage radical resection of three tumors, including robotic anterior resection for rectal cancer, segmental hepatectomy for liver metastasis, and wedge-shaped excision for lung metastasis. A 59-year-old man with primary rectal cancer and liver and lung metastases was operated upon with a one-stage radical resection approach using the Da Vinci Surgical System. Resection and anastomosis of rectal cancer were performed extracorporeally after undocking the robot. The procedure was successfully completed in 500 min. No surgical complications occurred during the intervention and postoperative period, and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of simultaneous resection for rectal cancer with liver and lung metastases using the Da Vinci Surgery System to be reported. The procedure is feasible and safe and its main advantages for patient are avoiding repeated operation, reducing surgical trauma, shortening recovery time, and early implementation of postoperative adjuvant therapy.
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Campa-Thompson M, Weir R, Calcetera N, Quirke P, Carmack S. Pathologic processing of the total mesorectal excision. Clin Colon Rectal Surg 2015; 28:43-52. [PMID: 25733973 DOI: 10.1055/s-0035-1545069] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique.
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Affiliation(s)
- Molly Campa-Thompson
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Robert Weir
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Natalie Calcetera
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Philip Quirke
- Department of Pathology and Tumor Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Susanne Carmack
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
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Araujo SEA, Seid VE, Klajner S. Robotic surgery for rectal cancer: Current immediate clinical and oncological outcomes. World J Gastroenterol 2014; 20:14359-14370. [PMID: 25339823 PMCID: PMC4202365 DOI: 10.3748/wjg.v20.i39.14359] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/21/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological (pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic (0%-41.3%) and laparoscopic (5.5%-29.3%) surgery regarding morbidity and anastomotic complications (respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results.
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Mak TWC, Lee JFY, Futaba K, Hon SSF, Ngo DKY, Ng SSM. Robotic surgery for rectal cancer: A systematic review of current practice. World J Gastrointest Oncol 2014; 6:184-193. [PMID: 24936229 PMCID: PMC4058726 DOI: 10.4251/wjgo.v6.i6.184] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 02/23/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery.
METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”.
RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery.
CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.
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