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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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Lopez MPJ, Viray BAG, Onglao MAS, Tampo MMT, Monroy HJ. Outcomes of Robotic versus Laparoscopic versus Open Resection for Rectal Cancer in a Center with a Beginning Robotic Colorectal Surgery Program. ACTA MEDICA PHILIPPINA 2024; 58:74-82. [PMID: 39600666 PMCID: PMC11586283 DOI: 10.47895/amp.vi0.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
Background and Objective Robotic surgery for rectal malignancies in the Philippines is emerging. Evidence has shown promising results for robot-assisted (R) rectal surgery when compared to the laparoscopic (L) and open (O) approach. This study discussed the clinicopathologic outcomes of the first robotic rectal resections versus laparoscopic and open rectal resections at the Philippine General Hospital (PGH). Methods This was a retrospective cohort of 45 consecutive surgical resections for rectal malignancy done at the PGH from March 2019 to October 2019 that compared the outcomes of the first 15 robotic procedures done at the institution versus laparoscopic (n=15) and open (n=15) operations performed during the same time period. One-way ANOVA was done to determine significant differences among variables, while Bonferonni multiple comparison test was done to analyze differences among means. Results The 45 patients in the study had a mean age of 56.04 ± 13.45 years. The patients were mostly male (60%). Most of the tumors were located in the low rectum (27/45; 60%). Most of the patients had locally-advanced (at least Stage IIIB) disease (27/45; 60%), and warranted neoadjuvant treatment (41/45; 91.11%). Most patients underwent a sphincter-saving procedure (34/45; 75.56%). All three groups had comparable baseline characteristics. The R-group had the longest operative time (438.07 ± 124.57; p value <0.0001). Blood loss was significantly highest in the R-group (399 ± 133.07 cc; p value - 0.0020) as well, while no statistical difference was observed between the O- and L-groups (p value - 0.75). No conversion to open was noted in the R- and L-groups. Most of the patients had well-differentiated adenocarcinoma (22/45; 48.49%). All patients in the L- and O-groups had an R0 resection There were two R1 resections in the R-group. All patients who underwent an open surgery had a negative circumferential resection margin (CRM); L-group 93.99%, R-group 69.23%. All patients had adequate proximal and distal resection margins. Those who underwent an open surgery had the shortest post-operative length of stay (LOS) (p value - 0.0002). Post-operative ileus (7/45; 15.56%) was the most commonly encountered morbidity, and was seen mostly in the R-group (3/15; 20%). One patient in the R-group underwent a transanal repair of an anastomotic dehiscence and was discharged three days after re-operation. There was no reported mortality. Conclusion Our institution with a beginning robotic colorectal surgery program showed promise as its initial outcomes for rectal cancer were compared to the more often-performed open and laparoscopic procedures. The authors expect more favorable clinicopathological outcomes as our staff overcome the prescribed learning curve for robotic surgery.
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Affiliation(s)
- Marc Paul J. Lopez
- Division of Colorectal Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Brent Andrew G. Viray
- Department of Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Marc Augustine S. Onglao
- Division of Colorectal Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Mayou Martin T. Tampo
- Division of Colorectal Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Hermogenes J. Monroy
- Division of Colorectal Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila
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Awad MM, Raynor MC, Padmanabhan-Kabana M, Schumacher LY, Blatnik JA. Evaluation of forces applied to tissues during robotic-assisted surgical tasks using a novel force feedback technology. Surg Endosc 2024; 38:6193-6202. [PMID: 39266755 PMCID: PMC11458697 DOI: 10.1007/s00464-024-11131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/27/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND The absence of force feedback (FFB) is considered a technical limitation in robotic-assisted surgery (RAS). This pre-clinical study aims to evaluate the forces applied to tissues using a novel integrated FFB technology, which allows surgeons to sense forces exerted at the instrument tips. METHODS Twenty-eight surgeons with varying experience levels employed FFB instruments to perform three robotic-assisted surgical tasks, including retraction, dissection, and suturing, on inanimate or ex-vivo models, while the instrument sensors recorded and conveyed the applied forces to the surgeon hand controllers of the robotic system. Generalized Estimating Equations (GEE) models were used to analyze the mean and maximal forces applied during each task with the FFB sensor at the "Off" setting compared to the "High" sensitivity setting for retraction and to the "Low", "Medium", and "High" sensitivity settings for dissection and suturing. Sub-analysis was also performed on surgeon experience levels. RESULTS The use of FFB at any of the sensitivity settings resulted in a significant reduction in both the mean and maximal forces exerted on tissue during all three robotic-assisted surgical tasks (p < 0.0001). The maximal force exerted, potentially associated with tissue damage, was decreased by 36%, 41%, and 55% with the use of FFB at the "High" sensitivity setting while performing retraction, dissection, and interrupted suturing tasks, respectively. Further, the use of FFB resulted in substantial reductions in force variance during the performance of all three types of tasks. In general, reductions in mean and maximal forces were observed among surgeons at all experience levels. The degree of force reduction depends on the sensitivity setting selected and the types of surgical tasks evaluated. CONCLUSIONS Our findings demonstrate that the utilization of FFB technology integrated in the robotic surgical system significantly reduced the forces exerted on tissue during the performance of surgical tasks at all surgeon experience levels. The reduction in the force applied and a consistency of force application achieved with FFB use, could result in decreases in tissue trauma and blood loss, potentially leading to better clinical outcomes in patients undergoing RAS. Future studies will be important to determine the impact of FFB instruments in a live clinical environment.
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Affiliation(s)
- Michael M Awad
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Mathew C Raynor
- Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Jeffrey A Blatnik
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Song L, Xu WQ, Wei ZQ, Tang G. Robotic vs laparoscopic abdominoperineal resection for rectal cancer: A propensity score matching cohort study and meta-analysis. World J Gastrointest Surg 2024; 16:1280-1290. [PMID: 38817290 PMCID: PMC11135314 DOI: 10.4240/wjgs.v16.i5.1280] [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: 12/06/2023] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Robotic surgery (RS) is gaining popularity; however, evidence for abdominoperineal resection (APR) of rectal cancer (RC) is scarce. AIM To compare the efficacy of RS and laparoscopic surgery (LS) in APR for RC. METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022. Data regarding short-term surgical outcomes were compared between the two groups. To reduce the effect of potential confounding factors, propensity score matching was used, with a 1:1 ratio between the RS and LS groups. A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery. RESULTS Of 133 patients, after propensity score matching, there were 42 patients in each group. The postoperative complication rate was significantly lower in the RS group (17/42, 40.5%) than in the LS group (27/42, 64.3%) (P = 0.029). There was no significant difference in operative time (P = 0.564), intraoperative transfusion (P = 0.314), reoperation rate (P = 0.314), lymph nodes harvested (P = 0.309), or circumferential resection margin (CRM) positive rate (P = 0.314) between the two groups. The meta-analysis showed patients in the RS group had fewer positive CRMs (P = 0.04), lesser estimated blood loss (P < 0.00001), shorter postoperative hospital stays (P = 0.02), and fewer postoperative complications (P = 0.002) than patients in the LS group. CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
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Affiliation(s)
- Li Song
- Department of Gastrointestinal Surgery, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
| | - Wen-Qiong Xu
- Department of Nephrology, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Gang Tang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Yang H, Yang G, Wu WY, Wang F, Yao XQ, Wu XY. Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients. World J Gastrointest Surg 2024; 16:1271-1279. [PMID: 38817284 PMCID: PMC11135294 DOI: 10.4240/wjgs.v16.i5.1271] [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: 10/31/2023] [Revised: 02/05/2024] [Accepted: 04/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer. AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery. METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared. RESULTS There were 45 elderly patients (≥ 60 years) in the R-TME group and 50 elderly patients (≥ 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The L-TME group had a longer surgical time than the R-TME group [145 (125, 187.5) vs 180 (148.75, 206.25) min, P = 0.005), and the first postoperative meal time in the L-TME group was longer than that in the R-TME (4 vs 3 d, P = 0.048). Among the sex and body mass index (BMI) subgroups, the R-TME group had better outcomes than did the L-TME group in terms of operation time (P = 0.042) and intraoperative assessment of bleeding (P = 0.042). In the high BMI group, catheter removal occurred earlier in the R-TME group than in the L-TME group (3 vs 4 d, P = 0.001), and autonomous voiding function was restored. CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery; however, robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis. Optimizing the learning curve can shorten the operation time, reduce the recovery time of gastrointestinal function, and improve the prognosis.
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Affiliation(s)
- Hao Yang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Gang Yang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Wen-Ya Wu
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Fang Wang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Xue-Quan Yao
- Department of Surgical Oncology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Xiao-Yu Wu
- Department of Surgical Oncology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Azevedo JM, Panteleimonitis S, Mišković D, Herrando I, Al-Dhaheri M, Ahmad M, Qureshi T, Fernandez LM, Harper M, Parvaiz A. Textbook Oncological Outcomes for Robotic Colorectal Cancer Resections: An Observational Study of Five Robotic Colorectal Units. Cancers (Basel) 2023; 15:3760. [PMID: 37568576 PMCID: PMC10417291 DOI: 10.3390/cancers15153760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the 'desirable' or 'ideal' postoperative clinical and oncological outcomes from both a patient's and doctor's point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. METHODS We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized-no conversion to open, no complication with a Clavien-Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of "ideal" practice called textbook oncological outcomes. RESULTS A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. CONCLUSIONS Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.
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Affiliation(s)
- José Moreira Azevedo
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal
| | - Sofoklis Panteleimonitis
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
- St. Mark’s Hospital, London NW10 7NS, UK;
| | | | - Ignacio Herrando
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
| | | | - Mukhtar Ahmad
- Poole Hospital NHS Trust, Longfleet Road, Poole BH15 2JB, UK; (M.A.); (T.Q.)
| | - Tahseen Qureshi
- Poole Hospital NHS Trust, Longfleet Road, Poole BH15 2JB, UK; (M.A.); (T.Q.)
| | | | - Mick Harper
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
| | - Amjad Parvaiz
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
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Zheng H, Wang Q, Fu T, Wei Z, Ye J, Huang B, Li C, Liu B, Zhang A, Li F, Gao F, Tong W. Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis. Tech Coloproctol 2023; 27:559-568. [PMID: 36964884 DOI: 10.1007/s10151-023-02781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer. METHODS Patients who had RLC or LLC with CME for left-sided colon cancer at 5 hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes. RESULTS A total of 292 patients (187 males; median age 61.0 [20.0-85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinical-pathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 minutes, p=0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p< 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival. CONCLUSIONS Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.
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Affiliation(s)
- H Zheng
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - Q Wang
- Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China
| | - T Fu
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, China
| | - Z Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - J Ye
- Department of Gastrointestinal Surgery, The People's Hospital of Shapingba District, Chongqing, China
| | - B Huang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - C Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - B Liu
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - A Zhang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - F Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China.
| | - F Gao
- Department of Colorectal Surgery, 940th Hospital of Joint Logistics Support force of PLA, Lanzhou, China.
| | - W Tong
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China.
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Walshaw J, Huo B, McClean A, Gajos S, Kwan JY, Tomlinson J, Biyani CS, Dimashki S, Chetter I, Yiasemidou M. Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery-a narrative review. Front Surg 2023; 10:1193486. [PMID: 37288133 PMCID: PMC10242011 DOI: 10.3389/fsurg.2023.1193486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort.
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Affiliation(s)
- Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adam McClean
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Samantha Gajos
- Emergency Medicine Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Jing Yi Kwan
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James Tomlinson
- Department of Spinal Surgery, SheffieldTeaching Hospitals, Sheffield, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Safaa Dimashki
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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Zheng J, Zhao S, Chen W, Zhang M, Wu J. Comparison of robotic right colectomy and laparoscopic right colectomy: a systematic review and meta-analysis. Tech Coloproctol 2023:10.1007/s10151-023-02821-2. [PMID: 37184773 DOI: 10.1007/s10151-023-02821-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured. RESULTS Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar. CONCLUSION The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.
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Affiliation(s)
- Jianchun Zheng
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, Jiangsu Province, China
| | - Wei Chen
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Ming Zhang
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Jianxiang Wu
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
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10
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Zheng H, Wang Q, Fu T, Wei Z, Ye J, Huang B, Li C, Liu B, Zhang A, Li F, Gao F, Tong W. Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis. Tech Coloproctol 2023:10.1007/s10151-023-02788-0. [PMID: 37014449 DOI: 10.1007/s10151-023-02788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/14/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer. METHODS Patients who had RLC or LLC with CME for left-sided colon cancer at five hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes. RESULTS A total of 292 patients (187 male; median age 61.0 [20.0-85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinicopathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 min, p = 0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p < 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival. CONCLUSION Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.
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Affiliation(s)
- Huichao Zheng
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tao Fu
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingwang Ye
- Department of Gastrointestinal Surgery, The People's Hospital of Shapingba District, Chongqing, China
| | - Bin Huang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Chunxue Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Baohua Liu
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Anping Zhang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Fan Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.
| | - Feng Gao
- Department of Colorectal Surgery, 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China.
| | - Weidong Tong
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.
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11
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Minimally Invasive Surgery Approach is Not Associated With Differences in Long-Term Bowel Function Patient-Reported Outcomes After Elective Sigmoid Colectomy. J Surg Res 2022; 274:85-93. [DOI: 10.1016/j.jss.2021.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
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Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. Surg Oncol 2022; 40:101708. [PMID: 35092916 DOI: 10.1016/j.suronc.2022.101708] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
The safety of colorectal surgery for oncological disease is steadily improving, but anastomotic leakage is still the most feared and devastating complication from both a surgical and oncological point of view. Anastomotic leakage affects the outcome of the surgery, increases the times and costs of hospitalization, and worsens the prognosis in terms of short- and long-term outcomes. Anastomotic leakage has a wide range of clinical features ranging from radiological only finding to peritonitis and sepsis with multi-organ failure. C-reactive protein and procalcitonin have been identified as early predictors of anastomotic leakage starting from postoperative day 2-3, but abdominal-pelvic computed tomography scan is still the gold standard for the diagnosis. Several treatments can be adopted for anastomotic leakage. However, there is not a universally accepted flowchart for the management, which should be individualized based on patient's general condition, anastomotic defect size and location, indication for primary resection and presence of the proximal stoma. Non-operative management is usually preferred in patients who underwent proximal faecal diversion at the initial operation. Laparoscopy can be attempted after minimal invasive surgery and can reduce surgical stress in patients allowing a definitive treatment. Reoperation for sepsis control is rarely necessary in those patients who already have a diverting stoma at the time of the leak, especially in extraperitoneal anastomoses. In patients without a stoma who do not require abdominal reoperation for a contained pelvic leak, there are several treatment options, including laparoscopic diverting ileostomy combined with trans-anal anastomotic tube drainage, percutaneous drainage or recently developed endoscopic procedures, such as stent or clip placement or endoluminal vacuum-assisted therapy. We describe the current approaches to treat this complication, as well as the clinical tests necessary to diagnose and provide an effective therapy.
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Affiliation(s)
| | - Pietro Fransvea
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Cariati
- Department of Surgery, General Surgery Unit, "San Giovanni di Dio" Hospital, Crotone, Italy
| | - Neill James Adams
- Department of Health Sciences, Clinical Microbiology Unit, "Magna Grecia" University, Catanzaro, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Brisinda
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
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13
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Operative and Survival Outcomes of Robotic-Assisted Surgery for Colorectal Cancer in Elderly and Very Elderly Patients: A Study in a Tertiary Hospital in South Korea. JOURNAL OF ONCOLOGY 2022; 2022:7043380. [PMID: 35140787 PMCID: PMC8818427 DOI: 10.1155/2022/7043380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022]
Abstract
Materials and Methods Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75–80 years), middle-old (MO: 81–85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups. Results Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m2 (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups (p = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868–59.047, p = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875–0.992, p = 0.027) and CSS (HR of 0.928, 95% CI 0.861–0.999, p = 0.047) in elderly patients. Conclusion Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.
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14
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Maeda A, Takahashi H, Watanabe K, Yanagita T, Suzuki T, Nakai N, Maeda Y, Shiga K, Hirokawa T, Ogawa R, Hara M, Matsuo Y, Takiguchi S. The clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy. Asian J Endosc Surg 2022; 15:36-43. [PMID: 34145964 DOI: 10.1111/ases.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 05/29/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopic surgery has been performed in various fields, especially in the pelvic cavity. However, little is known about the utility of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy (RARP). We herein report the clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with RARP. METHODS We experienced five cases of robot-assisted laparoscopic rectal cancer surgery associated with RARP. One involved robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy for T4b rectal cancer, and one involved robot-assisted laparoscopic intersphincteric resection combined with RARP for synchronous rectal and prostate cancer. The remaining three involved robot-assisted laparoscopic low anterior resection (RaLAR) after RARP. For robot-assisted laparoscopic rectal cancer surgery, the da Vinci Xi surgical system was used. RESULTS We could perform planned robotic rectal cancer surgery in all cases. The median operation time was 529 min (373-793 min), and the median blood loss was 307 ml (32-1191 ml). No patients required any transfusion in the intra-operative or immediate peri-operative period. The circumferential resection margin was negative in all cases. There were no complications of grade ≥III according to the Clavien-Dindo classification and no conversions to conventional laparoscopic or open surgery. CONCLUSION Robot-assisted laparoscopic surgery associated with RARP is feasible in patients with rectal cancer. The long-term surgical outcomes remain to be further evaluated.
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Affiliation(s)
- Anri Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kaori Watanabe
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Yanagita
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Suzuki
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nozomu Nakai
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuzo Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuyoshi Shiga
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masayasu Hara
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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15
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Update on Robotic Total Mesorectal Excision for Rectal Cancer. J Pers Med 2021; 11:jpm11090900. [PMID: 34575677 PMCID: PMC8472541 DOI: 10.3390/jpm11090900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 12/16/2022] Open
Abstract
The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint.
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16
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Li C, Wang Q, Jiang KW. What is the best surgical procedure of transverse colon cancer? An evidence map and minireview. World J Gastrointest Oncol 2021; 13:391-399. [PMID: 34040700 PMCID: PMC8131907 DOI: 10.4251/wjgo.v13.i5.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/25/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancers comprise a large percentage of tumors worldwide, and transverse colon cancer (TCC) is defined as tumors located between hepatic and splenic flexures. Due to the anatomy and embryology complexity, and lack of large randomized controlled trials, it is a challenge to standardize TCC surgery. In this study, the current situation of transverse/extended colectomy, robotic/ laparoscopic/open surgery and complete mesocolic excision (CME) concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap. In summary, transverse colectomy challenges the dogma of traditional extended colectomy, with similar oncological and prognostic outcomes. Compared with conventional open resection, laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy. The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes. According to published studies, laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.
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Affiliation(s)
- Chen Li
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Quan Wang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Ke-Wei Jiang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China
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17
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Nasir I, Mureb A, Aliozo CC, Abunada MH, Parvaiz A. State of the art in robotic rectal surgery: marginal gains worth the pain? Updates Surg 2021; 73:1073-1079. [PMID: 33675509 DOI: 10.1007/s13304-020-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
After their first introduction in the 1990s to overcome the limitations of conventional laparoscopic surgery, especially in confined spaces such as the pelvis, telemanipulators (i.e., master-slave manipulators) have gained popularity and acceptance among gastrointestinal surgeons. These complex, interventional surgical devices use multiple technologies, such as 3-D advanced imaging, tremor reduction and 7-degree movement. Superior instrument dexterity, stable precise vision and accessibility to narrow confined spaces make these devices well suited for colorectal surgery. The drive for innovations in the field of surgical robotics will leverage novel robots driven by data, image integration, and artificial intelligence. However, if this vision is to be realized, lessons must be learned from the current literature and clinical trials. The feasibility and safety of robotic rectal surgery is now well established; increasing evidence suggests that when compared to laparoscopic rectal surgery, robotic approaches might offer superior peri-operative outcomes. Notably, the marginal gains achieved with the use of robotics in rectal cancer surgery are linked with structured training and standardization of operative techniques. With decreasing costs and wider availability of new systems, it is foreseeable that robotic surgical systems will be an integral part of colorectal practice.
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Affiliation(s)
- Irfan Nasir
- NHS Foundation Trust, Norfolk and Norwich University Hospital, Norwich, UK
| | - Amro Mureb
- NHS Foundation Trust, Poole Hospital, Long Fleet Road, Poole, BH15 2JB, Dorset, UK
| | - Chukwuebuka C Aliozo
- NHS Foundation Trust, Poole Hospital, Long Fleet Road, Poole, BH15 2JB, Dorset, UK
| | | | - Amjad Parvaiz
- NHS Foundation Trust, Poole Hospital, Long Fleet Road, Poole, BH15 2JB, Dorset, UK. .,University of Portsmouth, Portsmouth, UK.
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18
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Müller C, Laengle J, Riss S, Bergmann M, Bachleitner-Hofmann T. Surgical Complexity and Outcome During the Implementation Phase of a Robotic Colorectal Surgery Program-A Retrospective Cohort Study. Front Oncol 2021; 10:603216. [PMID: 33665163 PMCID: PMC7923881 DOI: 10.3389/fonc.2020.603216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Robotic surgery holds particular promise for complex oncologic colorectal resections, as it can overcome many limitations of the laparoscopic approach. However, similar to the situation in laparoscopic surgery, appropriate case selection (simple vs. complex) with respect to the actual robotic expertise of the team may be a critical determinant of outcome. The present study aimed to analyze the clinical outcome after robotic colorectal surgery over time based on the complexity of the surgical procedure. Methods All robotic colorectal resections (n = 85) performed at the Department of Surgery, Medical University of Vienna, between the beginning of the program in April 2015 until December 2019 were retrospectively analyzed. To compare surgical outcome over time, the cohort was divided into 2 time periods based on case sequence (period 1: patients 1–43, period 2: patients 44–85). Cases were assigned a complexity level (I-IV) according to the type of resection, severity of disease, sex and body mass index (BMI). Postoperative complications were classified using the Clavien-Dindo classification. Results In total, 47 rectal resections (55.3%), 22 partial colectomies (25.8%), 14 abdomino-perineal resections (16.5%) and 2 proctocolectomies (2.4%) were performed. Of these, 69.4% (n = 59) were oncologic cases. The overall rate of major complications (Clavien Dindo III-V) was 16.5%. Complex cases (complexity levels III and IV) were more often followed by major complications than cases with a low to medium complexity level (I and II; 25.0 vs. 5.4%, p = 0.016). Furthermore, the rate of major complications decreased over time from 25.6% (period 1) to 7.1% (period 2, p = 0.038). Of note, the drop in major complications was associated with a learning effect, which was particularly pronounced in complex cases as well as a reduction of case complexity from 67.5% to 45.2% in the second period (p = 0.039). Conclusions The risk of major complications after robotic colorectal surgery increases significantly with escalating case complexity (levels III and IV), particularly during the initial phase of a new colorectal robotic surgery program. Before robotic proficiency has been achieved, it is therefore advisable to limit robotic colorectal resection to cases with complexity levels I and II in order to keep major complication rates at a minimum.
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Affiliation(s)
- Catharina Müller
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Laengle
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Thomas Bachleitner-Hofmann
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
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Fleszar MG, Fortuna P, Zawadzki M, Hodurek P, Bednarz-Misa I, Witkiewicz W, Krzystek-Korpacka M. Sex, Type of Surgery, and Surgical Site Infections Are Associated with Perioperative Cortisol in Colorectal Cancer Patients. J Clin Med 2021; 10:jcm10040589. [PMID: 33557291 PMCID: PMC7914878 DOI: 10.3390/jcm10040589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
Excessive endocrine response to trauma negatively affects patients’ well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1β, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-α but did not correlate with changes in IL-6 or interferon (IFN)-γ at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient’s sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.
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Affiliation(s)
- Mariusz G. Fleszar
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.G.F.); (P.F.); (P.H.); (I.B.-M.)
| | - Paulina Fortuna
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.G.F.); (P.F.); (P.H.); (I.B.-M.)
| | - Marek Zawadzki
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland; (M.Z.); (W.W.)
- Department of Physiotherapy, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Paweł Hodurek
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.G.F.); (P.F.); (P.H.); (I.B.-M.)
| | - Iwona Bednarz-Misa
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.G.F.); (P.F.); (P.H.); (I.B.-M.)
| | - Wojciech Witkiewicz
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland; (M.Z.); (W.W.)
- Research and Development Centre at Regional Specialist Hospital, 51-124 Wroclaw, Poland
| | - Małgorzata Krzystek-Korpacka
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland; (M.G.F.); (P.F.); (P.H.); (I.B.-M.)
- Correspondence: ; Tel.: +48-71-784-1375
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Hargest R. Five thousand years of minimal access surgery: 1990-present: organisational issues and the rise of the robots. J R Soc Med 2021; 114:69-76. [PMID: 33135951 PMCID: PMC7879007 DOI: 10.1177/0141076820967907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/01/2020] [Indexed: 11/15/2022] Open
Abstract
The last 30 years have seen a revolution in the provision of minimal access surgery for many conditions, and technological advances are increasing exponentially. Many instruments are superseded by improved versions before the NHS and publicly funded health services can offer widespread coverage. Although we tend to think of minimal access surgery as a modern concept, Parts I and II of this series have shown that there is a 5000-year history to this specialty and our predecessors laid down many principles which still apply today. During the 19th and early 20th centuries, minimal access surgery was driven forward by visionary individuals, often in the face of opposition from colleagues and the medical establishment. However, in the last 30 years, innovation has been driven more in partnerships between healthcare, scientific, financial, educational and charitable organisations. There are far too many individuals involved to detail every contribution here, but this third part of the series will concentrate on some of the important themes in the development of minimal access surgery to its current status.
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Affiliation(s)
- Rachel Hargest
- Cardiff China Medical Research Collaborative, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN, UK
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21
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Panteleimonitis S, Miskovic D, Bissett-Amess R, Figueiredo N, Turina M, Spinoglio G, Heald RJ, Parvaiz A. Short-term clinical outcomes of a European training programme for robotic colorectal surgery. Surg Endosc 2020; 35:6796-6806. [PMID: 33289055 PMCID: PMC8599412 DOI: 10.1007/s00464-020-08184-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery-EARCS). METHODS Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. RESULTS Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. CONCLUSIONS Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.
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Affiliation(s)
- Sofoklis Panteleimonitis
- School of Health and Care Professions, University of Portsmouth, St Andrews Court, St Michael's Road, Portsmouth, PO1 2PR, UK
| | | | | | - Nuno Figueiredo
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Matthias Turina
- Division of Colorectal Surgery and Proctology, University of Zurich Hospital, Moussonstrasse 2, 8044, Zurich, Switzerland
| | | | - Richard J Heald
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal.,Pelican Cancer Foundation, Dinwoodie Dr, Basingstoke, RG24 9NN, UK
| | - Amjad Parvaiz
- School of Health and Care Professions, University of Portsmouth, St Andrews Court, St Michael's Road, Portsmouth, PO1 2PR, UK. .,Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal. .,Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK.
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22
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Ye SP, Zhu WQ, Liu DN, Lei X, Jiang QG, Hu HM, Tang B, He PH, Gao GM, Tang HC, Shi J, Li TY. Robotic- vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: Short-term outcomes at a colorectal center in China. World J Gastrointest Oncol 2020; 12:424-434. [PMID: 32368320 PMCID: PMC7191331 DOI: 10.4251/wjgo.v12.i4.424] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/28/2019] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reports in the field of robotic surgery for rectal cancer are increasing year by year. However, most of these studies enroll patients at a relatively early stage and have small sample sizes. In fact, studies only on patients with locally advanced rectal cancer (LARC) and with relatively large sample sizes are lacking.
AIM To investigate whether the short-term outcomes differed between robotic-assisted proctectomy (RAP) and laparoscopic-assisted proctectomy (LAP) for LARC.
METHODS The clinicopathological data of patients with LARC who underwent robotic- or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively. To reduce patient selection bias, we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching (PSM) analysis. Short-term outcomes were compared between the two groups.
RESULTS The clinical features were well matched in the PSM cohort. Compared with the LAP group, the RAP group had less intraoperative blood loss, lower volume of pelvic cavity drainage, less time to remove the pelvic drainage tube and urinary catheter, longer distal resection margin and lower rates of conversion (P < 0.05). However, the time to recover bowel function, the harvested lymph nodes, the postoperative length of hospital stay, and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups (P > 0.05). The rates of total complications and all individual complications were similar between the RAP and LAP groups (P > 0.05).
CONCLUSION This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP, but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.
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Affiliation(s)
- Shan-Ping Ye
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei-Quan Zhu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Dong-Ning Liu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiong Lei
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qun-Guang Jiang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hui-Min Hu
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Bo Tang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Peng-Hui He
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Geng-Mei Gao
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - He-Chun Tang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jun Shi
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Robotic rectal cancer surgery: Results from a European multicentre case series of 240 resections and comparative analysis between cases performed with the da Vinci Si and Xi systems. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Teaching robotic rectal cancer surgery at your workplace: does the presence of visiting surgeons in the operating room have a detrimental effect on outcomes? Surg Endosc 2019; 34:3936-3943. [PMID: 31598879 DOI: 10.1007/s00464-019-07164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Surgery demonstration (SD) is considered to be a mainstay of surgical education, but controversy exists concerning the patient's safety. Indeed, the presence of visiting surgeons is a source of distraction and may have an impact on surgeon's performance. This study's objective was to evaluate possible differences in outcomes between robotic sphincter-saving rectal cancer surgery (RRCS) performed during routine surgical practice versus in the presence of visiting surgeons in the operating room (OR) with direct access to the surgeon. METHODS Retrospective case-matched studies were conducted from a prospectively collected database. 114 patients (38 with the presence of visiting surgeons) who underwent RRCS between January 2013 and September 2018 were included. Patients were matched in a 1:2 basis after propensity score analysis using five criteria: gender, body mass index, preoperative chemoradiation, type of mesorectum excision, and synchronous liver metastasis. RESULTS There was no difference between the two groups with regard to mean operating time, estimated blood loss, conversion, and hospital stay. Also, overall (44% vs. 40%; P = 0.6), major morbidity (26% vs. 19%; P = 0.5), and unplanned reoperation (17% vs. 15%; P = 1.0) rates were not statistically different. No difference was noted with regard to the quality of mesorectum excision, or positive rate of circumferential and distal longitudinal resection margins. The mean number of harvested lymph nodes (17 vs. 14.5; P = 0.04) was lower in the SD group and the number of patients with < 12 harvested lymph nodes (31% vs. 16%; P = 0.09) was greater after SD although it did not reach statistical significance. No differences were observed in disease-free or overall survival. CONCLUSIONS The presence of visiting surgeons in the OR seems not to interfere in the quality of rectal resection and does not compromise patient's short-term outcome and survival. However, mild differences in the extent of lymphadenectomy were observed and the surgeons performing SD may be aware of this.
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25
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Washington K, Watkins JR, Jay J, Jeyarajah DR. Oncologic Resection in Laparoscopic Versus Robotic Transhiatal Esophagectomy. JSLS 2019; 23:JSLS.2019.00017. [PMID: 31148912 PMCID: PMC6532833 DOI: 10.4293/jsls.2019.00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Objectives: As the use of robotic surgery continues to increase, little is known about robotic oncologic outcomes compared with traditional methods in esophagectomy. The aim of this study was to examine the perioperative oncologic outcomes of patients undergoing laparoscopic versus robot-assisted transhiatal esophagectomy (THE). Methods: Thirty-six consecutive patients who underwent laparoscopic and robot-assisted THE for malignant disease over a 3-year period were identified in a retrospective database. Eighteen patients underwent robotic-assisted THE with cervical anastomosis, and 18 patients underwent laparoscopic THE. All procedures were performed by a single foregut and thoracic surgeon. Results: Patient demographics were similar between the 2 groups with no significant differences. Lymph node yields for both laparoscopic and robot-assisted THE were similar at 13.9 and 14.3, respectively (P = .90). Ninety-four percent of each group underwent R0 margins, but only 1 patient from each modality had microscopic positive margins. All of the robot-assisted patients underwent neoadjuvant chemoradiation, whereas 83.3% underwent neoadjuvant therapy in the laparoscopy group (P = .23). Clinical and pathologic stagings were similar in each group. There was 1 death after laparoscopic surgery in a cirrhotic patient and no mortalities among the robot-assisted THE patients (P = .99). One patient from each group experienced an anastomotic leak, but neither patient required further intervention. Conclusions: Laparoscopic and robot-assisted THEs yield similar perioperative oncologic results including lymph node yield and margin status. In the transition from laparoscopic surgery, robotic surgery should be considered oncologically noninferior compared with laparoscopy.
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Affiliation(s)
| | | | - John Jay
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas
| | - D Rohan Jeyarajah
- Department of Surgery, Methodist Richardson Medical Center, Dallas, Texas
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26
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Hyde LZ, Baser O, Mehendale S, Guo D, Shah M, Kiran RP. Impact of surgical approach on short-term oncological outcomes and recovery following low anterior resection for rectal cancer. Colorectal Dis 2019; 21:932-942. [PMID: 31062521 DOI: 10.1111/codi.14677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
AIM The aim was to evaluate the influence of operative approach for low anterior resection (LAR) on oncological and postoperative outcomes. Minimally invasive surgical approaches are increasingly used for the treatment of rectal cancer with mixed outcomes. METHOD We compared patients undergoing LAR in the National Cancer Database between 2010 and 2015 by surgical approach. Multivariable regression was used to identify risk factors associated with conversion rate, prolonged length of stay (LOS) and 30-day unplanned readmission. RESULTS During the study period, 41 282 patients underwent LAR: 6035 robotic-assisted (RLAR) (14.6%), 13 826 laparoscopic (LLAR) (33.5%) and 21 421 open (OLAR) (51.9%). In propensity score matched analysis, RLAR compared to LLAR was associated with shorter LOS (6.3 vs 6.8 days, P < 0.0001), lower risk of prolonged LOS (22.1% vs 25.6%, P < 0.0001) and lower rate of conversion to open (7.5% vs 14.95%, P < 0.0001). Compared to OLAR, RLAR had shorter LOS (6.3 vs 7.8 days, P < 0.0001) and less prolonged LOS (14.1% vs. 20.9%, P < 0.0001). In multivariable analysis, for conversion to open, the laparoscopic approach was one of the risk factors; for prolonged LOS, conversion to open and non-robotic approaches (i.e. LLAR and OLAR) were risk factors; and for unplanned 30-day readmission, conversions and prolonged LOS were risk factors. CONCLUSIONS For patients with rectal cancer, RLAR shows recovery benefits over both open and laparoscopic LAR with reduced conversion to open compared with LLAR and less prolonged LOS compared with LLAR and OLAR. RLAR is associated with short-term oncological outcomes comparable to OLAR, supporting its use in minimally invasive surgery for rectal cancer.
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Affiliation(s)
- L Z Hyde
- Division of Colorectal Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York City, New York, USA
| | - O Baser
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York City, New York, USA
| | - S Mehendale
- Clinical Affairs, Intuitive Surgical, Sunnyvale, California, USA
| | - D Guo
- Clinical Affairs, Intuitive Surgical, Sunnyvale, California, USA
| | - M Shah
- Clinical Affairs, Intuitive Surgical, Sunnyvale, California, USA
| | - R P Kiran
- Division of Colorectal Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York City, New York, USA.,Center for Innovation and Outcomes Research, Columbia University Medical Center, New York City, New York, USA
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27
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Shah MF, Nasir IUI, Parvaiz A. Robotic Surgery for Colorectal Cancer. Visc Med 2019; 35:247-250. [PMID: 31602387 DOI: 10.1159/000500785] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 01/21/2023] Open
Abstract
Master-slave manipulators (otherwise known as telemanipulators) were introduced into minimally invasive surgery in the 1990s to overcome the limitations of laparoscopic surgery. This led to the development of the first robotic surgical systems which, over the last 10 years, have rapidly gained acceptance among colorectal surgeons. Advantages of robotic surgical systems such as superior instrumentation and field of vision enable precise dissection in confined spaces such as the pelvis, which make it a particularly attractive tool for rectal surgery. The feasibility and safety of robotic rectal surgery is now well established and there is increasing evidence that it might offer superior peri- and postoperative outcomes when compared to laparoscopic rectal surgery. Robotic rectal surgery is easier to learn than laparoscopic surgery and the creation of a structured training program for robotic rectal surgery in Europe has facilitated the learning of this technique in an environment that promotes patient safety and improved patient outcomes through equipment fidelity and operator skill. It is foreseeable that in the near future robotic systems will become part of routine surgical practice in colorectal surgery.
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Affiliation(s)
- Muhammad Fahd Shah
- Advanced Laparoscopy and Robotic Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - Irfan Ul Islam Nasir
- Advanced Laparoscopy and Robotic Surgery, Champalimaud Foundation, Lisbon, Portugal
| | - Amjad Parvaiz
- Surgery and Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom.,Minimal Access and Robotic Colorectal Surgery, Champalimaud Foundation, Lisbon, Portugal
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Panteleimonitis S, Pickering O, Abbas H, Harper M, Kandala N, Figueiredo N, Qureshi T, Parvaiz A. Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis 2018; 33:1079-1086. [PMID: 29577170 PMCID: PMC6060802 DOI: 10.1007/s00384-018-3030-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Laparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients. METHODS All consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined. RESULTS A total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033). CONCLUSIONS In this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.
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Affiliation(s)
- Sofoklis Panteleimonitis
- Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK.
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st road, Portsmouth, PO1 2FR, UK.
| | | | - Hassan Abbas
- Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK
| | - Mick Harper
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st road, Portsmouth, PO1 2FR, UK
| | - Ngianga Kandala
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st road, Portsmouth, PO1 2FR, UK
| | - Nuno Figueiredo
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Tahseen Qureshi
- Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK
- Bournemouth University School of Health and Social Care, Bournemouth, UK
| | - Amjad Parvaiz
- Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st road, Portsmouth, PO1 2FR, UK
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
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Panteleimonitis S, Popeskou S, Aradaib M, Harper M, Ahmed J, Ahmad M, Qureshi T, Figueiredo N, Parvaiz A. Implementation of robotic rectal surgery training programme: importance of standardisation and structured training. Langenbecks Arch Surg 2018; 403:749-760. [PMID: 29926187 PMCID: PMC6153605 DOI: 10.1007/s00423-018-1690-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
Abstract
Purpose A structured training programme is essential for the safe adoption of robotic rectal cancer surgery. The aim of this study is to describe the training pathway and short-term surgical outcomes of three surgeons in two centres (UK and Portugal) undertaking single-docking robotic rectal surgery with the da Vinci Xi and integrated table motion (ITM). Methods Prospectively, collected data for consecutive patients who underwent robotic rectal cancer resections with the da Vinci Xi and ITM between November 2015 and September 2017 was analysed. The short-term surgical outcomes of the first ten cases of each surgeon (supervised) were compared with the subsequent cases (independent). In addition, the Global Assessment Score (GAS) forms from the supervised cases were analysed and the GAS cumulative sum (CUSUM) charts constructed to investigate the training pathway of the participating surgeons. Results Data from 82 patients was analysed. There were no conversions to open, no anastomotic leaks and no 30-day mortality. Mean operation time was 288 min (SD 63), median estimated blood loss 20 (IQR 20–20) ml and median length of stay 5 (IQR 4–8) days. Thirty-day readmission and reoperation rates were 4% (n = 3) and 6% (n = 5) respectively. When comparing the supervised cases with the subsequent solo cases, there were no statistically significant changes in any of the short-term outcomes with the exception of mean operative time, which was significantly shorter in the independent cases (311 vs 275 min, p = 0.038). GAS form analysis and GAS CUSUM charting revealed that ten proctoring cases were enough for trainee surgeons to independently perform robotic rectal resections with the da Vinci Xi. Conclusions Our results show that by applying a structured training pathway and standardising the surgical technique, the single-docking procedure with the da Vinci Xi is a valid, reproducible technique that offers good short-term outcomes in our study population.
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Affiliation(s)
- Sofoklis Panteleimonitis
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK. .,School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK.
| | | | - Mohamed Aradaib
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK
| | - Mick Harper
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK
| | - Jamil Ahmed
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK
| | - Mukhtar Ahmad
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK
| | - Tahseen Qureshi
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK.,Bournemouth University School of Health and Social Care, Bournemouth, UK
| | - Nuno Figueiredo
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Amjad Parvaiz
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK.,School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK.,Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
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30
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Crolla RMPH, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 2018; 32:4562-4570. [DOI: 10.1007/s00464-018-6209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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Ackerman SJ, Daniel S, Baik R, Liu E, Mehendale S, Tackett S, Hellan M. Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery? J Med Econ 2018; 21:254-261. [PMID: 29065737 DOI: 10.1080/13696998.2017.1396994] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion. MATERIALS AND METHODS A US-based database study was conducted utilizing the 2012-2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample. RESULTS Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals. LIMITATIONS Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics. CONCLUSIONS Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.
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Affiliation(s)
| | | | - Rebecca Baik
- b Covance Market Access Services , Gaithersburg , MD , USA
| | - Emelline Liu
- c Health Economics and Outcomes Research, Intuitive Surgical , Sunnyvale , CA , USA
| | | | - Scott Tackett
- c Health Economics and Outcomes Research, Intuitive Surgical , Sunnyvale , CA , USA
| | - Minia Hellan
- e Surgical Oncology, Wright State University , Centerville , OH , USA
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Panteleimonitis S, Harper M, Hall S, Figueiredo N, Qureshi T, Parvaiz A. Precision in robotic rectal surgery using the da Vinci Xi system and integrated table motion, a technical note. J Robot Surg 2017; 12:433-436. [PMID: 28916892 PMCID: PMC6096689 DOI: 10.1007/s11701-017-0752-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 12/26/2022]
Abstract
Robotic rectal surgery is becoming increasingly more popular among colorectal surgeons. However, time spent on robotic platform docking, arm clashing and undocking of the platform during the procedure are factors that surgeons often find cumbersome and time consuming. The newest surgical platform, the da Vinci Xi, coupled with integrated table motion can help to overcome these problems. This technical note aims to describe a standardised operative technique of single docking robotic rectal surgery using the da Vinci Xi system and integrated table motion. A stepwise approach of the da Vinci docking process and surgical technique is described accompanied by an intra-operative video that demonstrates this technique. We also present data collected from a prospectively maintained database. 33 consecutive rectal cancer patients (24 male, 9 female) received robotic rectal surgery with the da Vinci Xi during the preparation of this technical note. 29 (88%) patients had anterior resections, and four (12%) had abdominoperineal excisions. There were no conversions, no anastomotic leaks and no mortality. Median operation time was 331 (249–372) min, blood loss 20 (20–45) mls and length of stay 6.5 (4–8) days. 30-day readmission rate and re-operation rates were 3% (n = 1). This standardised technique of single docking robotic rectal surgery with the da Vinci Xi is safe, feasible and reproducible. The technological advances of the new robotic system facilitate the totally robotic single docking approach.
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Affiliation(s)
- Sofoklis Panteleimonitis
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK.
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK.
| | - Mick Harper
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK
| | - Stuart Hall
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK
| | - Nuno Figueiredo
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Tahseen Qureshi
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK
- Bournemouth University School of Health and Social Care, Bournemouth, UK
| | - Amjad Parvaiz
- School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, PO1 2FR, UK
- Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
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Odermatt M, Ahmed J, Panteleimonitis S, Khan J, Parvaiz A. Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 2017; 31:4067-4076. [PMID: 28271267 DOI: 10.1007/s00464-017-5453-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The learning curve for robotic colorectal surgery is ill-defined. This study aimed to investigate the learning curve of experienced laparoscopic rectal surgeons when starting with robotic total mesorectal excision (TME) using cumulative sum (CUSUM) charts. METHODS This retrospective case series analysed patients who underwent curative and elective laparoscopic or robotic TMEs for rectal cancer performed by two surgeons. The first consecutive robotic TME cases of each surgeon were 1:1 propensity score matched to their laparoscopic TME cases using age, body mass index, American Society of Anesthesiologists grade, T stage (AJCC) and tumour location height. The matched laparoscopic cases defined individual standards for the quality indicators: operating time, R stage, lymph node harvest, length of hospital stay and major complications (Clavien-Dindo grade 3-5). Deviation of more than a quarter of a standard deviation from the mean for the continuous indicators, or exceeding the observed risk for the binary indicators was defined as off-target with an upward inflection in the CUSUM curve. RESULTS From 2006 to 2015, 384 (294 laparoscopic; 90 robotic) TMEs met the inclusion criteria. Surgeon A performed 206 (70.1%) of the laparoscopic and 43 (47.8%) of the robotic cases. Surgeon B performed 88 (29.9%) of the laparoscopic and 47 (52.2%) of the robotic cases. After matching, no covariate exhibited an absolute standardised mean difference >0.25. For surgeon A, the CUSUM curves showed no apparent learning process compared to his laparoscopic standards. For surgeon B, a learning process for operation time, lymph node harvest and major complications was demonstrated by an initial upward inflection of the CUSUM curves; after 15 cases, all quality indicators were generally on target. CONCLUSIONS For experienced laparoscopic colorectal surgeons, the formal learning process for robotic TME may be short to reach a similar performance level as obtained in conventional laparoscopy.
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Affiliation(s)
- Manfred Odermatt
- Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
| | - Jamil Ahmed
- Poole Hospital NHS Foundation Trust, Poole, UK
| | | | - Jim Khan
- Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - Amjad Parvaiz
- FRCS (Gen) FRCS, European Academy of Robotic Colorectal Surgery, Poole Hospital NHS Foundation Trust, Poole, UK.,Laparoscopic and Robotic Colorectal Surgery Champalimaud Foundation, Lisbon, Portugal
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Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients. Surg Endosc 2017; 31:4085-4091. [PMID: 28271268 DOI: 10.1007/s00464-017-5455-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Minimally invasive sphincter-saving rectal resection represents a challenging procedure. Robotic surgery for rectal cancer has several advantages over conventional surgery in performing precise dissection and was proved to be safe and effective in previous studies. However, comparison between laparoscopic and robotic rectal resection has drawn contradictory results. The aim of the present study was to compare robotic and laparoscopic sphincter-saving rectal resections for short-term and pathological outcomes. METHODS Between January 2013 and May 2016, we performed a total of 258 robotic surgeries, including 146 colorectal resections (56%). For this study, we included the first 65 sphincter-saving robotic resections and compared them to the last 65 consecutive laparoscopic resections. The laparoscopic group was constituted by the last 65 consecutively operated patients who matched the inclusion criteria. RESULTS Patients' baseline characteristics were similar in both the groups. Conversion rate was greater in the laparoscopic group (17 vs. 5%, p=0.044). Reoperation rate, overall and severe morbidity, and median hospital stay were similar in both the groups. Quality of mesorectal excision specimen was considered complete or near complete in 97 and 96% in the laparoscopic and robotic groups, respectively. There was no difference in the rates of negative circumferential radial margin, distal margin, and surgical success measured by composite criteria. CONCLUSION The main finding of this study was that robotic proctectomy for sphincter-saving procedures offers similar quality of TME with a statistically significant lower rate of conversion when compared to laparoscopic proctectomy.
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Holzmacher JL, Luka S, Aziz M, Amdur RL, Agarwal S, Obias V. The Use of Robotic and Laparoscopic Surgical Stapling Devices During Minimally Invasive Colon and Rectal Surgery: A Comparison. J Laparoendosc Adv Surg Tech A 2017; 27:151-155. [PMID: 27893300 DOI: 10.1089/lap.2016.0409] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jeremy L. Holzmacher
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Samuel Luka
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Madiha Aziz
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Richard L. Amdur
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Samir Agarwal
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Vincent Obias
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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[Initial experience in robot-assisted colorectal surgery in Mexico]. CIR CIR 2016; 85:284-291. [PMID: 27855992 DOI: 10.1016/j.circir.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. MATERIAL AND METHODS A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. RESULTS The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. CONCLUSION This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option.
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Gómez Ruiz M, Alonso Martin J, Cagigas Fernández C, Martín Parra J, Real Noval H, Martín Rivas B, Toledo Martínez E, Castillo Diego J, Gómez Fleitas M. Short- and mid-term outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Our experience after 198 consecutive cases. Eur J Surg Oncol 2016; 42:848-54. [DOI: 10.1016/j.ejso.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/31/2016] [Accepted: 03/08/2016] [Indexed: 12/31/2022] Open
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Karcz WK, von Braun W. Minimally Invasive Surgery for the Treatment of Colorectal Cancer. Visc Med 2016; 32:192-8. [PMID: 27493947 PMCID: PMC4945781 DOI: 10.1159/000445815] [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: 12/15/2022] Open
Abstract
BACKGROUND Reduction in operative trauma along with an improvement in endoscopic access has undoubtedly occupied surgical minds for at least the past 3 decades. It is not at all surprising that minimally invasive colon surgery has come a long way since the first laparoscopic appendectomy by Semm in 1981. It is common knowledge that the recent developments in video and robotic technologies have significantly furthered advancements in laparoscopic and minimally invasive surgery. This has led to the overall acceptance of the treatment of benign colorectal pathology via the endoscopic route. Malignant disease, however, is still primarily treated by conventional approaches. METHODS AND RESULTS This review article is based on a literature search pertaining to advances in minimally invasive colorectal surgery for the treatment of malignant pathology, as well as on personal experience in the field over the same period of time. Our search was limited to level I and II clinical papers only, according to the evidence-based medicine guidelines. We attempted to present our unbiased view on the subject relying only on the evidence available. CONCLUSION Focusing on advances in colorectal minimally invasive surgery, it has to be stated that there are still a number of unanswered questions regarding the surgical management of malignant diseases with this approach. These questions do not only relate to the area of boundaries set for the use of minimally invasive techniques in this field but also to the exact modality best suited to the treatment of every particular case whilst maintaining state-of-the-art oncological principles.
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Affiliation(s)
- W. Konrad Karcz
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany, Brisbane, Australia
| | - William von Braun
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany, Brisbane, Australia
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Kim JC, Yu CS, Lim SB, Park IJ, Kim CW, Yoon YS. Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients. Int J Colorectal Dis 2016; 31:1179-1187. [PMID: 27080161 DOI: 10.1007/s00384-016-2586-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Because there are few comparative studies of open, laparoscopy-assisted (LA), and robot-assisted (RA) total mesorectal excision (TME) for rectal cancer, we aimed to compare these three procedures in terms of sphincter-saving operation (SSO) achievement, surgical complications, and early oncological outcomes. METHODS The short-term outcomes of 2114 patients with rectal cancer consecutively enrolled between July 2010 and February 2015 at Asan Medical Center (Seoul, Korea) were retrospectively evaluated. Patients underwent either open, LA, or RA TME (n = 1095, 486, and 533, respectively) performed by experienced surgeons. RESULTS RA TME was a significant determinant of SSO in multivariate analysis that included potential variables such as tumor location and T4 category (odds ratio, 2.458; 95 % confidence interval, 1.497-4.036; p < 0.001). The cumulative rates of 3-year local recurrence, overall survival, and disease-free survival did not differ among the three groups: 2.5-3.4, 91.9-94.6, and 82.2-83.1 % (p = 0.85, 0.352, and 0.944, respectively). Early general surgical complications occurred more frequently in the open group than in the LA and RA groups (19.3 versus 13.0 versus 12.2 %, p < 0.001), specifically ileus and wound infection. CONCLUSIONS There were no significant differences in 3-year survival outcomes and local recurrence among open, LA, and RA TME. RA TME is useful for SSO achievement, regardless of advanced stage and location of rectal cancer. The open procedure had a slightly but significantly higher incidence of postoperative complications than LA and RA.
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Affiliation(s)
- Jin Cheon Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
- Institute of Innovative Cancer Research, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Chang Sik Yu
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Seok-Byung Lim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - In Ja Park
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Chan Wook Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Yong Sik Yoon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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de Jesus JP, Valadão M, de Castro Araujo RO, Cesar D, Linhares E, Iglesias AC. The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer. Eur J Surg Oncol 2016; 42:808-12. [PMID: 27038996 DOI: 10.1016/j.ejso.2016.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution. METHODS Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups. RESULTS CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p = 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0-2.7), 0.7 cm (0-2.0) and 0.6 cm (0-2.0) (p = 0.960). Overall mean LN harvest was 14 (0-56); 16 (0-52) in OTME, 13 (1-56) in LTME and 10 (0-45) in RTME (p = 0.156). CONCLUSION Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer.
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Affiliation(s)
- J P de Jesus
- Department of Abdominal and Pelvic Surgery, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - M Valadão
- Department of Abdominal and Pelvic Surgery, National Cancer Institute (INCA), Rio de Janeiro, Brazil.
| | - R O de Castro Araujo
- Department of Abdominal and Pelvic Surgery, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - D Cesar
- Department of Abdominal and Pelvic Surgery, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - E Linhares
- Department of Abdominal and Pelvic Surgery, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - A C Iglesias
- Department of General and Digestive Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Guerra F, Pesi B, Amore Bonapasta S, Perna F, Di Marino M, Annecchiarico M, Coratti A. Does robotics improve minimally invasive rectal surgery? Functional and oncological implications. J Dig Dis 2016; 17:88-94. [PMID: 26749061 DOI: 10.1111/1751-2980.12312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Robot-assisted surgery has been reported to be a safe and effective alternative to conventional laparoscopy for the treatment of rectal cancer in a minimally invasive manner. Nevertheless, substantial data concerning functional outcomes and long-term oncological adequacy is still lacking. We aimed to assess the current role of robotics in rectal surgery focusing on patients' functional and oncological outcomes. METHODS A comprehensive review was conducted to search articles published in English up to 11 September 2015 concerning functional and/or oncological outcomes of patients who received robot-assisted rectal surgery. All relevant papers were evaluated on functional implications such as postoperative sexual and urinary dysfunction and oncological outcomes. RESULTS Robotics showed a general trend towards lower rates of sexual and urinary postoperative dysfunction and earlier recovery compared with laparoscopy. The rates of 3-year local recurrence, disease-free survival and overall survival of robotic-assisted rectal surgery compared favourably with those of laparoscopy. CONCLUSIONS This study fails to provide solid evidence to draw definitive conclusions on whether robotic systems could be useful in ameliorating the outcomes of minimally invasive surgery for rectal cancer. However, the available data suggest potential advantages over conventional laparoscopy with reference to functional outcomes.
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Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Stefano Amore Bonapasta
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federico Perna
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
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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: 78] [Impact Index Per Article: 8.7] [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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Outcomes of Open, Laparoscopic, and Robotic Abdominoperineal Resections in Patients With Rectal Cancer. Dis Colon Rectum 2015; 58:1123-9. [PMID: 26544808 DOI: 10.1097/dcr.0000000000000475] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are limited available data comparing open, laparoscopic, and robotic approaches for rectal cancer surgery. OBJECTIVE We sought to investigate outcomes of different surgical approaches to abdominoperineal resection in patients with rectal cancer. DESIGN The nationwide inpatient sample database was used to examine the clinical data of patients with rectal cancer who underwent elective abdominoperineal resection between 2009 and 2012 in the United States. Multivariate regression analysis was performed to compare outcomes of different surgical approaches. SETTINGS A retrospective review according to the national inpatient sample database was designed. PATIENTS We included patients with rectal cancer who underwent elective abdominoperineal resection between 2009 and 2012. MAIN OUTCOME MEASURES Outcomes of different surgical approaches to abdominoperineal resection were investigated. RESULTS We sampled 18,359 patients with rectal cancer who underwent elective abdominoperineal resections. Of these, 69.5% had open surgery, 25.8% had laparoscopic surgery, and 4.7% had robotic surgery. The rate of robotic procedures increased >4-fold, from 2.1% to 8.1%, from 2009 to 2012. The conversion rate in robotic surgery was significantly lower compared with laparoscopic surgery (5.7% vs 13.4%; p < 0.01). After risk adjustment, patients who underwent laparoscopic and robotic approaches had lower morbidity risks compared with those who underwent the open approach (adjusted OR = 0.77 (95% CI, 0.65-0.92), 0.57 (95% CI, 0.40-0.80); p < 0. 01). There were no significant differences in the morbidity rate of patients who underwent laparoscopic or robotic approaches (adjusted OR = 0.79 (95% CI, 0.55-1.14); p = 0.21). However, patients who underwent the robotic approach had significantly higher total hospital charges compared with those who underwent the laparoscopic approach (mean difference, $24,890; p < 0.01). LIMITATIONS We could not adjust the results with some important factors, such as the tumor stage and BMI. CONCLUSIONS The use of robotic and laparoscopic approaches to abdominoperineal resection have increased between 2009 and 2012. Both minimally invasive approaches decrease morbidity rates of patients undergoing abdominoperineal resection. The robotic approach has a significantly lower conversion rate compared with the laparoscopic approach. However, it had significantly higher total hospital charges compared with the laparoscopic approach.
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de'Angelis N, Alghamdi S, Renda A, Azoulay D, Brunetti F. Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study. World J Surg Oncol 2015; 13:295. [PMID: 26452727 PMCID: PMC4598969 DOI: 10.1186/s12957-015-0708-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 09/22/2015] [Indexed: 01/10/2023] Open
Abstract
Background Robotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon’s psychological stress and physical pain. Methods The study population included the first 22 consecutive patients who underwent RC between March 2013 and December 2014 for histologically confirmed transverse colon adenocarcinoma. These patients were compared with 22 matched patients undergoing LC between December 2010 and February 2013. Patients were matched based on age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) score, American Joint Committee on Cancer (AJCC) tumor stage, and tumor location (ratio 1:1). Mortality, morbidity, operative, and short-term oncologic outcomes were compared between groups. The operating surgeon’s stress and pain were assessed before and after surgery on a 0–100-mm visual analog scale. Results The demographic and preoperative characteristics were comparable between RC and LC patients. No group difference was observed for intraoperative complications, blood loss, postoperative pain, time to flatus, time to regular diet, and hospital stay. RC was associated with longer operative time than LC (260 min vs. 225 min; p = 0.014), but the overall operative and robotic time in the RC group decreased over time reflecting the increasing experience in performing this procedure. No conversion to laparotomy was observed in the RC group, while two LC patients were converted due to uncontrolled bleeding and technically difficult middle colic pedicle dissection. Postoperative complications (Dindo-Clavien grade I or II) occurred in 11.3 % of patients with no group difference. Mortality was nil. All resections were R0, with >12 lymph nodes harvested in 90.9 % of RC and 95.5 % of LC patients. The surgeon’s stress was not different between RC and LC, whereas the surgeon’s hand and neck/shoulder pain were significantly lower after RC. Conclusions RC for transverse colon cancer appears to be safe and feasible with short-term outcomes comparable to LC.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
| | - Salah Alghamdi
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
| | - Andrea Renda
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80125, Naples, Italy.
| | - Daniel Azoulay
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
| | - Francesco Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK. A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 2015; 30:1576-84. [PMID: 26169638 DOI: 10.1007/s00464-015-4381-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Until randomized trials mature, large database analyses assist in determining the role of robotics in colorectal surgery. ACS NSQIP database coding now allows differentiation between laparoscopic (LC) and robotic (RC) colorectal procedures. The purpose of this study was to compare LC and RC outcomes by analyzing the ACS NSQIP database. METHODS The ACS NSQIP database was queried to identify patients who had undergone RC and LC during 2013. Demographic characteristics, intraoperative data, and postoperative outcomes were identified. Using propensity score matching, abdominal and pelvic colorectal operative and postoperative outcomes were analyzed. RESULTS A total of 11,477 cases were identified. In the abdomen, 7790 LC and 299 RC cases were identified, and 2057 LC and 331 RC cases were identified in the pelvis. There were significant differences in operative time, conversion to an open procedure in the pelvis, and hospital length of stay. RC operative times were significantly longer in both abdominal and pelvic cases. Conversion rates in the pelvis were less for RC when compared to LC--10.0 and 13.7%, respectively (p = 0.01). Hospital length of stay was significantly shorter for RC abdominal cases than for LC abdominal cases (4.3 vs. 5.3 days, p < 0.001) and for RC pelvic cases when compared to LC pelvic cases (4.5 vs. 5.3 days, p < 0.001). There were no significant differences in surgical site infection (SSI), organ/space SSI, wound complications, anastomotic leak, sepsis/shock, or need for reoperation within 30 days. CONCLUSION As the robotic platform continues to grow in colorectal surgery and as technical upgrades continue to advance, comparison of outcomes requires continuous reevaluation. This study demonstrated that robotic operations have longer operative times, decreased hospital length of stay, and decreased rates of conversion to open in the pelvis. These findings warrant continued evaluation of the role of minimally invasive technical upgrades in colorectal surgery.
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Affiliation(s)
- Anuradha R Bhama
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA.
| | - Vincent Obias
- Division Colon and Rectal Surgery, Department of Surgery, George Washington University, Washington, DC, 20037, USA
| | - Kathleen B Welch
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - James F Vandewarker
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
| | - Robert K Cleary
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
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Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ. National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 2015; 30:1060-7. [PMID: 26092020 DOI: 10.1007/s00464-015-4296-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/01/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Social and racial disparities have been identified as factors contributing to differences in access to care and oncologic outcomes in patients with colorectal cancer. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS), both laparoscopic and robotic, across different racial, socioeconomic and geographic populations of patients with rectal cancer. METHODS We utilized the American College of Surgeons National Cancer Database to identify patients with rectal cancer from 2004 to 2011 who had undergone definitive surgical procedures through either an open, laparoscopic or robotic approach. Inclusion criteria included only one malignancy and no adjuvant therapy. Multivariate analysis was performed to investigate differences in age, gender, race, income, education, insurance coverage, geographic setting and hospital type in relation to the surgical approach. RESULTS A total of 8633 patients were identified. The initial surgical approach included 46.5% open (4016), 50.9% laparoscopic (4393) and 2.6% robotic (224). In evaluating type of insurance coverage, patients with private insurance were most likely to undergo laparoscopic surgery [OR (odds ratio) 1.637, 95% CI 1.178-2.275], although there was a less statistically significant association with robotic surgery (OR 2.167, 95% CI 0.663-7.087). Patients who had incomes greater than $46,000 and received treatment at an academic center were more likely to undergo MIS (either laparoscopic or robotic). Race, education and geographic setting were not statistically significant characteristics for surgical approach in patients with rectal cancer. CONCLUSIONS Minimally invasive approaches for rectal cancer comprise approximately 53% of surgical procedures in patients not treated with adjuvant therapy. Robotics is associated with patients who have higher incomes and private insurance and undergo surgery in academic centers.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA.
| | - Pragatheeshwar Thirunavukarasu
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Eisar Al-Sukhni
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
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