• Hinotori
• Intracorporeal anastomosis
• Right colectomy
• Robotic surgery
• Surgical procedure

• artifical intelligence
• colon capsule endoscopy
• colorectal cancer
• computed tomographic colonography
• microsatellite instability

• Africa
• Colorectal cancer
• Laparoscopic
• Robotic

• Humans
• Colorectal Neoplasms/surgery
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Laparoscopy/adverse effects
• Robotic Surgical Procedures/statistics & numerical data
• Robotic Surgical Procedures/methods
• Length of Stay/statistics & numerical data
• Operative Time
• Blood Loss, Surgical/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Nigeria/epidemiology
• Africa/epidemiology
• Treatment Outcome
• Conversion to Open Surgery/statistics & numerical data

• accelerated recovery
• colorectal surgery
• enhanced recovery after surgery (eras)
• pain management
• postoperative care
• postoperative complications

• colorectal disease
• complications
• laparoscopic surgery
• postoperative outcomes
• robotic surgery

• Humans
• Colonic Diseases/surgery
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Length of Stay/statistics & numerical data
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Randomized Controlled Trials as Topic
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/statistics & numerical data
• Treatment Outcome

• complete mesocolic excision
• laparoscopic surgery
• right colon cancer
• robotic surgery

• Humans
• Colonic Neoplasms/surgery
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Robotic Surgical Procedures/methods
• Male
• Female
• Laparoscopy/methods
• Mesocolon/surgery
• Middle Aged
• Aged
• Survival Rate
• Colectomy/methods
• Retrospective Studies
• Treatment Outcome
• Propensity Score

• Colectomy
• Conversion
• Neoplasia

• Robotic Surgical Procedures/methods
• Humans
• Laparoscopy/methods
• Colectomy/methods
• Conversion to Open Surgery
• Female
• Male

• Cedars-Sinai Medical Center

• Laparoscopy
• Lateral lymph-node dissection
• Open surgery
• Rectal cancer
• Robot

• Humans
• Blood Loss, Surgical/statistics & numerical data
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Lymph Node Excision/methods
• Operative Time
• Postoperative Complications/epidemiology
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/methods
• Time Factors
• Treatment Outcome

• Humans
• Gastrointestinal Tract/surgery
• Anastomosis, Surgical/methods
• Minimally Invasive Surgical Procedures/methods
• Esophagectomy/methods
• Esophageal Neoplasms/surgery

• colectomy
• colorectal cancer
• laparoscopic surgery
• robotic surgery
• surgical outcomes

• Laparoscopic
• Long-term survival
• Meta-analysis
• Right colon cancer
• Robotic

• Humans
• Retrospective Studies
• Robotic Surgical Procedures
• Prospective Studies
• Treatment Outcome
• Laparoscopy
• Colonic Neoplasms/pathology
• Colectomy
• Multicenter Studies as Topic

• colectomy
• colon cancer
• laparoscopy
• minimally invasive surgical procedures
• robotics

• Colectomy
• Colon cancer
• Minimally invasive
• Robot-assisted colectomy
• Robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Robotics/methods
• Netherlands
• Colonic Neoplasms/surgery
• Rectum/surgery
• Colectomy/methods
• Laparoscopy/methods
• Retrospective Studies
• Treatment Outcome
• Postoperative Complications/surgery

• Colectomy
• Laparoscopic
• Minimally invasive
• Robotic

• Humans
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Length of Stay
• Patient Readmission
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Colectomy/adverse effects
• Colectomy/methods
• Postoperative Complications/epidemiology
• Treatment Outcome

• Colon cancer
• Diverticular disease
• Laparoscopy
• Left emicolectomy
• Robot
• Robot-assisted

• Humans
• Robotic Surgical Procedures/methods
• Propensity Score
• Laparoscopy/methods
• Colectomy/adverse effects
• Colectomy/methods
• Operative Time
• Length of Stay
• Retrospective Studies
• Treatment Outcome
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology

• Alma Mater Studiorum - Università di Bologna

• Colon cancer
• Colorectal cancer
• MIS
• RHC
• Robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Prospective Studies
• Treatment Outcome
• Robotics
• Colectomy/methods
• Colonic Neoplasms/surgery
• Colonic Neoplasms/pathology
• Laparoscopy/methods
• Retrospective Studies

• University of Geneva

• Colorectal cancer
• Colorectal surgery
• Laparoscopic
• Robotic

• Humans
• Robotic Surgical Procedures/adverse effects
• Propensity Score
• Retrospective Studies
• Laparoscopy/adverse effects
• Colorectal Neoplasms/surgery

• Eugene P. Frenkel, M.D. Scholar Award from the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern

• da vinci surgical system
• minimally invasive surgical procedures
• robot-enhanced surgery
• robotic-assisted surgery
• urology

• colonic cancer
• complete mesocolic excision
• laparoscopic surgery
• right hemicolectomy
• robotic surgery

• Colorectal surgery
• ERAS
• Enhanced recovery

• Humans
• Colon
• Digestive System Surgical Procedures
• Endoscopy
• Rectum
• Surgeons
• United States

• Humans
• United States
• Rectum
• Colon/surgery
• Digestive System Surgical Procedures
• Surgeons

• Groin hernia repair
• Minimally invasive repair
• Robotic hernia surgery
• Robotic surgery

• Hernia, Inguinal/surgery
• Herniorrhaphy/methods
• Humans
• Laparoscopy/methods
• Operative Time
• Robotic Surgical Procedures/methods

• Alma Mater Studiorum - Università di Bologna

• Colorectal surgery
• Laparoscopy
• Left colectomy
• Left hemicolectomy
• Robotic surgery

• Colectomy/adverse effects
• Colectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay
• Operative Time
• Postoperative Complications/etiology
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods

• Alma Mater Studiorum - Università di Bologna

• Completely robotic right hemicolectomy
• Intra-corporeal robotic-sewn anastomosis
• Robotic-sewn anastomosis

Right colectomy (RC) is a frequently performed procedure. Beneath standard conventional open surgery (COS), various minimally invasive techniques had been introduced. Several advantages had recently been described for robotic approaches over COS or conventional laparoscopy. Nevertheless, novel minimally invasive techniques require continuous benchmarking against standard COS to gain maximum patient safety. Bowel dysfunction is a frequent problem after RC. Together with general complication rates postoperative bowel recovery are used as surrogate parameters for postoperative patient outcome in this study.

Retrospective, 10-year single-center analysis of consecutive patients who underwent sequentially either COS (n = 22), robotic-assisted (ECA: n = 39), or total robotic surgery (ICA: n = 56) for oncologic RC was performed.

The conversion from robotic to open surgery rate was low (overall: 3.2%). Slightly longer duration of surgery had been observed during the early phase after introduction of the robotic program to RC (ECA versus COS, p = 0.044), but not anymore thereafter (versus ICA). No differences were observed in oncologic parameters including rates of tumor-negative margins, lymph node-positive patients, and lymph node yield during mesocolic excision. Both robotic approaches are beneficial regarding postoperative complication rates, especially wound infections, and shorter length of in-hospital stay compared with COS. The duration until first postoperative stool is the shortest after ICA (COS: 4 [2–8] days, ECA: 3 [1–6] days, ICA: 3 [1–5] days, p = 0.0004). Regression analyses reveal neither a longer duration of surgery nor the extent of mesocolic excision, but the degree of minimally invasiveness and postoperative systemic inflammation contribute to postoperative bowel dysfunction, which prolongs postoperative in-hospital stay significantly.

The current study reflects the institutional learning curve of oncologic RC during implementation of robotic surgery from robotic-assisted to total robotic approach without compromises in oncologic results and patient safety. However, the total robotic approach is beneficial regarding postoperative bowel recovery and general patient outcome.

• Bowel dysfunction
• Complete mesocolic excision
• Ileus
• Intracorporal anastomosis
• Right colectomy
• Robot

Ileal pouch anal anastomosis is the treatment of choice for patients with chronic ulcerative colitis and familial adenomatous polyposis undergoing a proctocolectomy and desiring bowel continuity. It is a technically complex operation associated with significant morbidity and may be performed by an open, laparoscopic, or robotic approach. However, there is a paucity of data regarding the comparative perioperative outcomes between these 3 techniques outside of institutional studies.

The NSQIP targeted proctectomy data set was used to identify patients who underwent open, laparoscopic, and robotic ileal pouch anal anastomosis between 2016 and 2019. Thirty-day outcomes between different surgical approaches were compared using univariate and multivariable analysis.

During the study period, 1,067 open, 971 laparoscopic, and 341 robotic ileal pouch anal anastomosis were performed. The most frequent indications were inflammatory bowel disease (64%), malignancy (18%), and familial adenomatous polyposis (7%). Mean age of the cohort was 43 ± 15 years with 43% female and 76% with body mass index ≤ 30 kg/m². Overall morbidity was 26.8% for the entire cohort with 4% anastomotic leak, 6% reoperation, 21% ileus, and 21% readmission rate. After adjusting for available confounders, operative approach was not associated with better short-term outcomes, including length of stay, overall morbidity, anastomotic leak, reoperation, incidence of ileus, and 30-day readmissions.

Ileal pouch anal anastomosis continues to be associated with significant postoperative morbidity regardless of operative approach. Patient-related advantages in terms of perioperative outcomes for laparoscopic and robotic platforms compared to open surgery are less pronounced in complex operations such as ileal pouch anal anastomosis.

•

Ileal anal pouch anastomosis is a technically complex operation associated with significant postoperative 30-day morbidity.

In recent years, robotic-assisted surgery has demonstrated remarkable progress as a minimally invasive procedure for colorectal cancer. While there have been fewer studies investigating robotic-assisted surgery for the treatment of colon cancer than rectal cancer, evidence regarding robotic-assisted colectomy has been accumulating due to increasing use of the procedure. Robotic-assisted colectomy generally requires a long operative time and involves high costs. However, as evidence is increasingly supportive of its higher accuracy and less invasive nature compared to laparoscopic colectomy, the procedure is anticipated to improve the ratio of conversion to laparotomy and accelerate postoperative recovery. Robotic-assisted surgery has also been suggested for a specific level of effectiveness in manipulative procedures, such as intracorporeal anastomosis, and is increasingly indicated as a less problematic procedure compared to conventional laparoscopy and open surgery in terms of long-term oncological outcomes. Although robotic-assisted colectomy has been widely adopted abroad, only a limited number of institutions have been using this procedure in Japan. Further accumulation of experience and studies investigating surgical outcomes using this approach are required in Japan.

• costs
• laparoscopic surgery
• long-term outcome
• right colectomy
• robotic surgery
• short-term outcome

Postoperative ileus (POI) has long been a challenging clinical problem for both patients and healthcare physicians alike. Although a standardized definition does not exist, it generally includes symptoms of intolerance to diet, lack of passing stool, abdominal distension, or flatus. Not only does prolonged POI increase patient discomfort and morbidity, but it is possibly the single most important factor that results in prolongation of the length of hospital stay with a significant deleterious effect on healthcare costs in surgical patients. Determining the exact pathogenesis of POI is difficult to achieve; however, it can be conceptually divided into patient-related and operative factors, which can further be broadly classified as neurogenic, inflammatory, hormonal, and pharmacological mechanisms.

Different strategies have been introduced aimed at improving the quality of perioperative care by reducing perioperative morbidity and length of stay, which include Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical approaches, and the use of specific pharmaceutical therapies. Recent studies have shown that the ERAS pathway and laparoscopic approach are generally effective in reducing patient morbidity with early return of gut function. Out of many studies on pharmacological agents over the recent years, alvimopan has shown the most promising results. However, due to its potential complications and cost, its clinical use is limited. Therefore, this article aimed to review the pathophysiology of POI and explore recent advances in treatment modalities and prevention of postoperative ileus.

• abdominal adhesions
• conversion
• laparoscopic surgery
• robotic surgery

Robot-assisted surgery is increasingly adopted in colorectal surgery. However, evidence for the implementation of robot-assisted surgery for colon cancer is sparse. This study aims to evaluate the short-term outcomes of robot-assisted colon surgery (RCS) for cancer compared to laparoscopic colon surgery (LCS).

Embase, MEDLINE, and Cochrane Library were searched between January 1, 2005 and October 2, 2020. Randomized clinical trials and observational studies were included. Non-original literature was excluded. Primary endpoints were anastomotic leakage rate, conversion to open surgery, operative time, and length of hospital stay. Secondary endpoints were surgical efficacy and postoperative morbidity. We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I², and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE.

Twenty studies enrolling 13,799 patients (RCS 1740 (12.6%) and LCS 12,059 (87.4%) were included in the meta-analysis that demonstrated RCS was superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD =  − 0.29, 95% CI [− 0.56, 0.02]). LCS proved to have a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]). Level of evidence was very low according to GRADE.

RCS showed advantages in colonic cancer surgery regarding surgical efficacy and morbidity compared to LCS despite a predominant inclusion of non-RCT with serious risk of bias assessment and a very low level of evidence.

The online version contains supplementary material available at 10.1007/s00464-021-08782-7.

• Colon cancer
• Laparoscopy
• Minimally invasive surgery
• Robot-assisted surgery

Robot-assisted surgery is being increasingly adopted in treating colorectal cancer, and the transition from laparoscopic surgery to robot-assisted surgery is a trend. The evidence of the benefits of robot-assisted surgery is sparse. However, findings are associated with improved patient-related outcomes and overall morbidity rates compared to laparoscopic surgery. This induction is unclear, considering both surgical modalities are characterized as minimally invasive. This study aims to evaluate the systemic and peritoneal inflammatory stress response induced by robot-assisted surgery compared with laparoscopic surgery for elective colon cancer resections in a prospective, randomized controlled clinical trial.

This study is a single-centre randomized controlled superiority trial with 50 colon cancer participants. The primary endpoint is the level of systemic inflammatory response expressed as serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels between postoperative days one and three. Secondary endpoints include (i) levels of systemic inflammation in serum expressed by a panel of inflammatory and pro-inflammatory cytokines measured during the first three postoperative days, (ii) postoperative surgical and medical complications (30 days) according to Clavien-Dindo classification and Comprehensive Complication Index, (iii) intraoperative blood loss, (iv) conversion rate to open surgery, (v) length of surgery, (vi) operative time, (vii) the number of harvested lymph nodes, and (viii) length of hospital stay. The exploratory endpoints are (i) levels of peritoneal inflammatory response in peritoneal fluid expressed by inflammatory and pro-inflammatory cytokines between postoperative day one and three, (ii) patient-reported health-related quality of recovery-15 (QoR-15), (iii) 30 days mortality rate, (iv) heart rate variability and (v) gene transcript (mRNA) analysis.

To our knowledge, this is the first clinical randomized controlled trial to clarify the inflammatory stress response induced by robot-assisted or laparoscopic surgery for colon cancer resections.

Trial registration This trial is registered at Clinicaltrials.gov (Identifier: NCT04687384) on December, 29, 2020, Regional committee on health research ethics, Region of Southern Denmark (N75709) and Data Protection Agency, Hospital Sønderjylland, University Hospital of Southern Denmark (N20/46179).

The online version contains supplementary material available at 10.1186/s12893-021-01355-4.

• Colon cancer
• Inflammatory surgical stress response
• Laparoscopic surgery
• Minimally invasive surgery
• Robot-assisted surgery

• Colorectal cancer
• Laparoscopic surgery
• Nationwide
• Propensity score matching
• Right colectomy
• Robotic surgery

• Cohort Studies
• Colectomy
• Colonic Neoplasms/surgery
• Humans
• Laparoscopy
• Operative Time
• Postoperative Complications/etiology
• Retrospective Studies
• Robotic Surgical Procedures/adverse effects
• Treatment Outcome

Colonic leiomyomas are rare. Their clinical presentation ranges from asymptomatic polyps detected on endoscopy to large symptomatic abdominopelvic masses. Imaging findings are usually non-specific, and percutaneous biopsy might help with differential diagnosis. However, radical surgery with negative margins is ultimately needed to rule out malignancy. We describe an uncommon presentation of a colonic leiomyoma mimicking a right hepatic lobe tumor on preoperative imaging. The robotic approach allowed a precise abdominal exploration with confirmation of colonic and hepatic infiltration and subsequent oncological en-block resection. Surgeons operating on hepatic tumors close to the right colic flexure should be aware of this diagnosis.

In recent years, the incidence of gastrointestinal cancer has remained high. Currently, surgical resection is still the most effective method for treating gastrointestinal cancer. Traditionally, radical surgery depends on open surgery. However, traditional open surgery inflicts great trauma and is associated with a slow recovery. Minimally invasive surgery, which aims to reduce postoperative complications and accelerate postoperative recovery, has been rapidly developed in the last two decades; it is increasingly used in the field of gastrointestinal surgery and widely used in early-stage gastrointestinal cancer. Nevertheless, many operations for gastrointestinal cancer treatment are still performed by open surgery. One reason for this may be the challenges of minimally invasive technology, especially when operating in narrow spaces, such as within the pelvis or near the upper edge of the pancreas. Moreover, some of the current literature has questioned oncologic outcomes after minimally invasive surgery for gastrointestinal cancer. Overall, the current evidence suggests that minimally invasive techniques are safe and feasible in gastrointestinal cancer surgery, but most of the studies published in this field are retrospective studies and case-matched studies. Large-scale randomized prospective studies are needed to further support the application of minimally invasive surgery. In this review, we summarize several common minimally invasive methods used to treat gastrointestinal cancer and discuss the advances in the minimally invasive treatment of gastrointestinal cancer in detail.

• Gastrointestinal neoplasms
• Laparoscopy
• Minimally invasive surgical procedures
• Robotic surgical procedures
• Therapeutics

• Colon cancer
• Intracorporeal anastomosis
• Laparoscopic surgery
• Right colectomy
• Robotic surgery

• Crohn’s disease
• Extracorporeal
• Ileocolonic resection
• Intracorporeal
• Robotic

• Colectomy
• Costs and cost analysis
• Laparoscopy
• Patient outcome assessment
• Robotic surgical procedures

• Intra-corporeal anastomosis
• Right colectomy
• Robotic surgery
• da Vinci

• Anastomosis, Surgical
• Colectomy
• Colic
• Humans
• Laparoscopy
• Robotic Surgical Procedures/adverse effects

• Università di Pisa

Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted.

We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response.

Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates.

Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.

• Colorectal cancer
• Laparoscopic colorectal surgery
• Minimally invasive surgery
• Postoperative inflammatory stress response
• Robot-assisted colorectal surgery
• Surgical oncology

• adhesiolysis
• adhesions
• conversions
• previous abdominal surgery
• robotic surgery

• Conversion to Open Surgery
• Humans
• Laparoscopy
• Postoperative Complications/etiology
• Robotic Surgical Procedures/adverse effects
• Tissue Adhesions/etiology
• Tissue Adhesions/surgery
• Treatment Outcome

• average treatment effect
• laparoscopy
• rectal cancer
• robotic rectal surgery
• robotic surgery

• Humans
• Laparoscopy
• Postoperative Complications
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures
• Treatment Outcome