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Birrer DL, Frehner M, Kitow J, Zoetzl KM, Rickenbacher A, Biedermann L, Turina M. Combining staged laparoscopic colectomy with robotic completion proctectomy and ileal pouch–anal anastomosis (IPAA) in ulcerative colitis for improved clinical and cosmetic outcomes: a single-center feasibility study and technical description. J Robot Surg 2022; 17:877-884. [DOI: 10.1007/s11701-022-01466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
AbstractRobotic proctectomy has been shown to lead to better functional outcomes compared to laparoscopic surgery in rectal cancer. However, in ulcerative colitis (UC), the potential value of robotic proctectomy has not yet been investigated, and in this indication, the operation needs to be adjusted to the total colectomy typically performed in the preceding 6 months. In this study, we describe the technique and analyze outcomes of a staged laparoscopic and robotic three-stage restorative proctocolectomy and compare the clinical outcome with the classical laparoscopic procedure. Between December 2016 and May 2021, 17 patients underwent robotic completion proctectomy (CP) with ileal pouch–anal anastomosis (IPAA) for UC. These patients were compared to 10 patients who underwent laparoscopic CP and IPAA, following laparoscopic total colectomy with end ileostomy 6 months prior by the same surgical team at our tertiary referral center. 27 patients underwent a 3-stage procedure for refractory UC (10 in the lap. group vs. 17 in the robot group). Return to normal bowel function and morbidity were comparable between the two groups. Median length of hospital stay was the same for the robotic proctectomy/IPAA group with 7 days [median; IQR (6–10)], compared to the laparoscopic stage II with 7.5 days [median; IQR (6.25–8)]. Median time to soft diet was 2 days [IQR (1–3)] vs. 3 days in the lap group [IQR 3 (3–4)]. Two patients suffered from a major complication (Clavien–Dindo ≥ 3a) in the first 90 postoperative days in the robotic group vs. one in the laparoscopic group. Perception of cosmetic results were favorable with 100% of patients reporting to be highly satisfied or satisfied in the robotic group. This report demonstrates the feasibility of a combined laparoscopic and robotic staged restorative proctocolectomy for UC, when compared with the traditional approach. Robotic pelvic dissection and a revised trocar placement in staged proctocolectomy with synergistic use of both surgical techniques with their individual advantages will likely improve overall long-term functional results, including an improved cosmetic outcome.
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A Comparative Analysis of Short-term Patient Outcomes After Laparoscopic Versus Robotic Rectal Surgery. Dis Colon Rectum 2022; 65:1274-1278. [PMID: 34907989 DOI: 10.1097/dcr.0000000000002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The popularity of robot-assisted colorectal surgery has risen over recent years; however, patient-related advantages over laparoscopic surgery remain uncertain. OBJECTIVE The goal of this study was to compare short-term patient outcomes following robotic and laparoscopic partial or complete rectal resections. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at 5 large tertiary care Kaiser Permanente medical centers across Southern California. PATIENTS There were 863 consecutive robotic and laparoscopic pelvic rectal surgeries, including low anterior resections, proctectomies with coloanal anastomosis, and abdominoperineal resections, performed between January 2010 and December 2019. MAIN OUTCOME MEASURES Short-term patient outcomes, including postoperative length of hospital stay, emergency department returns, and 30-day readmissions, and mortality. RESULTS A total of 458 surgical procedures were performed via robotic versus 405 via laparoscopic approaches. The robotic group had a higher proportion of male patients (57.4% vs 50.4%; p = 0.04) and a higher proportion of obese (27.1% vs 26.9%; p = 0.02) and overweight patients (36.9% vs 35.1%; p = 0.01). There was no difference in underlying comorbidities of diabetes or smoking, or in the rate of ileostomy creation. After adjusting for Charlson Comorbidity Index, no significant difference was found in emergency department returns between robotic and laparoscopic surgical patients ( p = 0.17). There were no significant outcome differences between the 2 groups with regards to length of stay during procedure, 30-day readmission, or death rates. LIMITATIONS This study was limited by the lack of randomization in its design, selection of patients for surgical approach, and training and familiarity with robotic rectal surgery. CONCLUSIONS This study shows length of stay during the procedure and postoperative 30-day readmission rates were generally similar between robotic and laparoscopic patients. Male patients and those with a higher BMI were more likely to have been operated via a robotic method. See Video Abstract at http://links.lww.com/DCR/B857 . UN ANLISIS COMPARATIVO DE LOS RESULTADOS A CORTO PLAZO DE LOS PACIENTES DESPUS DE LA CIRUGA RECTAL LAPAROSCPICA VERSUS LA ROBTICA ANTECEDENTES:La popularidad de la cirugía colorrectal asistida por robot ha aumentado en los últimos años. Sin embargo, las ventajas relacionadas con el paciente siguen siendo inciertas sobre la cirugía laparoscópica.OBJETIVO:Nuestro objetivo era comparar los resultados de los pacientes a corto plazo después de resecciones rectales completas o parciales robóticas y laparoscópicas.DISEÑO:Este fue un estudio de cohorte retrospectivo.AJUSTE:El estudio se llevó a cabo en cinco grandes centros médicos de Kaiser Permanente de atención terciaria en el sur de California.PACIENTES:Se realizaron 863 cirugías robóticas y laparoscópicas rectales pélvicas consecutivas, incluidas resecciones anteriores bajas, proctectomías con anastomosis coloanal y resecciones abdominoperineales, realizadas entre enero de 2010 y diciembre de 2019.PRINCIPALES MEDIDAS DE RESULTADO:Resultados de los pacientes a corto plazo, incluida la duración de la estancia hospitalaria después del procedimiento, los retornos al departamento de emergencias y los reingresos y la mortalidad a los 30 días.RESULTADOS:Se realizaron un total de 458 procedimientos quirúrgicos a través del robot versus 405 con laparoscopia. El grupo robótico tuvo una mayor proporción de pacientes masculinos (57,4 vs 50,4%, p = 0,04) y una mayor proporción de pacientes obesos (27,1 vs 26,9%, p = 0,02) y con sobrepeso (36,9 vs 35,1%, p = 0,01). No hubo diferencia en las comorbilidades subyacentes de la diabetes y el tabaquismo, y en la tasa de creación de ileostomía. Después de ajustar por el índice de comorbilidad de Charlson, no se encontraron diferencias significativas en los retornos al servicio de urgencias entre los pacientes robóticos y laparoscópicos ( p = 0,17). No hubo diferencias significativas en los resultados entre los dos grupos con respecto a la duración de la estadía durante el procedimiento, las tasas de readmisión a los 30 días y las tasas de muerte.LIMITACIONES:Falta de aleatorización en el diseño del estudio, selección de pacientes para abordaje quirúrgico, capacitación y familiaridad con la cirugía rectal robótica.CONCLUSIONES:Este estudio muestra la duración de la estadía durante el procedimiento y las tasas de reingreso a los 30 días después del procedimiento fueron generalmente similares entre los pacientes robóticos y laparoscópicos. Los pacientes masculinos y aquellos con un índice de masa corporal más alto tenían más probabilidades de haber sido operados mediante un método robótico. Consulte Video Resumen en http://links.lww.com/DCR/B857 . (Traducción-Dr Yolanda Colorado ).
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Angehrn FV, Schneider R, Wilhelm A, Daume D, Koechlin L, Fourie L, von Flüe M, Kern B, Steinemann DC, Bolli M. Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II-III locally advanced rectal cancer: a single-centre cohort study. J Robot Surg 2022; 16:1133-1141. [PMID: 35000106 DOI: 10.1007/s11701-021-01351-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
Neoadjuvant chemo-radiotherapy (nCRT) of locally advanced rectal cancer is associated with challenging surgical treatment and increased postoperative morbidity. Robotic technology overcomes laparoscopy limitations by enlarged 3D view, improved anatomical transection accuracy, and physiologic tremor reduction. Patients with UICC stage II-III rectal cancer, consecutively referred to our institution between March 2015 and June 2020 (n = 102) were treated with robotic (Rob-G, n = 38) or laparoscopic (Lap-G, n = 64) low anterior resection (LAR) for total meso-rectal excision (TME) following highly standardized and successful nCRT treatment. Feasibility, conversion rates, stoma creation, morbidity and clinical/pathological outcome were comparatively analysed. Sex, age, BMI, ASA scores, cTN stages and tumour distance from dentate line were comparable in the two groups. Robotic resection was always feasible without conversion to open surgery, which was necessary in 11/64 (17%) Lap-G operations (p = 0.006). Primary or secondary stomata were created in 17/38 (45%) Rob-G and 52/64 (81%) Lap-G patients (p < 0.001). Major morbidity occurred in 7/38 (18.4%) Rob-G and 6/64 (9.3%) Lap-G patients (p = 0.225). Although median operation time was longer in Rob-G compared with Lap-G (376; IQR: 330-417 min vs. 300; IQR: 270-358 min; p < 0.001), the difference was not significant in patients (Rob-G, n = 6; Lap-G, n = 10) with ≥30 BMI (p = 0.106). Number of resected lymph nodes, ypTN staging and circumferential resection margins (CRM) were comparable. Resection was complete in 87% of Rob-G and 89% of Lap-G patients (p = 0.750). Robotic LAR is not inferior to laparoscopic LAR following nCRT. Larger, randomized studies are needed to confirm lower conversion in robotic, compared to laparoscopic resection.
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Affiliation(s)
- Fiorenzo V Angehrn
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.
| | - Romano Schneider
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Alexander Wilhelm
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Diana Daume
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Luca Koechlin
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Lana Fourie
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Markus von Flüe
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Beatrice Kern
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Daniel C Steinemann
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Martin Bolli
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
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McKechnie T, Khamar J, Daniel R, Lee Y, Park L, Doumouras AG, Hong D, Bhandari M, Eskicioglu C. The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg 2022; 17:325-334. [PMID: 36127508 DOI: 10.1007/s11701-022-01455-0] [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: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
The Senhance Surgical System allows for infrared eye tracking, haptic feedback, and an adjustable upright seat allowing for improved ergonomics. This systematic review was designed with the aim of reviewing the current literature pertaining to the use of the Senhance Surgical System in colorectal surgery. Medline, EMBASE, and CENTRAL were searched. Articles were eligible for inclusion if they evaluated adults undergoing colorectal surgery with the Senhance Surgical System. The primary outcome was intraoperative efficacy; as defined by operative time, estimated blood loss (EBL), and conversion. A DerSimonian and Laird inverse variance random-effects meta-analysis was used to generate overall effect size estimates and narrative review was provided for each outcome. Six observational studies with 223 patients (mean age: 63.7, 41.2% female, mean BMI: 24.4 kg/m2) were included. The most common indication for surgery was colorectal cancer (n = 180, 80.7%) and the most common operation was anterior resection (n = 72, 32.3%). Meta-analyses demonstrated a pooled total operative time of 229.8 min (95% CI 189.3-270.4, I2 = 0%), console time of 141.3 min (95% CI 106.5-176.1, I2 = 0%), and docking time of 10.8 min (95% CI 6.4-15.2, I2 = 0%). The pooled EBL was 37.0 mL (95% CI 24.7-49.2, I2 = 20%). Overall, there were nine (4.0%) conversions to laparoscopy/laparotomy. The Senhance Surgical System has an acceptable safety profile, reasonable docking and console times, low conversion rates, and an affordable case cost across a variety of colorectal surgeries. Further prospective, comparative trials with other robotic surgical platforms are warranted.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jigish Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan Daniel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Mohit Bhandari
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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5
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Jung WB. Current status of robotic surgery for colorectal cancer: A review. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Won Beom Jung
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
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6
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Warps AK, Saraste D, Westerterp M, Detering R, Sjövall A, Martling A, Dekker JWT, Tollenaar RAEM, Matthiessen P, Tanis PJ. National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes. Surg Endosc 2022; 36:5986-6001. [PMID: 35258664 PMCID: PMC9283170 DOI: 10.1007/s00464-021-08974-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/31/2021] [Indexed: 12/24/2022]
Abstract
Background The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden. Methods Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012–2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012–2013 versus Sweden 2017–2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes. Results A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012–2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non-surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017–2018. Conclusion This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08974-1.
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Affiliation(s)
- A K Warps
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - D Saraste
- Department of Surgery, Södersjukhuset, 118 83, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden
| | - M Westerterp
- Department of Surgery, Haagland Medisch Centrum, Lijnbaan 32, 2512 VA, Den Haag, Netherlands
| | - R Detering
- Department of Surgery, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - A Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625 AD, Delft, Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - P Matthiessen
- Department of Surgery, Örebro University Hospital, von Rosens väg 1, 70185, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, 70182, Örebro, Sweden
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
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Darwich I, Abuassi M, Aliyev R, Scheidt M, Alkadri MA, Hees A, Demirel-Darwich S, Chand M, Willeke F. Early experience with the ARTISENTIAL ® articulated instruments in laparoscopic low anterior resection with TME. Tech Coloproctol 2022; 26:373-386. [PMID: 35141794 PMCID: PMC9018813 DOI: 10.1007/s10151-022-02588-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022]
Abstract
Background The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL®. Methods Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed. Results Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47–80 years) and a median body mass index of 28 kg/m2 (range 23–33 kg/m2). The median time to rectal transection was 155 min (range 118–280 min) and the median total operative time was 276 min (range 192–458 min). The median estimated blood loss was 30 ml (range 5–70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12–28). Total mesorectal excision (TME) quality was ‘good’ in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7–14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality. Conclusions Low anterior resection with ARTISENTIAL® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL® in comparison with standard laparoscopic instruments through a larger study. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02588-y.
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Affiliation(s)
- I Darwich
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany.
| | - M Abuassi
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - R Aliyev
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M Scheidt
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M A Alkadri
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - A Hees
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - S Demirel-Darwich
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7JN, UK
| | - F Willeke
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
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Keller DS, Jenkins CN. Safety with Innovation in Colon and Rectal Robotic Surgery. Clin Colon Rectal Surg 2021; 34:273-279. [PMID: 34504400 PMCID: PMC8416332 DOI: 10.1055/s-0041-1726352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Robotic colorectal surgery has been touted as a possible way to overcome the limitations of laparoscopic surgery and has shown promise in rectal resections, thus shifting traditional open surgeons to a minimally invasive approach. The safety, efficacy, and learning curve have been established for most colorectal applications. With this and a robust sales and marketing model, utilization of the robot for colorectal surgery continues to grow steadily. However, this disruptive technology still requires standards for training, privileging and credentialing, and safe implementation into clinical practice.
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Affiliation(s)
- Deborah S. Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento, California
| | - Christina N. Jenkins
- Division of Colorectal Surgery, Department of General and Trauma Surgery, Loma Linda University Medical Center, Loma Linda, California
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9
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Mitsala A, Tsalikidis C, Pitiakoudis M, Simopoulos C, Tsaroucha AK. Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era. ACTA ACUST UNITED AC 2021; 28:1581-1607. [PMID: 33922402 PMCID: PMC8161764 DOI: 10.3390/curroncol28030149] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
The development of artificial intelligence (AI) algorithms has permeated the medical field with great success. The widespread use of AI technology in diagnosing and treating several types of cancer, especially colorectal cancer (CRC), is now attracting substantial attention. CRC, which represents the third most commonly diagnosed malignancy in both men and women, is considered a leading cause of cancer-related deaths globally. Our review herein aims to provide in-depth knowledge and analysis of the AI applications in CRC screening, diagnosis, and treatment based on current literature. We also explore the role of recent advances in AI systems regarding medical diagnosis and therapy, with several promising results. CRC is a highly preventable disease, and AI-assisted techniques in routine screening represent a pivotal step in declining incidence rates of this malignancy. So far, computer-aided detection and characterization systems have been developed to increase the detection rate of adenomas. Furthermore, CRC treatment enters a new era with robotic surgery and novel computer-assisted drug delivery techniques. At the same time, healthcare is rapidly moving toward precision or personalized medicine. Machine learning models have the potential to contribute to individual-based cancer care and transform the future of medicine.
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Affiliation(s)
- Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
- Correspondence: ; Tel.: +30-6986423707
| | - Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Constantinos Simopoulos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece;
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Abstract
Abstract
Introduction Minimally invasive surgery has revolutionized surgical management in the treatment of colorectal neoplasms, reducing morbidity and mortality, hospitalization, inactivity time and minimizing cost, as well as providing adequate oncological results when compared to the conventional approach. Robotic surgery, with Da Vinci Platform, emerges as a step ahead for its potentials. The objective of this article is to report the single institutional experience with the use of Da Vinci Platform in robotic colorectal surgeries performed at a reference center in oncological surgery in Brazil.
Materials and methods A retrospective cohort study was conducted based on the prospective database of patients from the institution submitted to robotic surgery for treatment of colorectal cancer from July 2012 to September 2017. Clinical and surgical variables were analyzed as predictors of morbidity and mortality.
Results A total of 117 patients underwent robotic surgery. The complications related to surgery occurred in 33 patients (28%), the most frequent being anastomotic fistula and surgical wound infection, which corresponded to 11% and 3%, respectively. Conversion rate was 1.7%. Median length of stay was 5 days. The only variable associated with increase of complications and death risk was BMI >30, with p-value of 0.038 and 0.027, respectively.
Conclusion Robotic surgery is safe and feasible for approaching colorectal cancer surgeries, presenting satisfactory results regarding length of hospital stay and rate of operative complications, as well as presenting a low rate of conversion. Obesity has been shown to be a risk factor for surgical complication in robotic colorectal surgery.
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Rompen IF, Scheiwiller A, Winiger A, Metzger J, Gass JM. Robotic-Assisted Laparoscopic Resection of Tailgut Cysts. JSLS 2021; 25:JSLS.2021.00035. [PMID: 34354334 PMCID: PMC8325480 DOI: 10.4293/jsls.2021.00035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Tailgut cysts are rare remnants of the embryological hindgut. Resections are difficult to perform due to the narrow and delicate presacral space where they are usually located. Many different approaches have been described, but to date, no studies have been performed concerning robotic assisted surgery for this entity. Therefore, we conducted a retrospective analysis to evaluate the feasibility and outcome parameters of the robotic anterior approach for resection of tailgut cysts and to compare our results with available literature. Material and Methods: Data was retrospectively obtained from hospital records of all patients who underwent robotic assisted resection of tailgut cysts between January 1, 2017 and June 30, 2020. Outcomes include baseline characteristics, pre-operative radiological workup, operative time, intra- and postoperative complications, and histopathological results. Results: Between January 1, 2017 and June 30, 2020, five patients underwent robotic resection of tailgut cysts. All patients were female and mean age was 47.2 years (range 31.6–63.1 years). Only one patient reported to have local symptoms that could be attributed to the tailgut cyst. Median tumor size was 42 mm (range 30–64 mm). There was no conversion and median operating time was 235 minutes (range 184–331 minutes). Four patients had additional procedures. Intra- and postoperative complications included one intra-operative injury of the rectal wall, which was immediately oversewn, and one postoperative presacral hematoseroma with mild neurological symptoms. None of the specimens showed signs of malignant transformation in histopathological workup. Conclusion: This retrospective analysis shows that robotic resections of tailgut cysts are feasible and safe. Regarding the localization of tailgut cysts in the presacral space, the robotic assisted anterior approach is excellently suited, especially if the cysts are localized above the levator muscle. Longer operative times and higher material costs are outweighed by precise and safe preparation with a robotic platform in this delicate region and confined space. We recommend the robotic assisted anterior approach for the resection of tailgut cysts and retrorectal lesions in general.
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Affiliation(s)
- Ingmar F Rompen
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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12
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Noh GT, Han M, Hur H, Baik SH, Lee KY, Kim NK, Min BS. Impact of laparoscopic surgical experience on the learning curve of robotic rectal cancer surgery. Surg Endosc 2020; 35:5583-5592. [PMID: 33030590 DOI: 10.1007/s00464-020-08059-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Robotic surgery has advantages in terms of the ergonomic design and expectations of shortening the learning curve, which may reduce the number of patients with adverse outcomes during a surgeon's learning period. We investigated the differences in the learning curves of robotic surgery and clinical outcomes for rectal cancer among surgeons with differences in their experiences of laparoscopic rectal cancer surgery. METHODS Patients who underwent robotic surgery for colorectal cancer were reviewed retrospectively. Patients were divided into five groups by surgeons, and their clinical outcomes were analyzed. The learning curve of each surgeon with different volumes of laparoscopic experience was analyzed using the cumulative sum technique (CUSUM) for operation times, surgical failure (open conversion or anastomosis-related complications), and local failure (positive resection margins or local recurrence within 1 year). RESULTS A total of 662 patients who underwent robotic low anterior resection (LAR) for rectal cancer were included in the analysis. Number of laparoscopic LAR cases performed by surgeon A, B, C, D, and E prior to their first case of robotic surgery were 403, 40, 15, 5, and 0 cases, respectively. Based on CUSUM for operation time, surgeon A, B, C, D, and E's learning curve periods were 110, 39, 114, 55, and 23 cases, respectively. There were no significant differences in the surgical and oncological outcomes after robotic LAR among the surgeons. CONCLUSIONS This study demonstrated the limited impact of laparoscopic surgical experience on the learning curve of robotic rectal cancer surgery, which was greater than previously reported curves.
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Affiliation(s)
- Gyoung Tae Noh
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myunghyun Han
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. .,Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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13
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Concors SJ, Murken DR, Hernandez PT, Mahmoud NN, Paulson EC. The volume-outcome relationship in robotic protectectomy: does center volume matter? Results of a national cohort study. Surg Endosc 2020; 34:4472-4480. [PMID: 31637603 DOI: 10.1007/s00464-019-07227-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/04/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Utilization of robotic proctectomy (RP) for rectal cancer has steadily increased since the inception of robotic surgery in 2002. Randomized control trials evaluating the safety of RP are in process to better understand the role of robotic assistance in proctectomy. This study aimed to characterize the trends in the use of RP for rectal cancer, and to compare oncologic outcomes with center-level RP volume. MATERIALS AND METHODS 8107 patients with rectal adenocarcinoma who underwent RP were identified in the National Cancer Database (2010-2015). Logistic regression was used to evaluate associations between center-level volume and conversion to open proctectomy, margin status, lymph node yield, 30- and 90-day post-operative mortality, and overall survival. RESULTS The utilization of RP increased from 2010 to 2015. On multivariate regression, lower center-level volume of RP was associated with significantly higher rates of conversion to open, positive margins, inadequate lymph node harvest (≥ 12), and lower overall survival. The present study was limited by its retrospective design and lack of information regarding disease-specific survival. CONCLUSIONS This series suggests a volume-outcome relationship association; patients who have robot-assisted proctectomies performed at low-volume centers are more likely to have poorer overall survival, positive margins, inadequate lymph node harvest, and require conversion to open surgery. While these data demonstrate the increased adoption of robot-assisted proctectomy, an understanding of the appropriateness of this intervention is still lacking. As with any new intervention, further information from ongoing randomized controlled trials is needed to better clarify the role of RP in order to optimize patient outcomes.
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Affiliation(s)
- Seth J Concors
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Douglas R Murken
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Paul T Hernandez
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Najjia N Mahmoud
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - E Carter Paulson
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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14
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Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital. J Robot Surg 2020; 15:135-142. [DOI: 10.1007/s11701-020-01087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
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15
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Wells LE, Smith B, Honaker MD. Rate of conversion to an open procedure is reduced in patients undergoing robotic colorectal surgery: A single-institution experience. J Minim Access Surg 2020; 16:229-234. [PMID: 31339114 PMCID: PMC7440010 DOI: 10.4103/jmas.jmas_318_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Robotic-assisted surgery is becoming increasingly used in colorectal operations. It has many advantages over laparoscopic surgery including three-dimensional viewing, motion scaling, improved dexterity and ergonomics as well as increased precision. However, there are also disadvantages to robotic surgery such as lack of tactile feedback, cost as well as limitations on multi-quadrant surgeries. The purpose of this study was to compare the rate of conversion to an open surgery in patients undergoing robotic-assisted colorectal surgery and traditional laparoscopic surgery. Methods Patients undergoing minimally invasive colorectal surgery for neoplastic and dysplastic disease from 2009 to 2016 were identified and examined retrospectively. The statistical software SAS, manufactured by SAS Institute, Cary, North Carolina. Continuous variables were analysed using analysis of variance test. Chi-square test was used to analyse categorical variables. P <0.05 was considered statistically significant. Results Two hundred and thirty-five patients were identified that underwent minimally invasive colorectal surgery. One hundred and sixty-four underwent laparoscopic resection and 71 underwent robotic-assisted resection. There was no statistical difference in gender or race between the two groups (both P > 0.05). Patients that underwent robotic-assisted resection were slightly younger than patients that underwent laparoscopic resection (61.6 years vs. 65.6 years; P= 0.02). When examining conversion to an open procedure, patients that underwent robotic-assisted resection had a significantly lower chance of conversion than did the patients undergoing a laparoscopic approach (11.27% vs. 29.78%; P= 0.0018). Conclusion Conversion rates from a minimally invasive procedure to an open procedure appear to be lower with robotic-assisted surgery compared to laparoscopic surgery.
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Affiliation(s)
- Leah Ellis Wells
- Department of Internal Medicine, Mercer University School of Medicine, Navicent Health, Macon, Georgia
| | - Betsy Smith
- Department of Internal Medicine, Mercer University School of Medicine, Navicent Health, Macon, Georgia
| | - Michael Drew Honaker
- Surgical Oncology and Colorectal Surgery, Mercer University School of Medicine, Navicent Health, Macon, Georgia
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16
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Ng KT, Tsia AKV, Chong VYL. Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. World J Surg 2019; 43:1146-1161. [PMID: 30610272 DOI: 10.1007/s00268-018-04896-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectal cancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectal cancer remain unclear in the literature. The primary aim of this review was to determine whether robotic-assisted laparoscopic surgery (RAS) has better clinical outcomes for colorectal cancer patients than conventional laparoscopic surgery (CLS). METHODS All randomized clinical trials (RCTs) and observational studies were systematically searched in the databases of CENTRAL, EMBASE and PubMed from their inception until January 2018. Case reports, case series and non-systematic reviews were excluded. RESULTS Seventy-three studies (6 RCTs and 67 observational studies) were eligible (n = 169,236) for inclusion in the data synthesis. In comparison with the CLS arm, RAS cohort was associated with a significant reduction in the incidence of conversion to open surgery (ρ < 0.001, I2 = 65%; REM: OR 0.40; 95% CI 0.30,0.53), all-cause mortality (ρ < 0.001, I2 = 7%; FEM: OR 0.48; 95% CI 0.36,0.64) and wound infection (ρ < 0.001, I2 = 0%; FEM: OR 1.24; 95% CI 1.11,1.39). Patients who received RAS had a significantly shorter duration of hospitalization (ρ < 0.001, I2 = 94%; REM: MD - 0.77; 95% CI 1.12, - 0.41; day), time to oral diet (ρ < 0.001, I2 = 60%; REM: MD - 0.43; 95% CI - 0.64, - 0.21; day) and lesser intraoperative blood loss (ρ = 0.01, I2 = 88%; REM: MD - 18.05; 95% CI - 32.24, - 3.85; ml). However, RAS cohort was noted to require a significant longer duration of operative time (ρ < 0.001, I2 = 93%; REM: MD 38.19; 95% CI 28.78,47.60; min). CONCLUSIONS This meta-analysis suggests that RAS provides better clinical outcomes for colorectal cancer patients as compared to the CLS at the expense of longer duration of operative time. However, the inconclusive trial sequential analysis and an overall low level of evidence in this review warrant future adequately powered RCTs to draw firm conclusion.
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Affiliation(s)
- Ka Ting Ng
- Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
| | - Azlan Kok Vui Tsia
- Department of Surgery, International Medical University, Bukit Jalil, 50603, Kuala Lumpur, Malaysia
| | - Vanessa Yu Ling Chong
- Department of Surgery, International Medical University, Bukit Jalil, 50603, Kuala Lumpur, Malaysia
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17
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Huang YJ, Kang YN, Huang YM, Wu ATH, Wang W, Wei PL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: An update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 2019; 42:657-666. [DOI: 10.1016/j.asjsur.2018.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/06/2018] [Accepted: 11/08/2018] [Indexed: 02/08/2023] Open
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18
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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: 6] [Impact Index Per Article: 1.2] [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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19
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Liu WH, Yan PJ, Hu DP, Jin PH, Lv YC, Liu R, Yang XF, Yang KH, Guo TK. Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study. Am Surg 2019. [DOI: 10.1177/000313481908500336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.
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Affiliation(s)
- Wen-Han Liu
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Pei-Jing Yan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China; and
| | - Dong-Ping Hu
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Peng-Hui Jin
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yao-Chun Lv
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Rong Liu
- The Second Department of Hepatobiliary surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiong-Fei Yang
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Ke-Hu Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Tian-Kang Guo
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
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20
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Sun XY, Xu L, Lu JY, Zhang GN. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. MINIM INVASIV THER 2019; 28:135-142. [PMID: 30688139 DOI: 10.1080/13645706.2018.1498358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this meta-analysis is to evaluate the evidence available on the safety as well as effectiveness of robotic resection as compared to conventional laparoscopic surgery for rectal cancer. MATERIAL AND METHODS A comparison of laparoscopic and robotic surgical treatments for rectal cancer was collected. Eligible trials that analyzed probabilistic hazard ratios (HR) for endpoints of interest (including perioperative morbidity) and postoperative complications were included in our review. RESULTS A total of six studies were included based on the present inclusion criteria. The pooled data showed that R-TME appeared to have association with remarkable reduction in the postoperative morbidity rate as compared to L-TME. Moreover, R-TME was also linked to lower conversion, decreased lymph node number, and longer operation time compared with L-TME. However, there was no difference in hospital stay, positive range of circumferential resection and blood loss between the two study groups. CONCLUSIONS Robotic rectal cancer surgery provides favorable outcomes and is considered as a safe surgical technique in terms of postoperative oncological safety. Like laparoscopic TME surgery, robotic surgery may be a valid alternative and complementary approach with beneficial effects on minimally-invasive surgery.
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Affiliation(s)
- Xi-Yu Sun
- a Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Lai Xu
- a Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jun-Yang Lu
- a Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Guan-Nan Zhang
- a Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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21
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Hoshino N, Sakamoto T, Hida K, Sakai Y. Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence. Surg Today 2019; 49:556-570. [DOI: 10.1007/s00595-019-1763-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
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22
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Phan K, Kahlaee HR, Kim SH, Toh JWT. Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol 2019; 23:221-230. [PMID: 30623315 DOI: 10.1007/s10151-018-1920-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. METHODS A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) RESULTS: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00-0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30-0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30-0.46). CONCLUSIONS Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
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Affiliation(s)
- K Phan
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia.,Division of Colorectal Surgery, Department of Surgery, Liverpool Hospital, Liverpool, Australia
| | - H R Kahlaee
- Department of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - S H Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - J W T Toh
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, NSW, Australia. .,The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia.
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23
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Jones K, Qassem MG, Sains P, Baig MK, Sajid MS. Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial. World J Gastrointest Oncol 2018; 10:449-464. [PMID: 30487956 PMCID: PMC6247103 DOI: 10.4251/wjgo.v10.i11.449] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).
METHODS Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
RESULTS One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.
CONCLUSION RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.
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Affiliation(s)
- Katie Jones
- Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom
| | - Mohamed G Qassem
- Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom
- Lecturer of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Parv Sains
- Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom
| | - Mirza K Baig
- Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, West Sussex BN11 2DH, United Kingdom
| | - Muhammad S Sajid
- Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom
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24
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Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, de Forges H, Colombo PE. Robotic Versus Laparoscopic Total Mesorectal Excision for Sphincter-Saving Surgery: Results of a Single-Center Series of 400 Consecutive Patients and Perspectives. Ann Surg Oncol 2018; 25:3572-3579. [PMID: 30171509 DOI: 10.1245/s10434-018-6738-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to compare robotic total mesorectal excision (R-TME) with laparoscopic TME (L-TME) in a series of consecutive rectal cancer patients. BACKGROUND R-TME and L-TME have drawn contradictory reports. A recent phase III trial (ROLARR) concluded that R-TME performed by surgeons with varying experience did not confer an advantage in rectal cancer resection. PATIENTS AND METHODS In this retrospective single-center cohort study (8/2008 to 4/2015), data were prospectively registered. A total of 200 L-TME and 200 R-TME were operated consecutively without selection. The primary outcome was the conversion rate to open laparotomy or transanal TME. The secondary endpoints were type of anastomosis, operative time, postoperative morbidity, circumferential radial (CRM) and distal margins, quality of life, bladder and sexual dysfunction, and oncological outcomes. RESULTS Baseline characteristics were well balanced. Type of anastomosis [colo-anal anastomosis (CAA) 40% vs 49%; p < 0.001], transanal TME (5% vs 13%; p = 0.005), and conversion rate (2% vs 9.5%; odd ratio (OR): 0.19 [95% confidence interval (CI): 0.05-0.60]) were significantly different. Intersphincteric resection (39% vs 47%), diverting stoma (66.5% vs 68%), CRM involvement, median operative time (243 vs 232 min), and R0 resection rate were similar. Conversion risk was lower for R-TME in male patients and those with small tumors (< 5 cm). The 3-year overall survival rate was 84.1% [77.3-88.9%] and 88.4% [82.9-92.2%] in the R-TME and L-TME group. No significant differences were reported in quality of life, and urinary or sexual function. CONCLUSIONS R-TME is less likely to be converted to open surgery than L-TME; operative time and curative pathologic criteria are equivalent. Future prospective trial should compare standardized procedures performed by experienced surgeons for subgroups of high-risk patients.
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Affiliation(s)
- Philippe Rouanet
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Martin Marie Bertrand
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Anne Mourregot
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Drissa Traore
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Christophe Taoum
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Hélène de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
| | - Pierre-Emmanuel Colombo
- Surgical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ Montpellier, Montpellier, France
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Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk Factors for Open Conversion in Minimally Invasive Cholecystectomy. JSLS 2018; 21:JSLS.2017.00062. [PMID: 29238153 PMCID: PMC5714218 DOI: 10.4293/jsls.2017.00062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Open conversion (OC) occurs in 5 to 10% of laparoscopic cholecystectomies (LCs) and results in suboptimal outcomes. Herein, we report our experience with OC in cholecystectomy performed with the minimally invasive (MIS) approach. Methods: Data from 960 minimally invasive cholecystectomies performed in the University of Illinois at Chicago (UIC) Division of General, Minimally Invasive, and Robotic Surgery were retrospectively compiled. Patient demographics and outcomes were analyzed for the major indicators that may predispose to OC. Results: Male gender and intraoperative diagnosis of acute or gangrenous cholecystitis were identified as statistically significant individual predictors for OC. Conversion incidence was significantly lower in every paired demographic combination when compared with the laparoscopic data. Conclusions: Our retrospective study identified some specific factors associated with significantly higher risk of OC in both laparoscopic and robotic cholecystectomy. The impact of these risk factors seems to be lesser in the robotic than in the laparoscopic approach. Further investigation is necessary to validate these findings.
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Affiliation(s)
- Antonio Gangemi
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard Danilkowicz
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Francesco Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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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: 1.8] [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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Holmer C, Kreis ME. Systematic review of robotic low anterior resection for rectal cancer. Surg Endosc 2017; 32:569-581. [DOI: 10.1007/s00464-017-5978-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/05/2017] [Indexed: 01/30/2023]
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Harsløf S, Stouge A, Thomassen N, Ravn S, Laurberg S, Iversen LH. Outcome one year after robot-assisted rectal cancer surgery: a consecutive cohort study. Int J Colorectal Dis 2017; 32:1749-1758. [PMID: 28803344 DOI: 10.1007/s00384-017-2880-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to investigate outcome after robot-assisted rectal cancer surgery (RARCS). We focused on conversion rate, postoperative complications, pathological evaluation (adequacy of resection margins), and bowel function (low anterior resection syndrome (LARS)) 1 year after surgery. METHODS An observational study of prospectively registered patients with data obtained from medical records. Data comprise the initial 208 rectal cancer patients operated with robot-assisted surgery at a single Danish university hospital from October 2011 to October 2014. RESULTS In total, 27 procedures (13%) were converted to open surgery, and 23 of the 27(85%) conversions were in the obese and overweight patients. The anastomotic leak rate was 12 (9%), and further 5 (2%) developed a complication requiring re-operation (ileus, bleeding, wound abscess). In total, 14 (7%) patients had a circumferential resection margin (CRM) ≤ 1 mm (R1-resection). In regard to bowel function, 15/22 (68%) of TME patients had major LARS at 6 months follow-up but at 12 months follow-up this proportion was reduced to 18/34 (53%). CONCLUSIONS The outcomes after RARCS at a single high-volume university center are overall comparable to outcomes reported from laparoscopic surgery. The results are satisfying because they are achieved during implementation of RARCS. Randomized trials are, however, needed and focus should especially be on long-term follow-up in regard to functional outcome.
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Affiliation(s)
- Sanne Harsløf
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - Anders Stouge
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Niels Thomassen
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Sissel Ravn
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Søren Laurberg
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Lene Hjerrild Iversen
- Surgical Department, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
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Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 2017; 318:1569-1580. [PMID: 29067426 PMCID: PMC5818805 DOI: 10.1001/jama.2017.7219] [Citation(s) in RCA: 775] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. OBJECTIVE To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. INTERVENTIONS Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). MAIN OUTCOMES AND MEASURES The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. RESULTS Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, -1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, -3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76]; P = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups. CONCLUSIONS AND RELEVANCE Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN80500123.
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Affiliation(s)
- David Jayne
- Department of Academic Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Helen Marshall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Joanne Copeland
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Phil Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Nick West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Tero Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | | | | | | | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2017; 32:24-38. [PMID: 28812154 DOI: 10.1007/s00464-017-5796-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 12/28/2022]
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Abstract
INTRODUCTION Robotic-assisted rectal cancer surgery offers multiple advantages for surgeons, and it seems to yield the same clinical outcomes as regards the short-time follow-up of patients compared to conventional laparoscopy. This surgical approach emerges as a technique aiming at overcoming the limitations posed by rectal cancer and other surgical fields of difficult access, in order to obtain better outcomes and a shorter learning curve. MATERIAL AND METHODS A systematic review of the literature of robot-assisted rectal surgery was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in October 2015 in PubMed, MEDLINE and the Cochrane Central Register of Controlled Trials, for articles published in the last 10 years and pertaining the learning curve of robotic surgery for colorectal cancer. It consisted of the following key words: "rectal cancer/learning curve/robotic-assisted laparoscopic surgery". RESULTS A total of 34 references were identified, but only 9 full texts specifically addressed the analysis of the learning curve in robot-assisted rectal cancer surgery, 7 were case series and 2 were non-randomised case-comparison series. Eight papers used the cumulative sum (CUSUM) method, and only one author divided the series into two groups to compare both. The mean number of cases for phase I of the learning curve was calculated to be 29.7 patients; phase II corresponds to a mean number 37.4 patients. The mean number of cases required for the surgeon to be classed as an expert in robotic surgery was calculated to be 39 patients. CONCLUSION Robotic advantages could have an impact on learning curve for rectal cancer and lower the number of cases that are necessary for rectal resections.
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Huang J, Zhang Z, Wang S. Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery. INT J ADV ROBOT SYST 2016. [DOI: 10.1177/1729881416664849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In order to compare the curative effect of the Da Vinci surgical system (DVSS) with laparoscopic surgery (LS) or open surgery for colorectal resection, literature search was conducted in PubMed, Excerpt Medica Database (Embase), and Cochrane library up to January 15, 2016. Odds ratio (OR) and weighted mean difference with their corresponding 95% confidence intervals were used as effect size for evaluation of different outcomes. In total, 10 studies consisting of 2767 patients were included for the meta-analysis. As a result, there were no significant differences between DVSS and LS/open surgery in the long-term oncologic outcomes ( p > 0.05). However, DVSS achieved a significantly lower length of hospital stay and estimated blood loss (EBL), but a longer operation time. Moreover, DVSS showed a significantly reduced conversion to open surgery than LS (OR = 0.19, 95% confidence interval: 0.08–0.48). Subgroup analysis indicated that DVSS had different results in rectal adenocarcinoma and colon cancer subgroups on outcomes of conversion to open surgery and operation time. DVSS is superior to LS/open surgery in length of hospital stay and EBL, but needs longer operation time. Long-term outcomes of DVSS are comparable with the other approaches. From long-term perspective, DVSS has an equivalent effect to the other two techniques.
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Affiliation(s)
- Jintang Huang
- Guizhou Provincial People’s Hospital, Guiyang, China
| | | | - Shaoyong Wang
- Guizhou Provincial People’s Hospital, Guiyang, China
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Affiliation(s)
- Rahila Essani
- Division of Colon & Rectal Surgery, State University of New York, Nichols Road, Stony Brook, NY 11794-819, USA
| | - Roberto Bergamaschi
- Division of Colon & Rectal Surgery, State University of New York, Nichols Road, Stony Brook, NY 11794-819, USA.
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Effect of BMI on Short-Term Outcomes with Robotic-Assisted Laparoscopic Surgery: a Case-Matched Study. J Gastrointest Surg 2016; 20:488-93. [PMID: 26704536 DOI: 10.1007/s11605-015-3016-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many benefits of minimally invasive surgery are lost in the obese, but robotic-assisted laparoscopic surgery (RALS) may offer advantages in this population. Our goal was to compare outcomes for RALS in obese and non-obese patients. METHODS A prospective database was reviewed for colorectal resections using RALS. Patients were stratified into obese (BMI > 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)), then case-matched for comparability. The main outcome measures were operative time, conversion rate, length of stay and complication, readmission, and reoperation rates between groups. RESULTS Forty-five patients were evaluated in each cohort. The BMI was significantly different (p < 0.01). All other demographics were well matched. There were no significant differences in operative time (p = 0.86), blood loss (p = 0.38), intraoperative complications (p = 0.54), or conversion rates (p = 0.91) across cohorts. Length of stay was comparable between groups (p = 0.45). Postoperatively, the complication (p = 0.87), readmission (p = 1.00), and reoperation rates (p = 0.95) were similar. There were no mortalities. For malignant cases (37.8 %), the lymph node yield (p = 0.48) and positive margins (p = 1.00) were similar and acceptable in both cohorts. CONCLUSIONS In our matched RALS series, perioperative and postoperative outcomes were similar between obese and non-obese patients undergoing colorectal surgery. RALS is a feasible option in the surgical setting of the obese patient. Further controlled studies are warranted to explore the full benefits.
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Roy S, Evans C. Overview of robotic colorectal surgery: Current and future practical developments. World J Gastrointest Surg 2016; 8:143-150. [PMID: 26981188 PMCID: PMC4770168 DOI: 10.4240/wjgs.v8.i2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete.
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Xu J, Qin X. Expert consensus on robotic surgery for colorectal cancer (2015 edition). CHINESE JOURNAL OF CANCER 2016; 35:23. [PMID: 26916742 PMCID: PMC4768422 DOI: 10.1186/s40880-016-0085-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/29/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Jianmin Xu
- Department of General surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
| | - Xinyu Qin
- Department of General surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Colombo PE, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrère S, Quénet F, Jarlier M, Rouanet P. Robotic Versus Laparoscopic Total Mesorectal Excision (TME) for Sphincter-Saving Surgery: Is There Any Difference in the Transanal TME Rectal Approach? : A Single-Center Series of 120 Consecutive Patients. Ann Surg Oncol 2015; 23:1594-600. [PMID: 26714950 DOI: 10.1245/s10434-015-5048-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Robotic total mesorectal excision (R-TME), a novel way for minimally invasive treatment of rectal cancer, was shown in previous studies to be safe and effective. However, comparison with laparoscopic total mesorectal excision (L-TME) has drawn contradictory disputes, especially concerning operative high-risk patients. The aim of this study was to compare R-TME and L-TME on the rectal technical approach. METHODS Between October 2009 and March 2013, a total of 120 consecutive rectal carcinomas, operated for sphincter-saving procedure, were enrolled. The patient population included the last 60 laparoscopic procedures and the first 60 robotic surgeries (six hybrid approaches, then 54 full robotic surgeries). There were no exclusions. RESULTS Patients' baseline characteristics were similar in both the R-TME and L-TME groups. Outcomes were equivalent for blood loss (200 vs. 100 mL), postoperative hospital stay (12 vs. 11 days), conversion rate (3.2 vs. 4.8 %), lymph nodes yield (15 vs. 19), no positive distal margin (0 %), positive radial margin (6.4 vs. 9.3 %), diverting ileostomy (73 vs. 58 %) and severe morbidity (28 vs. 20 %). Significant differences were found for median operative time (274 vs. 228 min; p = 0.003) and proctectomy performed via transanal approach (1.7 vs. 16.7 %; p = 0.004). The R-TME operative time curve stabilized to 245 min after the first 25 procedures. CONCLUSIONS For rectal cancer, R-TME may be as feasible and safe as L-TME in terms of technique. In our practice and for difficult cases, R-TME allows complete rectal dissection by an abdominal approach, while L-TME requires a transanal approach.
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Affiliation(s)
- Pierre-Emmanuel Colombo
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Martin M Bertrand
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Mathias Alline
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Eric Boulay
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Anne Mourregot
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Sébastien Carrère
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - François Quénet
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France
| | - Philippe Rouanet
- Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
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Lee SH, Lim S, Kim JH, Lee KY. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 2015; 89:190-201. [PMID: 26448918 PMCID: PMC4595819 DOI: 10.4174/astr.2015.89.4.190] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/13/2015] [Accepted: 07/04/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Robotic surgery (RS) overcomes the limitations of previous conventional laparoscopic surgery (CLS). Although meta-analyses have been published recently, our study evaluated the latest comparative surgical, urologic, and sexual results for rectal cancer and compares RS with CLS in patients with rectal cancer only. METHODS We searched three foreign databases (Ovid-MEDLINE, Ovid-Embase, and Cochrane Library) and five Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi) during July 2013. The Cochrane Risk of Bias and the Methodological Index for Non-Randomized were utilized to evaluate quality of study. Dichotomous variables were pooled using the risk ratio (RR), and continuous variables were pooled using the mean difference (MD). All meta-analyses were conducted with Review Manager, V. 5.3. RESULTS Seventeen studies involving 2,224 patients were included. RS was associated with a lower rate of intraoperative conversion than that of CLS (RR, 0.28; 95% confidence interval [CI], 0.15-0.54). Time to first flatus was short (MD, -0.13; 95% CI, -0.25 to -0.01). Operating time was longer for RS than that for CLS (MD, 49.97; 95% CI, 20.43-79.52, I(2) = 97%). International Prostate Symptom Score scores at 3 months better RS than CLS (MD, -2.90; 95% CI, -5.31 to -0.48, I(2) = 0%). International Index of Erectile Function scores showed better improvement at 3 months (MD, -2.82; 95% CI, -4.78 to -0.87, I(2) = 37%) and 6 months (MD, -2.15; 95% CI, -4.08 to -0.22, I(2) = 0%). CONCLUSION RS appears to be an effective alternative to CLS with a lower conversion rate to open surgery, a shorter time to first flatus and better recovery in voiding and sexual function. RS could enhance postoperative recovery in patients with rectal cancer.
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Affiliation(s)
- Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
| | - Sungwon Lim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jin Hee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kil Yeon Lee
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Trastulli S, Cirocchi R, Desiderio J, Coratti A, Guarino S, Renzi C, Corsi A, Boselli C, Santoro A, Minelli L, Parisi A. Robotic versus Laparoscopic Approach in Colonic Resections for Cancer and Benign Diseases: Systematic Review and Meta-Analysis. PLoS One 2015. [PMID: 26214845 PMCID: PMC4516360 DOI: 10.1371/journal.pone.0134062] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives The aim of this systematic review and meta-analysis is to compare robotic colectomy (RC) with laparoscopic colectomy (LC) in terms of intraoperative and postoperative outcomes. Materials and Methods A systematic literature search was performed to retrieve comparative studies of robotic and laparoscopic colectomy. The databases searched were PubMed, Embase and the Cochrane Central Register of Controlled Trials from January 2000 to October 2014. The Odds ratio, Risk difference and Mean difference were used as the summary statistics. Results A total of 12 studies, which included a total of 4,148 patients who had undergone robotic or laparoscopic colectomy, were included and analyzed. RC demonstrated a longer operative time (MD 41.52, P<0.00001) and higher cost (MD 2.42, P<0.00001) than did LC. The time to first flatus passage (MD -0.51, P = 0.003) and the length of hospital stay (MD -0.68, P = 0.01) were significantly shorter after RC. Additionally, the intraoperative blood loss (MD -16.82, P<0.00001) was significantly less in RC. There was also a significantly lower incidence of overall postoperative complications (OR 0.74, P = 0.02) and wound infections (RD -0.02, P = 0.03) after RC. No differences in the postoperative ileus, in the anastomotic leak, or in the conversion to open surgery rate and in the number of harvested lymph nodes outcomes were found between the approaches. Conclusions The present meta-analysis, mainly based on observational studies, suggests that RC is more time-consuming and expensive than laparoscopy but that it results in faster recovery of bowel function, a shorter hospital stay, less blood loss and lower rates of both overall postoperative complications and wound infections.
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Affiliation(s)
- Stefano Trastulli
- Department of Gastrointestinal Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
- * E-mail:
| | - Roberto Cirocchi
- Department of Gastrointestinal Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
| | - Jacopo Desiderio
- Department of Gastrointestinal Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
| | - Andrea Coratti
- Department of Oncology, Division of Oncological and Robotic Surgery, Careggi University Hospital, Florence, Italy
| | | | - Claudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Alessia Corsi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Alberto Santoro
- Department of Surgical Science, “Sapienza” University, Rome, Italy
| | - Liliana Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia. Perugia, Italy
| | - Amilcare Parisi
- Department of Gastrointestinal Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
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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: 90] [Impact Index Per Article: 10.0] [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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Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes. J Robot Surg 2015; 9:187-94. [PMID: 26531198 DOI: 10.1007/s11701-015-0514-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/07/2015] [Indexed: 02/01/2023]
Abstract
The aim of our study was to compare short-term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid-low RC after NCRT.
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Petrucciani N, Sirimarco D, Nigri GR, Magistri P, La Torre M, Aurello P, D'Angelo F, Ramacciato G. Robotic right colectomy: A worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy. J Minim Access Surg 2015; 11:22-8. [PMID: 25598595 PMCID: PMC4290114 DOI: 10.4103/0972-9941.147678] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/21/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Robotic right colectomy (RRC) is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach is worthwhile in enhancing patient recovery and reducing post-operative complications, compared with laparoscopic right colectomy (LRC). Literature is still fragmented and no meta-analyses have been conducted to compare the two procedures. This work aims at reducing this gap in literature, in order to draw some preliminary conclusions on the differences and similarities between RRC and LRC, focusing on short-term outcomes. MATERIALS AND METHODS: A systematic literature review was conducted to identify studies comparing RRC and LRC, and meta-analysis was performed using a random-effects model. Peri-operative outcomes (e.g., morbidity, mortality, anastomotic leakage rates, blood loss, operative time) constituted the study end points. RESULTS: Six studies, including 168 patients undergoing RRC and 348 patients undergoing LRC were considered as suitable. The patients in the two groups were similar with respect to sex, body mass index, presence of malignant disease, previous abdominal surgery, and different with respect to age and American Society of Anesthesiologists score. There were no statistically significant differences between RRC and LRC regarding estimated blood loss, rate of conversion to open surgery, number of retrieved lymph nodes, development of anastomotic leakage and other complications, overall morbidity, rates of reoperation, overall mortality, hospital stays. RRC resulted in significantly longer operative time. CONCLUSIONS: The RRC procedure is feasible, safe, and effective in selected patients. However, operative times are longer comparing to LRC and no advantages in peri-operative and post-operative outcomes are demonstrated with the use of the robotic surgical system.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Dario Sirimarco
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Giuseppe R Nigri
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Paolo Magistri
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Marco La Torre
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Paolo Aurello
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Francesco D'Angelo
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Giovanni Ramacciato
- Department of Surgery, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Analysis of conversion factors in robotic-assisted rectal cancer surgery. Int J Colorectal Dis 2014; 29:701-8. [PMID: 24651959 DOI: 10.1007/s00384-014-1851-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Robotic surgical management of rectal cancer has a series of advantages which might facilitate the surgical approach to the pelvic cavity and reduce conversion rates. The aim of the present study is to identify independent factors for conversion during robotic rectal cancer surgery. METHODS A total of 67 patients underwent preoperative CT scan in order to obtain a three-dimensional image of the pelvis, the tumour and prostate. We measured maximum and minimum ilio-iliac, sacral promontory-pubis, coccyx-pubis diameters and maximum lateral axis. Further variables under consideration were age, BMI and use of neoadjuvant therapy. We recorded short-term follow-up outcomes of the resected tumour. RESULTS The present study included 67 patients (39 males) with an average age of 65.11 ± 10.30 years and a BMI of 27.70 ± 3.97 kg/m(2). Operative procedures included nine abdominoperineal resections and 58 low anterior resections. There were 15 (22.38 %) conversions. Mean operating time was 192.2 ± 42.73 min. Minimum ilio-iliac, maximum ilio-iliac, promontory-pubic and coccyx-pubis diameter as well as maximum lateral axis were 100.38 ± 7.65, 107.10 ± 10.01, 109.97 ± 9.20, 105.61 ± 9.27 and 129.01 ± 9.94 mm, respectively. Mean tumour volume was 37.06 ± 44.08 cc; mean prostate volume was 42.07 ± 17.49 cc. The univariate analysis of the variables showed a correlation between conversion and BMI and minimum ilio-iliac and coccyx-pubis diameters (p = 0.004, 0.047, 0.046). In the multivariate analysis, the only independent predictive factor for conversion was the BMI (p = 0.004).No correlation was found between conversion and sex, age, tumour volume or the rest of pelvic diameters. CONCLUSION BMI is an independent factor for conversion in robotic-assisted rectal cancer surgery.
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Yu J, Wang Y, Li Y, Li X, Li C, Shen J. The safety and effectiveness of Da Vinci surgical system compared with open surgery and laparoscopic surgery: a rapid assessment. J Evid Based Med 2014; 7:121-34. [PMID: 25155768 DOI: 10.1111/jebm.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/14/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The primary objectives of this rapid assessment were to assess the clinical evidence of Da Vinci surgical system (DVSS) comparing with open procedures and laparoscopic procedures, and in order to provide the evidence for health decision makers and clinician. METHODS A comprehensive search of electronic databases (EMbase, PubMed, The Cochrane Library, Web of Science, CNKI, VIP, CBM and Wanfang) and HTA websites were completed up to 9 October, 2013. Two reviews (Jiajie Yu and Yingqiang Wang) independently extracted data of the manuscripts, and assessed quality of included studies using AMSTAR tools. Qualitative description and GRADE were used to report the outcomes and evidence quality. OUTCOMES A total of 17 studies were included: 3 were HTA and 14 were SR/meta-analysis. The included studies focused on prostatectomy, nephrectomy, hysterectomy colorectal surgery, and cardiac surgery. DVSS was shown to be associated with statistically significant reduction in length of hospital stay, blood loss, and transfusion rate compared with open and laparoscopic surgery, but increase in operative time when compared with open surgery. CONCLUSION Based on the evidence included in this rapid assessment, DVSS has a limited impact on several clinical outcomes. Considering no available data from randomized controlled trials and much higher cost, decisions will be complex and need to be made carefully. Decision makers should cut down the quantity of purchasing and reasonable allocate them.
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Affiliation(s)
- Jiajie Yu
- Chinese Cochrane/Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China; West China Medical School, Sichuan University, Chengdu, 610041, China
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Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 2014; 18:816-30. [PMID: 24496745 DOI: 10.1007/s11605-014-2469-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Robotic technology has been applied to colorectal surgery over the last decade. The aim of this review is to analyze the outcomes of robotic colorectal surgery systematically and to provide objective information to surgeons. METHODS Studies were searched and identified using PubMed and Google Scholar from Jan 2001 to Feb 2013 with the search terms "robot," "robotic," "colon," "rectum," "colorectal," and "colectomy." Appropriate data in the studies about the outcomes of robotic colorectal surgery were analyzed. RESULTS Sixty-nine publications were included in this review and composed of 39 case series, 29 comparative studies, and 1 randomized controlled trial. Most of the studies reported that robotic surgery showed a longer operation time, less estimated blood loss, shorter length of hospital stay, lower complication and conversion rates, and comparable oncologic outcomes compared to laparoscopic or open surgery. CONCLUSION Robotic colorectal surgery is a safe and feasible option. Robotic surgery showed comparable short-term outcomes compared to laparoscopic surgery or open surgery. However, the long operation time and high cost are the limitations of robotic surgery.
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Affiliation(s)
- Chang Woo Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
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Abstract
Robotic assistance has the potential to compensate for the limitations inherent in standard laparoscopic surgery. The daVinci® surgical system remains the only currently available commercial robotic system. It has found popularity in rectal cancer surgery where its application has consistently been shown to reduce the need to convert to open surgery. With this exception, the technological advances of the robotic system have not so far translated into any reproducible patient benefit. The first part of this manuscript presents an overview of the current daVinci® platform, its applications, the evidence base and future developments in colorectal surgery. The second part of the manuscript looks at other robot systems in development and the different innovations and strategies taken to advance minimally invasive surgery.The English full-text version of this article is available at SpringerLink (under supplemental).
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Affiliation(s)
- D Jayne
- St James's University Hospital & University of Leeds, Level 7 Clinical Sciences Building, LS9 7TF, Leeds, Großbritannien.
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Ielpo B, Caruso R, Quijano Y, Duran H, Diaz E, Fabra I, Oliva C, Olivares S, Ferri V, Ceron R, Plaza C, Vicente E. Robotic versus laparoscopic rectal resection: is there any real difference? A comparative single center study. Int J Med Robot 2014; 10:300-5. [PMID: 24692203 DOI: 10.1002/rcs.1583] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The aim of this study is to compare main outcomes of laparoscopic and robotic rectal resection. METHODS In total, 143 consecutive patients treated for rectal cancer in our department with laparoscopic or robotic-assisted surgery from October 2010 to July 2013 were retrospectively analyzed. RESULTS A total of 87 patients underwent laparoscopic rectal resection, and 56 patients were treated using a robotic approach. The conversion rate was 11.5% in the laparoscopic group and 3.5% in the robotics group (P = 0.09). The low rectal cancer conversion rate was significantly lower in the robotic group (1.8%) than in the laparoscopy group (9.2%) (P = 0.04). Mean operation time was 252 min in the laparoscopic group and 309 min in the robotic group (P = 0.023). CONCLUSIONS The robotic approach shows a lower conversion rate in low rectal cancer but with a longer operative time compared with the laparoscopic technique.
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Affiliation(s)
- Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
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Ghezzi TL, Luca F, Valvo M, Corleta OC, Zuccaro M, Cenciarelli S, Biffi R. Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 2014; 40:1072-9. [PMID: 24646748 DOI: 10.1016/j.ejso.2014.02.235] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. METHODS The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. RESULTS There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P = 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P = 0.024). CONCLUSION RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
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Affiliation(s)
- T L Ghezzi
- Division of Colorectal Surgery, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos Street 2350, 90035-903 Porto Alegre, Brazil.
| | - F Luca
- Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - M Valvo
- Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - O C Corleta
- Department of Surgery and General Surgery Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - M Zuccaro
- Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy
| | - S Cenciarelli
- Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy
| | - R Biffi
- Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy
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