Single-surgeon surgery in laparoscopic colonic resection

Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery

AIM

Robotic colorectal surgery is an emerging field and may offer a solution to some of the difficulties inherent to conventional laparoscopic surgery. The aim of this review is to provide a comprehensive and critical analysis of the available literature on the use of robotic technology in colorectal surgery.

METHOD

Studies reporting outcomes of robotic colorectal surgery were identified by systematic searches of electronic databases. Outcomes examined included operating time, length of stay, blood loss, complications, cost, oncological outcome, and conversion rates.

RESULTS

Seventeen Studies (nine case series, seven comparative studies, one randomized controlled trial) describing 288 procedures were identified and reviewed. Study heterogeneity precluded a meta-analysis of the data. Robotic procedures tend to take longer and cost more, but may reduce the length of stay, blood loss, and conversion rates. Complication profiles and short-term oncological outcomes are similar to laparoscopic surgery.

CONCLUSION

Robotic colorectal surgery is a promising field and may provide a powerful additional tool for optimal management of more challenging pathology, including rectal cancer. Further studies are required to better define its role.

Laparoscopic management of diverticular disease

Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.

Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature

BACKGROUND

Robotic-assisted laparoscopic surgery has recently gained enthusiasm for application in colorectal surgery. We present the safety and feasibility of using the da Vinci® robotic system for the surgical treatment of sigmoid diverticulitis.

METHODS

Between August 2008 and November 2009, robotic-assisted laparoscopic anterior rectosigmoid resection (RALS-AR) for diverticulitis was performed in 24 consecutive patients. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.

RESULTS

RALS-AR was performed in 14 male (58.3%) and 10 female (41.7%) patients with a diagnosis of recurrent diverticulitis. The mean patient age and BMI were 49.8 ± 9.3 years (range = 30-62 years) and 29.9 ± 6.3 kg/m(2) (range = 15.9-46.9 kg/m(2)), respectively. Disease stratification identified 15 cases of uncomplicated (62.5%) and 9 cases of complicated (37.5%) disease. The procedures required 14.1 ± 6.7 min (range = 6-30 min) for robotic docking, 100.5 ± 31.0 min (range = 50-180 min) for surgeon console time, and 224.2 ± 47.1 min (range = 150-330 min) for the total operative time. Robotic docking and surgeon console time represented 51.9% of the total operative time. A primary colorectal anastomosis was fashioned with avoidance of colostomy in all patients. There were no significant intraoperative complications, and none of the procedures required conversion to open, hand-assisted, or conventional laparoscopic technique. The length of hospital stay was 3.4 ± 2.6 days (range = 2-14 days), and the postoperative complication rate was 12.5% (n = 3). There were no anastomotic leaks, secondary surgical interventions, or hospital readmissions.

CONCLUSIONS

Robotic-assisted laparoscopic technique is a safe and feasible option for the surgical treatment of diverticulitis. The approach may be offered to patients with uncomplicated or complicated disease, and it results in a short hospital stay and low complication rate.

No relevant difference in quality of life and functional outcome at 12 months' follow-up-a randomised controlled trial comparing robot-assisted versus conventional laparoscopic Nissen fundoplication

PURPOSE

The present randomised pilot trial was designed to compare robot-assisted (RALF) and conventional laparoscopic fundoplication (CLF) focussing on post-operative quality of life (QOL) and functional outcome. Any long-lasting advantages for patients in this regard could be a justification for the use of RALF for the treatment of gastroesophageal reflux disease (GERD).

METHODS

Forty patients with GERD were randomised to either RALF or to CLF. During a follow-up period of 12 months, patients' QOL and functional outcome were investigated using disease-specific questionnaires.

RESULTS

There were no significant differences in the mean QOL (1.3 versus 1.1; P = 0.374) and functional outcome (1.27 versus 1.3; P = 0.913) between both groups. Minor side effects such as bloating and persistent diarrhoea were present in four patients of each group.

CONCLUSION

The present study did not show any benefit for RALF over CLF regarding QOL and functional outcome at 12 months' follow-up.

Laparoscopic cholecystectomy as solo surgery with the aid of a robotic camera holder: a case-control study

BACKGROUND

By using robotic camera holders, a laparoscopic cholecystectomy (LC) is possible as a solo-surgeon operation. The purpose of this paper is to examine the safeness and efficiency of solo-surgeon LCs.

METHODS

A series of 72 solo-surgeon LCs was retrospectively compared with a control cohort (matched pairs). Efficiency and safety parameters were compared by means of equivalence tests (scope=10%).

RESULTS

Nearly identical incision-suture times (means: 69.6 vs. 70.7 min) were recorded. An equivalence was also found in the cohorts for the total time in the operating room (means: 117.4 vs. 117.2 min). In terms of the rate of complications, the perioperative difference in hemoglobin, and the conversion rate, the robot cohort proved to be at least equal to the control cohort. The postoperative hospital stay was shorter for the robot cohort.

CONCLUSION

Solo-surgeon LC with a robotic camera holder is an efficient and safe method.

Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation

Subtotal colectomy with cecorectal anastomosis represents an interesting alternative to total colectomy with ileorectal anastomosis. Several technical variants to the methods for performing the anastomosis between the cecum and the rectal stump after subtotal colectomy have been reported. The mechanical, antiperistaltic, end-to-end cecorectal anastomosis is safe and easy to perform. The authors aimed to assess the safety and feasibility of this technique performed laparoscopically in a series of four patients. All the procedures were completed laparoscopically. The mean time for surgery was 200 min (range, 180-220 min). There was no mortality and no postoperative complications. The mean hospital stay was 4 days (range, 3-5 days). This technique can be performed laparoscopically with all the advantages inherent to the minimally invasive approach.

Laparoscopic total colectomy for slow-transit constipation

INTRODUCTION

Total colectomy is the preferred surgical option in proven slow-transit constipation. With advances in technology and instrumentation, laparoscopic total colectomy has become feasible.

METHODS

After a mechanical bowel preparation, the patient is placed in a modified lithotomy position and pneumoperitoneum is established. Using a subumbilical 12-mm trocar the camera is inserted. Two further 12-mm and 5-mm trocars, each, are used for access to the peritoneal cavity. In an approach from medial to lateral, ileocolic, middle colic vessels and the inferior mesenteric artery are divided. Medial mobilization is completed before the sigmoid is freed up laterally. The lateral mobilization continues orally to the descending, transverse, and ascending colon with the omentum being separated from the transverse colon completely. The mesorectum is divided using the harmonic scalpel, and the upper rectum is transected with either one or two passes of the endoscopic linear cutting stapler. The colon is exteriorized through a 5-cm Pfannenstiel incision. The terminal ileum is transected extracorporeally. After pneumoperitoneum has been reestablished, the ileorectal anastomosis is performed laparoscopically using a double-stapling technique.

RESULTS

The video reports about a 56-year-old lady who had been suffering from chronic constipation since childhood and had become dependent on laxatives. A dolichocolon had been found in barium enema. A prolonged colonic passage was proven in an x-ray transit study. There were no intraoperative or postoperative complications. After surgery, first bowel movements occurred on the second day and the patient was discharged from the hospital on the sixth postoperative day.

CONCLUSIONS

Laparoscopic total colectomy is a safe, feasible operation for slow transit constipation. With fast recovery and short length of stay it may become an attractive surgical approach.