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Mokhtari L, Hosseinzadeh F, Nourazarian A. Biochemical implications of robotic surgery: a new frontier in the operating room. J Robot Surg 2024; 18:91. [PMID: 38401027 DOI: 10.1007/s11701-024-01861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.
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Affiliation(s)
- Leila Mokhtari
- Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran.
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Zheng J, Zhao S, Chen W, Zhang M, Wu J. Comparison of robotic right colectomy and laparoscopic right colectomy: a systematic review and meta-analysis. Tech Coloproctol 2023:10.1007/s10151-023-02821-2. [PMID: 37184773 DOI: 10.1007/s10151-023-02821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured. RESULTS Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar. CONCLUSION The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.
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Affiliation(s)
- Jianchun Zheng
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, Jiangsu Province, China
| | - Wei Chen
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Ming Zhang
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Jianxiang Wu
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
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Complete Mesocolic Excision and Extent of Lymphadenectomy for the Treatment of Colon Cancer. Surg Oncol Clin N Am 2022; 31:293-306. [DOI: 10.1016/j.soc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ye SP, Zhu WQ, Huang ZX, Liu DN, Wen XQ, Li TY. Role of minimally invasive techniques in gastrointestinal surgery: Current status and future perspectives. World J Gastrointest Surg 2021; 13:941-952. [PMID: 34621471 PMCID: PMC8462081 DOI: 10.4240/wjgs.v13.i9.941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, the incidence of gastrointestinal cancer has remained high. Currently, surgical resection is still the most effective method for treating gastrointestinal cancer. Traditionally, radical surgery depends on open surgery. However, traditional open surgery inflicts great trauma and is associated with a slow recovery. Minimally invasive surgery, which aims to reduce postoperative complications and accelerate postoperative recovery, has been rapidly developed in the last two decades; it is increasingly used in the field of gastrointestinal surgery and widely used in early-stage gastrointestinal cancer. Nevertheless, many operations for gastrointestinal cancer treatment are still performed by open surgery. One reason for this may be the challenges of minimally invasive technology, especially when operating in narrow spaces, such as within the pelvis or near the upper edge of the pancreas. Moreover, some of the current literature has questioned oncologic outcomes after minimally invasive surgery for gastrointestinal cancer. Overall, the current evidence suggests that minimally invasive techniques are safe and feasible in gastrointestinal cancer surgery, but most of the studies published in this field are retrospective studies and case-matched studies. Large-scale randomized prospective studies are needed to further support the application of minimally invasive surgery. In this review, we summarize several common minimally invasive methods used to treat gastrointestinal cancer and discuss the advances in the minimally invasive treatment of gastrointestinal cancer in detail.
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Affiliation(s)
- Shan-Ping Ye
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Institute of Digestive Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei-Quan Zhu
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhi-Xiang Huang
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Dong-Ning Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiang-Qiong Wen
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Institute of Digestive Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Sigmoidectomy for Diverticulitis—A Propensity-Matched Comparison of Minimally Invasive Approaches. J Surg Res 2019; 243:434-439. [DOI: 10.1016/j.jss.2019.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022]
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Abstract
PURPOSE OF REVIEW Despite the growth in laparoscopic surgery, comparable oncological outcomes, and reduced complication rates, the majority of colorectal surgery is still performed via an open approach. Reasons for this may include technical difficulties associated with operating in narrow spaces such as in the pelvis and inadequate experience. Robotic surgery provides potential solutions to some of these challenges. This review will summarize the state of the literature regarding robotic colorectal surgery. RECENT FINDINGS The most consistent benefit of robotic surgery is decreasing operative conversions, specifically in rectal cancer. In partial colectomies, there is evidence to support quicker return to bowel function. Oncologic outcomes compared to the laparoscopic approach are equivalent. Robotic surgery provides solutions to the challenges posed by laparoscopy, including wristed instruments, ease of intracorporeal suturing, and ergonomic advantages. Randomized trials to evaluate peri-operative outcomes will be important. If robotics is able to facilitate conversion of open colectomies to their minimally invasive equivalent, robotics may end up proving to be advantageous in the peri-operative and post-operative period. Continued studies are warranted.
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Affiliation(s)
- Harith H Mushtaq
- General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.331, Houston, TX, 77030, USA
| | - Shinil K Shah
- Minimally Invasive and Elective General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Amit K Agarwal
- Colon and Rectal Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.158, Houston, TX, 77030, USA.
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Ma S, Chen Y, Chen Y, Guo T, Yang X, Lu Y, Tian J, Cai H. Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis. Asian J Surg 2018; 42:589-598. [PMID: 30503268 DOI: 10.1016/j.asjsur.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
To assess the clinical efficacy and safety of robotic-assisted right colectomy (RRC) with conventional laparoscopic right colectomy (LRC) by performing a systematic review and meta-analysis of the published studies. All published literature for comparative studies reporting preoperative outcomes of RRC and LRC were searched. We searched the databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, Web of Science and Chinese Biomedical Database (CBM) from 1973 to 2018. The censor date was up to January 2018. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated. All calculations and statistical tests were performed using Stata 12.0 software. A total of 7769 patients with colon cancer enrolled in 13 trials were divided into a study group (n = 674) and a control group (n = 7095). Meta-analysis suggested significantly greater length of hospital stay in the LRC group [MD = -0.85; 95% CI: -1.07 to -0.63; P < 0.00001]. Robotic surgery was also associated with a significantly lower complication rate [OR = 0.73; 95% CI: 0.52 to 1.01; P = 0.05]. There were statistically significant differences between the groups in estimated blood loss [MD = -16.89; 95% CI: -24.80 to -8.98; P < 0.00001] and the rate of intraoperative conversion to open surgery [OR = 0.34, 95% CI: 0.15 to 0.75; P = 0.008)], but these differences were not clinically relevant. The recovery of bowel function in two groups is no significant differences [MD = -0.58, 95% CI: -0.96 to -0.20, P = 0.0008]. However, operation times [MD = 43.61, 95% CI: 39.11 to 48.10, P < 0.00001] were longer for RRC than for LRC. Compared to LRC, RRC was associated with reduced estimated blood loss, reduced postoperative complications, longer operation times. Recovery of bowel function and other perioperative outcomes were equivalent between the two surgeries.
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Affiliation(s)
- Shixun Ma
- Gansu Province Hospital, Lanzhou, China.
| | - Yan Chen
- The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | | | | | | | - Yufeng Lu
- Gansu Province Hospital, Lanzhou, China.
| | | | - Hui Cai
- Gansu Province Hospital, Lanzhou, China.
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Spinoglio G, Bianchi PP, Marano A, Priora F, Lenti LM, Ravazzoni F, Petz W, Borin S, Ribero D, Formisano G, Bertani E. Robotic Versus Laparoscopic Right Colectomy with Complete Mesocolic Excision for the Treatment of Colon Cancer: Perioperative Outcomes and 5-Year Survival in a Consecutive Series of 202 Patients. Ann Surg Oncol 2018; 25:3580-3586. [DOI: 10.1245/s10434-018-6752-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 12/16/2022]
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Antoniou SA, van Veenendaal N, Bonjer HJ. Systematic reviews and meta-analyses in minimally invasive surgery. Am J Surg 2018; 218:232-233. [PMID: 29960646 DOI: 10.1016/j.amjsurg.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Stavros A Antoniou
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom.
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Mangano A, Gheza F, Bustos R, Masrur M, Bianco F, Fernandes E, Valle V, Giulianotti PC. Robotic right colonic resection. Is the robotic third arm a game-changer? MINERVA CHIR 2018; 75:1-10. [PMID: 29860773 DOI: 10.23736/s0026-4733.18.07814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way. This is in part because traditional laparoscopy may have some hurdles and a long learning curve to reach mastery. The robotic technology may help in increasing the MIS penetrance in colorectal surgery. The use of the R3 can potentially increase the number of surgical options available. METHODS In this retrospective case series, after a long robotic colorectal experience connected to a robotic program started by Giulianotti et al. in October 2000, we present our results regarding a subset of colorectal patients who underwent robotic right colonic resections performed, all by a single surgeon (P.C.G.), using the R3 according to our standardized technique. RESULTS Out of all the robotic colorectal operations performed, this sub-sample sample included 33 patients: 21 males and 12 females. The age range was between 51 and 95 years old. The Body Mass Index (BMI) was between 21.6 to 43.1. The conversion rate to laparoscopy or to open surgery has been 0%. No intraoperative complications have been registered. The postoperative complications rates are reported in this manuscript. The perfusion check of the anastomosis by Near-infrared ICG (Indocyanine Green) enhanced fluorescence has been used. In 11.2% of the sample, the site of the anastomosis has been changed after ICG-Test. Moreover, when the ICG perfusion test has been performed no leakage occurred. CONCLUSIONS This subset of patients suggests the potential role of R3 and the benefits correlated to robotic surgery. In fact, the laparoscopic approach uses mostly a medial to lateral mobilization. Indeed, during laparoscopic surgery an early right colon mobilization may create problems in the surgical field visualization. In robotic surgery, R3 can lift upwards the cecum/ascending colon/hepatic flexure exposing, in doing so, the anatomical structures. Hence, we can use also the same approach of the open surgery (where the first step is usually the mobilization of the ascending colon mesentery). In other words, the R3 offers more operative options in terms of surgical pathways maintaining at the same time good perioperative outcomes. However, more studies are needed to confirm our findings.
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Affiliation(s)
- Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Francesco Bianco
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Valentina Valle
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Sato T, Watanabe M. The present status and developments of laparoscopic surgery for colorectal cancer. J Anus Rectum Colon 2018; 1:1-6. [PMID: 31583293 PMCID: PMC6768680 DOI: 10.23922/jarc.2016-010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery for colorectal cancer has been shown to be less invasive than open surgery, while maintaining a similar safety level in many clinical trials. Furthermore, there are no significant differences between laparoscopic surgery and open surgery with respect to the long-term outcomes in colon cancer. Thus, laparoscopic surgery has been accepted as one of the standard treatments for colon cancer. In addition, laparoscopic surgery has also achieved favorable outcomes in the treatments of rectal cancer, with many reports showing long-term outcomes comparable to those of open surgery. Furthermore, the magnification in laparoscopy improves visualization in the pelvic cavity and facilitates precise manipulation, as well as providing an excellent educational opportunity. Laparoscopic surgery may be an ideal approach for the treatment of rectal cancer and colon cancer. Recently, two trials showed that, among patients with advanced rectal cancer, the use of laparoscopic surgery as compared with open surgery confirmed to meet the criterion for non-inferiority for long-term outcomes. In addition, new techniques such as single-port and robotic surgery have been introduced for laparoscopic surgery in recent years.
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Affiliation(s)
- Takeo Sato
- Department of Surgery, Kitasato University School of Medicine
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12
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Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 2017; 32:1104-1110. [PMID: 29218671 DOI: 10.1007/s00464-017-5980-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures. METHODS A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms. RESULTS After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD - 0.99 95% CI - 1.4 to - 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1-2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18-1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9-1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16-1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD - 0.52; 95% CI - 0.52 to - 0.04, p = 0.035). CONCLUSIONS RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.
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Ngu JCY, Tsang CBS, Koh DCS. The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery. ROBOTIC SURGERY (AUCKLAND) 2017; 4:77-85. [PMID: 30697566 PMCID: PMC6193435 DOI: 10.2147/rsrr.s119317] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Xi is the latest da Vinci surgical system approved for use in colorectal surgery. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures - from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis. While commonly criticized for its cost and prolonged operative time, robotic colorectal surgery holds the potential for enhanced ergonomics, superior precision, and a reduction in the learning curve involved in training an expert surgeon. This review appraises the existing literature on robotic colorectal surgery while elaborating how the improved capabilities of the Xi serve to usher in a new era of minimally invasive colorectal surgery.
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Affiliation(s)
| | - Charles Bih-Shiou Tsang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
- Colorectal Clinic Associates, Mount Elizabeth Novena Specialist Center, Singapore
| | - Dean Chi-Siong Koh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
- Colorectal Clinic Associates, Mount Elizabeth Novena Specialist Center, Singapore
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Ngu JCY, Sim S, Yusof S, Ng CY, Wong ASY. Insight into the da Vinci® Xi - technical notes for single-docking left-sided colorectal procedures. Int J Med Robot 2016; 13. [PMID: 28008712 DOI: 10.1002/rcs.1798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The adoption of robot-assisted laparoscopic colorectal surgery has been hampered by issues with docking, operative duration, technical difficulties in multi-quadrant access, and cost. The da Vinci® Xi has been designed to overcome some of these limitations. We describe our experience with the system and offer technical insights to its application in left-sided colorectal procedures. METHODS Our initial series of left-sided robotic colorectal procedures was evaluated. Patient demographics and operative outcomes were recorded prospectively using a predefined database. RESULTS Between March 2015 and April 2016, 54 cases of robot-assisted laparoscopic left-sided colorectal procedures were successfully completed with no cases of conversion. The majority were low anterior resections for colorectal malignancies. Using the da Vinci® Xi Surgical System, multi-quadrant surgery involving dissection from the splenic flexure to the pelvis was possible without redocking. CONCLUSIONS The da Vinci® Xi simplifies the docking procedure and makes single-docking feasible for multi-quadrant left-sided colorectal procedures.
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Affiliation(s)
| | - Sarah Sim
- Changi General Hospital, Surgery, Singapore
| | | | - Chee-Yung Ng
- Singapore General Hospital, Colorectal Surgery, Singapore
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15
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Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 2016; 31:2387-2396. [PMID: 27655383 DOI: 10.1007/s00464-016-5239-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/01/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Robotic colorectal surgery is being increasingly adopted. Our objective was to compare early postoperative outcomes between robotic and laparoscopic colectomy in a nationally representative sample. METHODS The American College of Surgeons National Surgical Quality Improvement Project Colectomy Targeted Dataset from 2012 to 2014 was used for this study. Adult patients undergoing elective colectomy with an anastomosis were included. Patients were stratified based on location of colorectal resection (low anterior resection (LAR), left-sided resection, or right-sided resection). Bivariate data analysis was performed, and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes. RESULTS There were a total of 25,998 laparoscopic colectomies (30 % LAR's, 45 % left-sided, and 25 % right-sided) and 1484 robotic colectomies (54 % LAR's, 28 % left-sided, and 18 % right-sided). The risk-adjusted overall morbidity, serious morbidity, and mortality were similar between laparoscopic and robotic approaches in all anastomotic groups. Patients undergoing robotic LAR had a lower conversion rate (OR 0.47, 95 % CI 1.20-1.76) and postoperative sepsis rate (OR 0.49, 95 % CI 0.29-0.85) but a higher rate of diverting ostomies (OR 1.45, 95 % CI 1.20-1.76). Robotic right-sided colectomies had significantly lower conversion rates (OR 0.58, 95 % CI 0.34-0.96). Robotic colectomy in all groups was associated with a longer operative time (by 40 min) and a decreased length of stay (by 0.5 days). CONCLUSIONS In a nationally representative sample comparing laparoscopic and robotic colectomies, the overall morbidity, serious morbidity, and mortality between groups are similar while length of stay was shorter by 0.5 days in the robotic colectomy group. Robotic LAR was associated with lower conversion rates and lower septic complications. However, robotic LAR is also associated with a significantly higher rate of diverting ostomy. The reason for this relationship is unclear. Surgeon factors, patient factors, and technical factors should be considered in future studies.
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Affiliation(s)
- Scott C Dolejs
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA.
| | - Joshua A Waters
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
| | - Ben L Zarzaur
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
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Sato T, Watanabe M. Present laparoscopic surgery for colorectal cancer in Japan. World J Clin Oncol 2016; 7:155-159. [PMID: 27081638 PMCID: PMC4826961 DOI: 10.5306/wjco.v7.i2.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/19/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
In many clinical studies, laparoscopic surgery (LS) for colon cancer has been shown to be less invasive than open surgery (OS) while maintaining similar safety. Furthermore, there are no significant differences between LS and OS in long-term outcomes. Thus, LS has been accepted as one of the standard treatments for colon cancer. In the treatments of rectal cancer as well, LS has achieved favorable outcomes, with many reports showing long-term outcomes comparable to those of OS. Furthermore, the magnification in laparoscopy improves visualization in the pelvic cavity and facilitates precise manipulation, as well as providing excellent educational effects. For these reasons, rectal cancer has seemed to be well indicated for LS, as has been colon cancer. The indication for LS in the treatment of locally advanced rectal cancer, which is relatively unresectable (e.g., cancer invading other organs), remains an open issue. In recent years, new techniques such as single-port and robotic surgery have begun to be introduced for LS. Presently, various clinical studies in our country as well as in most Western countries have demonstrated that LS, with these new techniques, are gradually showing long-term outcomes.
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