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Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [PMID: 39087097 PMCID: PMC11287670 DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
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Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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2
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Fefferman ML, Zheng C, Varsanik AM, Vigneswaran Y. Hidden Port Site Incisions for Robotic Foregut and Hepatopancreatobiliary Operations: A Cosmetically Superior Approach. J Am Coll Surg 2024; 239:e1-e6. [PMID: 38634560 DOI: 10.1097/xcs.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Marie L Fefferman
- From the Department of Surgery, The University of Chicago, Chicago, IL
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Zheng Z, Du Q, Huang L, Yang L, Zhou Z. Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis. Updates Surg 2024:10.1007/s13304-024-01876-6. [PMID: 38758468 DOI: 10.1007/s13304-024-01876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
To compare the short-term outcomes and explore the potential economic benefits of laparoscopic-assisted colectomy with extracorporeal anastomosis (LAC/EA) vs. laparoscopic complete colectomy with intracorporeal anastomosis (LCC/IA) for patients with non-metastatic resectable colon cancer. Data of patients who underwent laparoscopic hemicolectomy from January 2017 to March 2023 were collected and analyzed. Propensity score matching (PSM) analyses was carried out to minimize the selection bias. Before PSM, a total of 113 patients met the inclusion criteria (39 in the LCC/IA vs. 74 in the LAC/EA). Clinicopathologic characteristics were comparable except for the median number of removed lymph nodes (P = 0.023). LCC/IA was associated with longer operative time, less intraoperative blood loss, and shorter incision length. The rate of 30-day postoperative complications was similar, but the time to first flatus and soft diet was shorter in the LCC/IA. No deaths were reported in either group within 30 days after surgery. Costs of surgical instruments (25,945.8 ± 1,918.0 vs. 23,551.9 ± 2,665.5 RMB; P < 0.01) were higher for the LCC/IA but overall costs were similar (LCC/IA, 43,220.0 ± 4,954.0 vs. LAC/EA, 41,269.2 ± 6,685.9 RMB; P = 0.112). After PSM, 38 patients in the LCC/IA and 63 patients in the LAC/EA were compared. LCC/IA was superior in terms of intraoperative blood loss, incision length, and postoperative functional recovery. There was an extra charge of 2385.0 RMB regarding surgical instruments in the LCC/IA but the overall cost did not reach statistical significance. LCC/IA is a feasible, safe, and cost-effective surgical treatment for patients with non-metastatic resectable colon cancer.
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Affiliation(s)
- Zhaoyang Zheng
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Qiang Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Libin Huang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
| | - Zongguang Zhou
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
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Zhou D, Su J, Yang X, Huang L, Zheng Z, Wei H, Fang J. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy for overweight colon cancer patients: a case-control study. Langenbecks Arch Surg 2024; 409:112. [PMID: 38587671 DOI: 10.1007/s00423-024-03312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Either extracorporeal anastomosis (EA) or intracorporeal anastomosis (IA) could be selected for digestive reconstruction in laparoscopic right hemicolectomy (LRH). However, whether LRH with IA is feasible and beneficial for overweight right-side colon cancer (RCC) is unclear. This study aims to investigate the feasibility and advantage of IA in LRH for overweight RCC. METHODS Forty-eight consecutive overweight RCC patients undergoing LRH with IA were matched with 48 consecutive cases undergoing LRH with EA. Both clinical and surgical data were collected and analyzed. RESULTS The incidence of postoperative complications was 20.8% (10/48) in the EA group and 14.6% (7/48) in the IA group respectively, with no statistical difference. Compared to the EA group, patients in the IA group revealed faster gas (40.2 + 7.8 h vs. 45.6 + 7.9 h, P = 0.001) and stool discharge (4.0 + 1.2 d vs. 4.5 + 1.1 d, P = 0.040), shorter assisted incision (5.3 + 1.3 cm vs. 7.5 + 1.2 cm, P = 0.000), and less analgesic used (3.3 + 1.3 d vs. 4.0 + 1.3 d, P = 0.012). There were no significant differences in operation time, blood loss, or postoperative hospital stays. In the IA group, the first one third of cases presented longer operation time (228.4 + 29.3 min) compared to the middle (191.0 + 35.0 min, P = 0.003) and the last one third of patients (182.2 + 20.7 min, P = 0.000). CONCLUSION LRH with IA is feasible and safe for overweight RCC, with faster bowel function recovery and less pain. Accumulation of certain cases of LRH with IA will facilitate surgical procedures and reduce operation time.
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Affiliation(s)
- Dagui Zhou
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Jing Su
- Department of Nursing, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Yang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Lijun Huang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Zongheng Zheng
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Hongbo Wei
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Jiafeng Fang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China.
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Fan BH, Zhong KL, Zhu LJ, Chen Z, Li F, Wu WF. Clinical observation of extraction-site incisional hernia after laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:710-716. [PMID: 38577097 PMCID: PMC10989329 DOI: 10.4240/wjgs.v16.i3.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/17/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia (IH) at the tumor extraction site. AIM To investigate the incidence of IH at extraction sites following laparoscopic colorectal cancer surgery and identify the risk factors for IH incidence. METHODS This study retrospectively analyzed the data of 1614 patients who underwent laparoscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022. Differences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated. RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery, 303 (18.8%), 923 (57.2%), 171 (10.6%), and 217 (13.4%) tumors were extracted through supraumbilical midline, infraumbilical midline, umbilical, and off-midline incisions. Of these, 52 patients developed IH in the abdominal wall, with an incidence of 3.2%. The incidence of postoperative IH was significantly higher in the off-midline incision group (8.8%) than in the middle incision groups [the supraumbilical midline (2.6%), infraumbilical midline (2.2%), and umbilical incision (2.9%) groups] (χ2 = 24.985; P < 0.05). Univariate analysis showed that IH occurrence was associated with age, obesity, sex, chronic cough, incision infection, and combined diabetes, anemia, and hypoproteinemia (P < 0.05). Similarly, multivariate analysis showed that off-midline incision, age, sex (female), obesity, incision infection, combined chronic cough, and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery (P < 0.05). CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery. The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.
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Affiliation(s)
- Bao-Hang Fan
- Second Clinical Medical College of Jinan University, Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Ke-Li Zhong
- Department of Gastrointestinal Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong Province, China
| | - Li-Jin Zhu
- Department of Radiation Oncology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong Province, China
| | - Zhao Chen
- Second Clinical Medical College of Jinan University, Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Fang Li
- Department of Gastrointestinal Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong Province, China
| | - Wen-Fei Wu
- Second Clinical Medical College of Jinan University, Jinan University, Shenzhen 518020, Guangdong Province, China
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Meyer J, Meyer E, Meurette G, Liot E, Toso C, Ris F. Robotic versus laparoscopic right hemicolectomy: a systematic review of the evidence. J Robot Surg 2024; 18:116. [PMID: 38466445 PMCID: PMC10927893 DOI: 10.1007/s11701-024-01862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
Robotics may facilitate the realization of fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis and off-midline extraction, when compared to laparoscopy. Our aim was to compare laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. MEDLINE was searched for original studies comparing laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. The systematic review complied with the PRISMA 2020 recommendations. Variables related to patients' demographics, surgical procedures, post-operative recovery and pathological outcomes were collected and qualitatively assessed. Two-hundred and ninety-three publications were screened, 277 were excluded and 16 were retained for qualitative analysis. The majority of included studies were observational and of limited sample size. When the type of anastomosis was left at surgeon's discretion, intra-corporeal anastomosis was favoured in robotic right hemicolectomy (4/4 studies). When compared to laparoscopy, robotics allowed harvesting more lymph nodes (4/15 studies), a lower conversion rate to open surgery (5/14 studies), a shorter time to faeces (2/3 studies) and a shorter length of stay (5/14 studies), at the cost of a longer operative time (13/14 studies). Systematic review of existing studies, which are mostly non-randomized, suggests that robotic surgery may facilitate fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis, and offer improved post-operative recovery.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland.
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland.
| | - Elin Meyer
- Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
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Zukiwskyj M, Nicol A, Heathcote P. Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter? J Robot Surg 2024; 18:61. [PMID: 38308726 DOI: 10.1007/s11701-023-01816-3] [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: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.
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Affiliation(s)
- Marianna Zukiwskyj
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Alice Nicol
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Peter Heathcote
- Greenslopes Hospital, Newdegate Street, Greenslopes, QLD, 4121, Australia
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Steen CJ, Wei MYK, Vadakkenchery Varghese E, Asghari-Jafarabadi M, Sansom W, Balakrishnan V, An V, Chandra R. Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study. ANZ J Surg 2024; 94:187-192. [PMID: 37749845 DOI: 10.1111/ans.18709] [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: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.
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Affiliation(s)
- Christopher J Steen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Y K Wei
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy Sansom
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Yang F, He F, Tang C, Chen D, Xiong J, Zou Y, Woraikat S, Qian K, Li H. Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy. Front Oncol 2024; 14:1320508. [PMID: 38333683 PMCID: PMC10851147 DOI: 10.3389/fonc.2024.1320508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Background Laparoscopic right hemicolectomy is a standard treatment modality for right colon cancer. However, performing intracorporeal anastomosis (IA) for totally laparoscopic right hemicolectomy (TLRH) remains a challenge for some surgeons. To simplify IA in TLRH we used self-pulling and latter transection (SPLT) reconstruction in TLRH, and compared this procedure with overlap IA and laparoscopy-assisted right hemicolectomy (LARH) in order to evaluate its safety and effectiveness. Methods Patients with right colon cancer who underwent SPLT-TLRH, TLRH with overlap IA or LARH between July 2019 and June 2023 were evaluated retrospectively. Basic information, oncological features, perioperative outcomes, and postoperative complications were compared between groups. Results In total, 188 patients with right colon cancer that underwent SPLT-TLRH (n = 60), TLRH(n=21) or LARH (n = 107) were included in the study. No patient required conversion to open surgery. The operation time in SPLT-TLRH group was significantly shorter than that in TLRH group (P<0.05). Compared with LARH group, SPLT-TLRH group had significantly longer distal margins, shorter skin incisions (P < 0.001), time to first flatus, time to first defecation, and postoperative hospital stays (P<0.05). Conclusion We introduced SPLT to TLRH. The SPLT-TLRH group demonstrated better short-term outcomes. Therefore, we believe that SPLT reconstruction is effective and safe in TLRH for right colon cancer, and can simplify reconstruction.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Grüter AAJ, Toorenvliet BR, Belgers EHJ, Belt EJT, van Duijvendijk P, Hoff C, Hompes R, Smits AB, van de Ven AWH, van Westreenen HL, Bonjer HJ, Tanis PJ, Tuynman JB. Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study). Br J Surg 2024; 111:znad404. [PMID: 38103184 PMCID: PMC10763527 DOI: 10.1093/bjs/znad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Substantial variation exists when performing a minimally invasive right hemicolectomy (MIRH) due to disparities in training, expertise and differences in implementation of innovations. This study aimed to achieve national consensus on an optimal and standardized MIRH technique for colon cancer and to develop and validate a video-based competency assessment tool (CAT) for MIRH. METHOD Statements covering all elements of MIRH were formulated. Subsequently, the Delphi technique was used to reach consensus on a standardized MIRH among 76 colorectal surgeons from 43 different centres. A CAT was developed based on the Delphi results. Nine surgeons assessed the same 12 unedited full-length videos using the CAT, allowing evaluation of the intraclass correlation coefficient (ICC). RESULTS After three Delphi rounds, consensus (≥80% agreement) was achieved on 23 of the 24 statements. Consensus statements included the use of low intra-abdominal pressure, detailed anatomical outline how to perform complete mesocolic excision with central vascular ligation, the creation of an intracorporeal anastomosis, and specimen extraction through a Pfannenstiel incision using a wound protector. The CAT included seven consecutive steps to measure competency of the MIRH and showed high consistency among surgeons with an overall ICC of 0.923. CONCLUSION Nationwide consensus on a standardized and optimized technique of MIRH was reached. The CAT developed showed excellent interrater reliability. These achievements are crucial steps to an ongoing nationwide quality improvement project (the Right study).
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Affiliation(s)
- Alexander A J Grüter
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Eric H J Belgers
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | | | - Christiaan Hoff
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Anke B Smits
- Department of Surgery, St.Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | - Hendrik J Bonjer
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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11
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Grüter AA, Sijmons JM, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review. ANNALS OF SURGERY OPEN 2023; 4:e343. [PMID: 38144490 PMCID: PMC10735091 DOI: 10.1097/as9.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence. Background High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients' postoperative and oncological outcomes. Methods A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication. Results Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites. Conclusion According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.
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Affiliation(s)
- Alexander A.J. Grüter
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Julie M.L. Sijmons
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Usha K. Coblijn
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Jurriaan B. Tuynman
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Grüter AAJ, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study). Tech Coloproctol 2023; 27:1083-1090. [PMID: 37097330 PMCID: PMC10562307 DOI: 10.1007/s10151-023-02801-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. METHODS The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien-Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. DISCUSSION The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. TRIAL REGISTRATION ClinicalTrials.gov: NCT04889456, May 2021.
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Affiliation(s)
- Alexander A J Grüter
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Usha K Coblijn
- Department of Surgery, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, The Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Surgery, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Park SH, Kim YN, Hwang J, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the da Vinci Single Port(SP) robotic system. Sci Rep 2023; 13:18578. [PMID: 37903856 PMCID: PMC10616185 DOI: 10.1038/s41598-023-45655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
Minimally invasive surgery reduces surgical trauma and the size and number of incisions. The da Vinci SP robotic surgical system was designed to overcome the technical demands of single-incision laparoscopic surgery. This study aimed to demonstrate the safety and feasibility of single-port (SP) robotic distal gastrectomy (SPRDG) for patients with gastric cancer using the da Vinci SP system (Intuitive Surgical Inc., Sunnyvale, CA, USA). This study was designed as a single-arm prospective phase I/II clinical trial of SPRDG (first posted date: 21/09/2021, NCT05051670; clinicaltrials.gov). SPRDG using the da Vinci SP system was performed on 19 patients with gastric cancer between December 2021 and October 2022. The primary outcome was the safety of SPRDG as measured by major postoperative complications. The secondary outcomes were operation time, bleeding amount, bowel motility recovery, and length of hospital stay. SPRDG was performed in all 19 patients without unexpected events, such as use of additional trocars or conversion to laparoscopic or open surgery. No major complications occurred postoperatively (0/19, 0.0%). The mean operation time was 218 min (range 164-286 min). The mean hospital stay duration was 3.2 days (range 2-4 days). This phase I/II clinical trial, performed by a single expert surgeon, demonstrated the safety and feasibility of SPRDG with the da Vinci SP system in selected patients with gastric cancer. SPRDG could be a reasonable alternative to conventional or reduced-port minimally invasive gastrectomy, as it has cosmetic advantages, early recovery, and safe discharge.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Youn Nam Kim
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea.
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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Kobayashi T, Miki H, Yamamoto N, Hori S, Hatta M, Hashimoto Y, Mukaide H, Yamasaki M, Inoue K, Sekimoto M. Retrospective study of an incisional hernia after laparoscopic colectomy for colorectal cancer. BMC Surg 2023; 23:314. [PMID: 37845691 PMCID: PMC10580507 DOI: 10.1186/s12893-023-02229-7] [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: 04/03/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE This study aimed to examine the incidence of incisional hernia (IH) in elective laparoscopic colorectal surgery (LC) using regulated computed tomography (CT) images at intervals every 6 months. METHODS We retrospectively examined the diagnosis of IH in patients who underwent LC for colorectal cancer at Kansai Medical University Hospital from January 2014 to August 2018. The diagnosis of IH was defined as loss of continuity of the fascia in the axial CT images. RESULTS 470 patients were included in the analysis. IH was diagnosed in 47 cases at 1 year after LC. The IH size was 7.8 cm2 [1.3-55.6]. In total, 38 patients with IH underwent CT examination 6 months after LC, and 37 were already diagnosed with IH. The IH size was 4.1 cm2 [0-58.9]. The IH size increased in 17 cases between 6 months and 1 year postoperatively, and in 1 case, a new IH occurred. 47%(18/38) of them continued to grow until 1 year after LC. A multivariate analysis was performed on the risk of IH occurrence. SSI was most significantly associated with IH occurrence (OR:5.28 [2.14-13.05], p = 0.0003). CONCLUSION IH occurred in 10% and 7.9% at 1 year and 6 months after LC. By examining CT images taken for the postoperative surveillance of colorectal cancer, we were able to investigate the occurrence of IH in detail.
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Affiliation(s)
- Toshinori Kobayashi
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hisanori Miki
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Nobuyuki Yamamoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Soushi Hori
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Masahiko Hatta
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yuki Hashimoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hiromi Mukaide
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan.
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Yao Q, Sun QN, Zhou JJ, Ma Y, Ren J, Wang LH, Wang DR. Robotic-assisted intracorporeal versus extracorporeal techniques in sigmoidectomy: a propensity score-matched analysis. J Robot Surg 2023; 17:2479-2485. [PMID: 37515681 DOI: 10.1007/s11701-023-01678-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
Scarce research has been performed to assess the safety and efficacy of anastomosis technique on robotic-assisted sigmoidectomy. This study was designed to evaluate the difference between intracorporeal and extracorporeal techniques during robotic-assisted sigmoidectomy. Clinical data of 193 cases who received robotic-assisted sigmoidectomy were retrospectively collected and analyzed. Only 116 cases were available for analysis (intracorporeal group = 58 and extracorporeal group = 58) after propensity score matching. Independent sample t test was conducted to evaluate the continuous variables. Moreover, the statistical significance of categorical variables was tested using Chi-square or Fisher's exact tests. Statistical analysis showed that the intracorporeal group demonstrated greater superiorities in pain scale on the first and second postoperative day (P < 0.05), time of catheter indwelling (P = 0.009), and length of hospital stay (P = 0.019). Additionally, the intracorporeal technique contributed to fewer complications including urinary retention (P = 0.027) and hernia (P = 0.037) than the extracorporeal group. Our analysis revealed that intracorporeal technique was safe and feasible due to the shorter time of catheter indwelling and length of hospital stay and fewer post-operation complications.
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Affiliation(s)
- Qing Yao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Qian-Nan Sun
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
- Medical Research Center of Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jia-Jie Zhou
- Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Yue Ma
- Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Liu-Hua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Dao-Rong Wang
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China.
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16
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Seow-En I, Khor SN, Koo CH, Wee IJY, Tan EKW. Transvaginal Natural Orifice Specimen Extraction (NOSE) in Laparoscopic Colorectal Cancer Surgery With New Insights on Technique and Patient Selection. Surg Laparosc Endosc Percutan Tech 2023; 33:571-575. [PMID: 37523505 DOI: 10.1097/sle.0000000000001208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Following laparoscopic colorectal surgery, transabdominal specimen extraction requires a mini-laparotomy or Pfannenstiel incision, associated with increased postoperative pain and wound complications. The vagina has several unique properties that make natural orifice specimen extraction (NOSE) ideal. We report our experience with transvaginal NOSE for colorectal cancer surgery. MATERIALS AND METHODS A transvaginal sizer allows the posterior vagina to be incised under tension. A transverse or cruciate incision is made, followed by the insertion of a double-ring wound protector. The external ring is opened against the perineum to shorten the length of the conduit for specimen delivery. Vaginotomy closure is performed via laparoscopy using a barbed suture. RESULTS Seventeen consecutive female patients underwent elective colorectal cancer surgery with attempted transvaginal NOSE. Median age and body mass index was 67 (range: 50 to 82) years and 26.5 (range: 19.7 to 35.8) kg/m 2 , respectively. Fourteen patients (82%) underwent left-sided resections and 3 (18%) underwent right-sided resections. Median operating time, blood loss, and length of hospital stay was 245 (range: 155 to 360) minutes, 30 (range: 10 to 500) mL, and 3 (range: 2 to 9) days, respectively. Transvaginal extraction was unsuccessful in 1 (6%) patient. Two (12%) patients experienced early postoperative morbidity, neither attributable to the extraction procedure. Median tumor circumferential diameter was 3.3 (range: 2.2 to 7.0) cm. Median follow-up duration was 17 (range: 8 to 27) months. There was no instance of sexual dysfunction. CONCLUSIONS Transvaginal NOSE for colorectal cancer surgery is feasible and safe in selected patients. Overall specimen diameter, inclusive of tumor and mesentery, relative to pelvic outlet and conduit diameter is the most important consideration for transvaginal NOSE.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Meyer J, Wijsman J, Crolla R, van der Schelling G. Implementation of totally robotic right hemicolectomy: lessons learned from a prospective cohort. J Robot Surg 2023; 17:2315-2321. [PMID: 37341877 PMCID: PMC10492732 DOI: 10.1007/s11701-023-01646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Robotics facilitates the realization of intra-corporeal anastomosis during right hemicolectomy and allows extracting the operative specimen through a C-section, offering potential benefits in terms of post-operative recovery and incidence of incisional hernia. Therefore, we progressively implemented robotic right hemicolectomy (robRHC) in our centre, and would like to report our initial experience with the technique. Consecutive patients who underwent robRHC within a single centre were prospectively included. Variables related to patients' demographics, surgical procedures, post-operative recovery and pathological outcomes were collected. Sixty patients underwent robRHC in our centre. Indications for robRHC were colon cancer in 58 patients (96.7%) and polyps not amenable to endoscopic resection in 2 patients (3.3%). Fifty-eight patients underwent robRHC with D2 lymphadenectomy and central vessel ligation (96.7%), and two patients (3.3%) had robRHC associated with another procedure. All patients had intra-corporeal anastomosis. The mean ± operative time was of 200.4 ± 114.9 min. Two conversions (3.3%) to open surgery were performed. The mean ± SD length of stay was of 5.4 ± 3.8 days. Seven patients (11.7%) experienced a post-operative complication with a Clavien-Dindo score ≥ 2. Two patients (3.5%) had an anastomotic leak. The mean ± SD number of harvested lymph nodes was of 22.4 ± 7.6. All patients had negative pathological margins (R0 resection). To conclude, robotic RHC is a safe procedure, which can be implemented with satisfying peri- and post-operative outcomes. The potential benefits of the technique remain to be demonstrated by randomized controlled trials.
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Affiliation(s)
- Jeremy Meyer
- Department of Surgery, Amphia Hospital, Molengracht 21, 4811GX, Breda, The Netherlands.
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.
| | - Jan Wijsman
- Department of Surgery, Amphia Hospital, Molengracht 21, 4811GX, Breda, The Netherlands
| | - Rogier Crolla
- Department of Surgery, Amphia Hospital, Molengracht 21, 4811GX, Breda, The Netherlands
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Meyer J, Wijsman J, Crolla R, Meurette G, Ris F, van der Schelling G. A comprehensive step-by-step approach for total robotic right hemicolectomy with intracorporeal anastomosis: A Video Vignette. Colorectal Dis 2023; 25:1732-1733. [PMID: 37203361 DOI: 10.1111/codi.16609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
- Medical School, University of Geneva, Geneva, Switzerland
| | - Jan Wijsman
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Rogier Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Medical School, University of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Medical School, University of Geneva, Geneva, Switzerland
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Iwamoto H, Matsuda K, Takifuji K, Tamura K, Mitani Y, Mizumoto Y, Nakamura Y, Sakanaka T, Yokoyama S, Hotta T, Yamaue H. Randomized controlled trial comparing cosmetic results of midline incision versus off-midline incision for specimen extraction in laparoscopic colectomy. Langenbecks Arch Surg 2023; 408:281. [PMID: 37460849 DOI: 10.1007/s00423-023-03018-9] [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: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE A notable advantage of laparoscopic colorectal surgery is that only a small incision at the extraction site is necessary, which is considered to be cosmetically beneficial. Meanwhile, the optimal extraction site for the resected specimen in laparoscopic colectomy is controversial in terms of cosmetic benefit. This randomized controlled trial compares midline and off-midline extraction sites in laparoscopic colectomy in patients with colon cancer, with consideration of cosmetic benefits as the primary endpoint. METHODS Included were patients that underwent elective laparoscopic colectomy at WMUH between October 2014 and February 2017. Patients were randomly assigned to either midline incision group or off-midline incision group. Prospectively collected data included cosmetic results (patients and observer assessment scale) and complications including incidence of incisional hernia, SSI, and pain. This trial was registered with UMIN Clinical Trials (UMIN000028943). RESULTS Finally, 98 patients with colorectal cancer were analyzed. No significant differences were found between the two groups in patient and observer assessment scales of cosmetic results (midline 8 ± 1.1 vs off-midline 11 ± 5.9 p = 0.16, midline 13.5 ± 6.6 vs off-midline 15 ± 11 p = 0.58, respectively) or in postoperative pain. However, incisional hernia occurred in four cases in the midline group (8%), which was significantly higher than that in the off-midline group (no cases, 0%). CONCLUSION There was no significant difference in terms of cosmetic benefit, the primary endpoint, between the two groups. In this study, only the extraction site location was compared; future studies will examine differences depending on the incisional direction, including the incidence of incisional hernia.
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Affiliation(s)
- Hiromitsu Iwamoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Katsunari Takifuji
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Koichi Tamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yasuyuki Mitani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yuki Mizumoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yuki Nakamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Toshihiro Sakanaka
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shozo Yokoyama
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Tsukasa Hotta
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
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Calini G, Abdalla S, Aziz MAAE, Behm KT, Shawki SF, Mathis KL, Larson DW. Incisional hernia rates between intracorporeal and extracorporeal anastomosis in minimally invasive ileocolic resection for Crohn's disease. Langenbecks Arch Surg 2023; 408:251. [PMID: 37382678 DOI: 10.1007/s00423-023-02976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE One-third of patients with Crohn's disease (CD) require multiple surgeries during their lifetime. So, reducing the incisional hernia rate is crucial. We aimed to define incisional hernia rates after minimally invasive ileocolic resection for CD, comparing intracorporeal anastomosis with Pfannenstiel incision (ICA-P) versus extracorporeal anastomosis with midline vertical incision (ECA-M). METHODS This retrospective cohort compares ICA-P versus ECA-M from a prospectively maintained database of consecutive minimally invasive ileocolic resections for CD performed between 2014 and 2021 in a referral center. RESULTS Of the 249 patients included: 59 were in the ICA-P group, 190 in the ECA-M group. Both groups were similar according to baseline and preoperative characteristics. Overall, 22 (8.8%) patients developed an imaging-proven incisional hernia: seven at the port-site and 15 at the extraction-site. All 15 extraction-site incisional hernias were midline vertical incisions [7.9%; p = 0.025], and 8 patients (53%) required surgical repair. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months (p = 0.037). The length of stay was lower in the intracorporeal anastomosis with Pfannenstiel incision group [ICA-P: 3.3 ± 2.5 vs. ECA-M: 4.1 ± 2.4 days; p = 0.02] with similar 30-day postoperative complication [11(18.6) vs. 59(31.1); p = 0.064] and readmission rates [7(11.9) vs. 18(9.5); p = 0.59]. CONCLUSION Patients in the ICA-P group did not encounter any incisional hernias while having shorter hospital length of stay and similar 30-day postoperative complications or readmission compared to ECA-M. Therefore, more consideration should be given to performing intracorporeal anastomosis with Pfannenstiel incision during Ileocolic resection in patients with CD to reduce hernia risk.
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Affiliation(s)
- Giacomo Calini
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Solafah Abdalla
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Sherief F Shawki
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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Takano Y, Kodera K, Tsukihara S, Takahashi S, Yasunobu K, Kanno H, Saito R, Hanyu N. The impact of sarcobesity on incisional hernia after laparoscopic colorectal cancer surgery. Int J Colorectal Dis 2023; 38:124. [PMID: 37165256 DOI: 10.1007/s00384-023-04424-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Incisional hernia is a common complication after abdominal surgery, especially in obese patients. The aim of the present study was to evaluate the relationship between sarcobesity and incisional hernia development after laparoscopic colorectal cancer surgery. METHODS In total, 262 patients who underwent laparoscopic colorectal cancer surgery were included in the present study. Univariate and multivariate analyses were performed to evaluate the independent risk factors for the development of incisional hernia. We then performed subgroup analyses to assess the impact of visceral obesity according to clinical variables on the development of incisional hernia in laparoscopic surgery for colorectal cancer surgery. RESULTS Forty-four patients (16.8%) developed incisional hernias after laparoscopic colorectal cancer surgery. In the univariate analysis, the development of incisional hernia was significantly associated with female sex (P = 0.046), subcutaneous obesity (P = 0.002), visceral obesity (P = 0.002), sarcobesity (P < 0.001), and wound infection (P < 0.001). In the multivariate analysis, sarcobesity (P < 0.001) and wound infection (P < 0.001) were independent predictors of incisional hernia. In subgroup analysis, the odds ratio of visceral obesity was the highest (13.1; 95% confidence interval [CI], 4.51-37.8, P < 0.001) in the subgroup of sarcopenia. CONCLUSION Sarcobesity may be a strong predictor of the development of incisional hernia after laparoscopic surgery for colorectal cancer, suggesting the importance of body composition in the development of incisional hernia.
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Affiliation(s)
- Yasuhiro Takano
- Department of Surgery, Tokyo General Hospital, Tokyo, Japan.
| | - Keita Kodera
- Department of Surgery, Kasai Shoikai Hospital, Tokyo, Japan
| | - Shu Tsukihara
- Department of Surgery, Tokyo General Hospital, Tokyo, Japan
| | | | | | - Hironori Kanno
- Department of Surgery, Tokyo General Hospital, Tokyo, Japan
| | - Ryota Saito
- Department of Surgery, Kasai Shoikai Hospital, Tokyo, Japan
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22
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. National survey of colorectal surgery units on abdominal wall closure. Cir Esp 2023; 101:258-264. [PMID: 36108954 DOI: 10.1016/j.cireng.2022.09.017] [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: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.
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Affiliation(s)
- Salvador Pous-Serrano
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Providencia García-Pastor
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Bueno-Lledó
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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23
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Bhattacharya P, Hussain MI, Zaman S, Mohamedahmed AY, Faiz N, Mashar R, Sarma DR, Peravali R. Comparison of Midline and Off-midline specimen extraction following laparoscopic left-sided colorectal resections: A systematic review and meta-analysis. J Minim Access Surg 2023; 19:183-192. [PMID: 37056082 PMCID: PMC10246630 DOI: 10.4103/jmas.jmas_309_22] [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: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
Aims This study aims to evaluate comparative outcomes following midline versus off-midline specimen extractions following laparoscopic left-sided colorectal resections. Methods A systematic search of electronic information sources was conducted. Studies comparing 'midline' versus 'off midline' specimen extraction following laparoscopic left-sided colorectal resections performed for malignancies were included. The rate of incisional hernia formation, surgical site infection (SSI), total operative time and blood loss, anastomotic leak (AL) and length of hospital stay (LOS) was the evaluated outcome parameters. Results Five comparative observational studies reporting a total of 1187 patients comparing midline (n = 701) and off-midline (n = 486) approaches for specimen extraction were identified. Specimen extraction performed through an off-midline incision was not associated with a significantly reduced rate of SSI (odds ratio [OR]: 0.71; P = 0.68), the occurrence of AL (OR: 0.76; P = 0.66) and future development of incisional hernias (OR: 0.65; P = 0.64) compared to the conventional midline approach. No statistically significant difference was observed in total operative time (mean difference [MD]: 0.13; P = 0.99), intraoperative blood loss (MD: 2.31; P = 0.91) and LOS (MD: 0.78; P = 0.18) between the two groups. Conclusions Off-midline specimen extraction following minimally invasive left-sided colorectal cancer surgery is associated with similar rates of SSI and incisional hernia formation compared to the vertical midline incision. Furthermore, there were no statistically significant differences observed between the two groups for evaluated outcomes such as total operative time, intra-operative blood loss, AL rate and LOS. As such, we did not find any advantage of one approach over the other. Future high-quality well-designed trials are required to make robust conclusions.
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Affiliation(s)
- Pratik Bhattacharya
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | | | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Ali Yasen Mohamedahmed
- Department of Colorectal Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - Nameer Faiz
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Ruchir Mashar
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Diwakar Ryali Sarma
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West Birmingham Hospitals, Birmingham, West Midlands, UK
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He Q, Huang J, Niu L, Zhai C. A comparison of the efficacy and safety of natural orifice specimen extraction and conventional laparoscopic surgery in patients with sigmoid colon/high rectal cancer. J Surg Oncol 2023; 127:1160-1166. [PMID: 36913188 DOI: 10.1002/jso.27235] [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: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the efficacy and safety of natural orifice specimen extraction surgery (NOSES) compared to conventional laparoscopic radical resection in the treatment of patients with sigmoid colon/high rectal cancer. METHODS The control group (n = 62) underwent traditional laparoscopic radical resection, and the observation group (n = 62) underwent transanal NOSES laparoscopic radical resection. The operation length; amount of bleeding; number of lymph node dissections and days of hospitalization after surgery; visual pain scores on the first and third days after surgery; first leaving bed, anal exhaust, eating a liquid diet, and effective sleep times; and the postoperative complications (abdominal or incision infection or anastomotic fistula) of the two groups of patients were compared and analyzed. RESULTS The effective sleep time of the observation group on the first day after the operation was 12.3 ± 2.9 h, which was longer than that of the control group (10.6 ± 3.2 h), and the difference was statistically significant (p < 0.001). The pain degree of the two groups on the third day after the operation was lower than that on the first day, and the pain score of the observation group was lower than that of the control group (2.0 ± 1.0 vs. 3.2 ± 1.2, p < 0.001). The postoperative hospital stay in the observation group was significantly shorter than that in the control group (9.7 ± 2.3 vs. 11.2 ± 2.6, p < 0.001). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (3.2% vs. 12.9%, p = 0.048). In addition, it was found that the first leaving bed, anal exhaust and liquid diet times in the observation group were significantly shorter than those in the control group (p < 0.001). CONCLUSION Laparoscopic radical resection NOSES in patients with sigmoid colon cancer or high rectal cancer leads to lower postoperative pain and longer sleep time than in patients who undergo traditional laparoscopic radical surgery. The complication rate of this procedure is low, and the curative effect is safe and positive.
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Affiliation(s)
- Qiang He
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Jing Huang
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Liyun Niu
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Chunbao Zhai
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
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Meyer J, Crolla R, van der Schelling G. Comment on: Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy: A Multicenter, Triple-Blind, Randomized Clinical Trial. ANNALS OF SURGERY OPEN 2023; 4:e241. [PMID: 37600889 PMCID: PMC10431322 DOI: 10.1097/as9.0000000000000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Jeremy Meyer
- From the Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Medical School, University of Geneva, Geneva, Switzerland
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26
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Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial. Trials 2023; 24:152. [PMID: 36855158 PMCID: PMC9976431 DOI: 10.1186/s13063-023-07162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Minimally invasive surgery has become popular as a surgical approach for colorectal cancer because it has fewer complications related to the abdominal incision and perioperative complications. However, the incidence of incisional hernias in laparoscopic surgery has been reported to be similar to that in open surgery. We developed a new method, the non-muscle-cutting periumbilical transverse incision, for a small incision in laparoscopic colon cancer surgery. This study aims to evaluate the effectiveness of the non-muscle-cutting periumbilical transverse incision in comparison with the midline incision in reducing the incidence of an incisional hernia in patients undergoing laparoscopic colon cancer surgery. METHODS This is an open-label, multi-centre, parallel, superiority, and randomised trial. Altogether, 174 patients will be allocated in a 1:1 ratio to either the midline incision or the non-muscle-cutting periumbilical transverse incision group, after stratifying by the location of the tumour (right- or left-sided). The primary outcome of this study is the incidence of incisional hernias (both symptomatic and radiologic hernias) at 12 months after surgery. The secondary outcomes include operative outcomes, 30-day postoperative complications, pathological results, and patient-reported outcomes (short form-12 health survey questionnaire and body image questionnaire). Both primary (intention-to-treat) and secondary (as-treated principles) analyses will be performed for all outcomes. The statistical significance level was set at p < 0.05 (two-sided testing). DISCUSSION This trial may show that the non-muscle-cutting periumbilical transverse incision will reduce the incidence of incisional hernias compared to the midline incision. TRIAL REGISTRATION Clinical Research Information Service (CRiS) of Republic of Korea, KCT0006082 . Registered on April 12, 2021.
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Calini G, Abdalla S, Aziz MAAE, Behm KT, Shawki SF, Mathis KL, Larson DW. Incisional Hernia rates between Intracorporeal and Extracorporeal Anastomosis in Minimally Invasive Ileocolic Resection for Crohn's disease.. [DOI: 10.21203/rs.3.rs-2591968/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Purpose: One-third of patients with Crohn’s disease (CD) require multiple surgeries during their lifetime. So, reducing the incisional hernia rate is crucial. We aimed to define incisional hernia rates after minimally invasive ileocolic resection for CD, comparing intracorporeal anastomosis with Pfannenstiel incision (ICA-P) versus extracorporeal anastomosis with midline vertical incision (ECA-M).
Methods: This retrospective cohort compares ICA-P versus ECA-M from a prospectively maintained database of consecutive minimally invasive ileocolic resections for CD performed between 2014 and 2021 in a referral center.
Results: Of the 249 patients included: 59 were in the ICA-P group, 190 in the ECA-M group. Both groups were similar according to baseline and preoperative characteristics. Overall, 22 (8.8%) patients developed an imaging-proven incisional hernia: seven at the port-site and 15 at the extraction-site. All 15 extraction-site incisional hernias were midline vertical incisions [7.9%; p=0.025], and 8 patients (53%) required surgical repair. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months (p =0.037). The length of stay was lower in the intracorporeal anastomosis with Pfannenstiel incision group [ICA-P: 3.3±2.5 vs. ECA-M: 4.1±2.4 days; p=0.02] with similar 30-day postoperative complication [11(18.6) vs. 59(31.1); p=0.064] and readmission rates [7(11.9) vs. 18(9.5); p=0.59].
Conclusion: Patients in the ICA-P group did not encounter any incisional hernias while having shorter hospital length of stay and similar 30-day postoperative complications or readmission compared to ECA-M. Therefore, more consideration should be given to performing intracorporeal anastomosis with Pfannenstiel incision during Ileocolic resection in patients with CD to reduce hernia risk.
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Ozawa H, Toyota N, Sakamoto J, Nakanishi H, Nakanishi R, Fujita S. Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today 2023:10.1007/s00595-022-02636-y. [PMID: 36656391 DOI: 10.1007/s00595-022-02636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE There is still insufficient discussion of the mid- to long-term safety of the intracorporeal anastomosis (IA) method of reconstruction after laparoscopic colectomy (LAC) for colon cancer. The present study clarified the postoperative mid-term results of IA based on recurrence and the incidence of incision hernia. METHODS This single-institution observational retrospective study included 268 patients with colon cancer who underwent IA or extracorporeal anastomosis (EA) after LAC at our institution between 2018 and 2021. The mid-term results of the IA group were compared with those of the EA group using a propensity score matching method. RESULTS The median follow-up periods were 36 and 25 months in the EA and IA groups, respectively (p < 0.0001). In this matched cohort study, the recurrence-free survival (RFS) rates were comparable between the IA and EA groups (each group, n = 72; 3-year RFS: IA, 92.1%; EA, 88.2%; hazard ratio, 0.78; 95% confidence interval, 0.25-2.40; p = 0.66). The cumulative incisional hernia rates were 9.8% and 9.9% (p = 0.99) for the IA and EA groups, respectively. CONCLUSION The safety of IA after LAC was demonstrated in this study, as IA after LAC showed good mid-term results, including with regard to the rates of recurrence and incisional hernia.
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Affiliation(s)
- Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan.
| | - Naoyuki Toyota
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Junichi Sakamoto
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Hiroki Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Ryo Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
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29
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Total 102 natural orifice specimen extraction following laparoscopic colorectal resections. Updates Surg 2023; 75:197-203. [PMID: 36319790 DOI: 10.1007/s13304-022-01412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/23/2022] [Indexed: 01/12/2023]
Abstract
Natural orifice surgery has been used with increasing frequency in colon surgeries since the early 2000's. Our aim was to examine the patients retrospectively who underwent Natural Orifice Specimen Excision (NOSE) following laparoscopic colorectal resection. A total of 102 patients 2013 and 2018 were evaluated. The demographic characteristics, intra-operative and post-operative findings, pathology results, pain, incontinence, sexual dysfunction and cosmetic scores were examined. Mean age was 57.0 ± 14 and 52 of them (51%) were female. Specimen extraction was transanal in 72 (70%) (eventration technique in 10 patients) and transvaginal in the remaining 30 patients. The mean operating time was 272 ± 108 (median 240, range 120-540) minutes, and the mean blood loss was 92 ± 87 ml (median 54, range 5-400). The mean hospital stay was 7.0 ± 4.7 days (median 6, range 3-30). The main pain scores (visual analog score) on days 1-2-3 were 3.9 ± 2.0 (median 4, range 1-9), 3.1 ± 1.7 (median 3, range 0-8), 1.9 ± 1.5 (median 1.5, range 0-7), respectively. The mean cosmetic scores were 9.1 ± 1.5 (median 10, range 3-10). The median Wexner Incontinence score was 0 (0-9). Hospital mortality was 1% and unrelated with the NOSE. The 5-year overall survival and disease-free survival rates for cancer patients were 77.2-63.3%, respectively. NOSE has advantages in laparoscopic colorectal resections. It increases patient comfort and decreases incision related complications. CLINICAL TRIALS: www.clinicaltrials.gov (NCT04394988).
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30
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Khor SN, Cheok SHX, Sultana R, Tan EKW. Incidence of incisional hernia after major colorectal cancer surgery & analysis of associated risk factors in Asian population: Is laparoscopy any better? Asian J Surg 2023; 46:99-104. [PMID: 35165026 DOI: 10.1016/j.asjsur.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/27/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Incisional hernia is one of the common morbidities after major colorectal cancer surgery. We aim to compare the incidence of incisional hernias between laparoscopic and open surgery. We also aim to identify associated risk factors of incisional hernia among Asian population who has undergone major resection for colorectal cancer. METHODS Data of patients who had undergone major colorectal cancer surgery in year 2015 from a single institution was collected. Data were extracted from electronic clinical records from our institution's database. Incisional hernias were identified by clinical examination and computed tomography (CT) scan performed during post-operative follow up as part of colorectal cancer surveillance. Follow up data of up to 3 years were extracted. Univariate and multivariable logistic regression analysis were performed to identify associated risk factors for development of incisional hernia. Propensity score matching analysis was performed for laparoscopic and open resection. RESULTS 502 patients were included in the study. With a minimum follow up of 3 years, overall incisional hernia incidence rate of 13% was identified. Incisional hernias after laparoscopic and open surgery were 12.3% and 13.8% (p = 0.688) respectively. Univariate logistic regression analysis showed that body mass index (BMI) of >23kg/m2, ASA of III/IV and post-operative anastomotic leak were associated with development of incisional hernias. On multivariable analysis, female gender (OR 2.102, 95%CI: 1.155, 3.826), BMI of ≥23 kg/m2 (OR 2.862 95%CI: 1.582, 5.181), ASA III/IV (OR 2.052, 95%CI: 1.169, 3.602), were significantly associated with development of incisional hernia. Propensity scores matched analysis showed laparoscopic surgery did not significantly reduce the incidence of incisional hernia. CONCLUSION The overall incidence of incisional hernia seems lower in Asian population. Our study demonstrated no significant difference in incisional hernia rates between patients undergoing laparoscopic versus open colorectal cancer surgery. Female gender, higher BMI, and higher ASA are associated with increased risk of developing incisional hernia after major colorectal cancer resection.
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Affiliation(s)
- Shao Nan Khor
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
| | - S H X Cheok
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
| | | | - Emile Kwong Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
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Smith L, Meggy A, Watts T, Knight L, Torkington J, Cornish J. Incisional hernia prevention: risk-benefit from a patient perspective (INVITE) - protocol for a single-centre, mixed-methods, cross-sectional study aiming to determine if using prophylactic mesh in incisional hernia prevention is acceptable to patients. BMJ Open 2022; 12:e069568. [PMID: 36585153 PMCID: PMC9809247 DOI: 10.1136/bmjopen-2022-069568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Incisional hernia (IH) is a common complication of abdominal surgery affecting between 10% and 20% of patients and is associated with significant morbidity along with cost to the National Health Service. With high recurrence rates following repair, focus must be on prevention of IH rather than cure. There is an increasing evidence that patients at high risk of developing IH may benefit from prophylactic mesh placement during their index operation. With recent controversy surrounding the use of mesh in the UK, however, there is little understanding of whether this intervention would be acceptable to patients. METHODS AND ANALYSIS INVITE is a mixed-methods, cross-sectional study to explore patient perceptions of the use of mesh as prophylaxis to prevent IH. Patients with and without IH who have undergone colorectal surgery between 2017 and 2020 in a single UK health-board will be approached to participate. 120 participants will be asked to complete a questionnaire and a subgroup of 24 participants will be invited to semistructured interviews. The primary outcome is to assess the acceptability of prophylactic mesh to patients. Secondary outcomes include understanding patients' knowledge of IH, and factors that may influence or alter the acceptability of mesh. Questionnaires have been developed using a 5-point Likert scale to allow quantitative analysis. Qualitative analysis of interviews will be conducted using NVivo software and thematic analysis. Data will be presented using the Journal Article Reporting Standards for mixed-methods research. ETHICS AND DISSEMINATION Ethical approval has been granted by REC Wales (22/PR/0678), and the study is currently in setup. All participants will be required to provide informed consent prior to their participation in the study. We plan to report the results of the study in peer-reviewed scientific and medical journals and via presentations at scientific meetings. Results from this study will aid the design of interventional trials using prophylactic mesh. TRIAL REGISTRATION NUMBER NCT05384600.
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Affiliation(s)
- Laurie Smith
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
- Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Alun Meggy
- Research and Development, Cardiff and Vale University Health Board, Cardiff, UK
| | - Tessa Watts
- School of Healthcare Science, Cardiff University, Cardiff, UK
| | - Laura Knight
- CEDAR Health Technology Research Centre, Cardiff, UK
| | - Jared Torkington
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Julie Cornish
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
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den Hartog FPJ, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF, Tanis PJ, Deerenberg EB. The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2022; 25:586-599. [PMID: 36545836 DOI: 10.1111/codi.16455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023]
Abstract
AIM Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). The aim of this study was to determine pooled incidence of IH for each type of extraction site and to compare rates of IH after midline, nonmidline and Pfannenstiel extraction. METHOD A systematic review and meta-analysis was conducted using the PRISMA guidelines. Single-armed and multiple-armed cohort studies and randomized controlled trials regarding minimally invasive colorectal surgery were searched from five databases. Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias within the studies was assessed using the Cochrane ROBINS-I and RoB 2 tool. RESULTS Thirty six studies were included, with a total 11,788 patients. The pooled extraction site IH rate was 16.0% for midline (n = 4081), 9.3% for umbilical (n = 2425), 5.2% for transverse (n = 3213), 9.4% for paramedian (n = 134) and 2.1% for Pfannenstiel (n = 1449). Nonmidline extraction (transverse and paramedian) showed significantly lower odds ratios (ORs) for IH when compared with midline extraction (including umbilical). Pfannenstiel extraction resulted in a significantly lower OR for IH compared with midline [OR 0.12 (0.50-0.30)], transverse [OR 0.25 (0.13-0.50)] and umbilical (OR 0.072 [0.033-0.16]) extraction sites. The risks of surgical site infection, seroma/haematoma or wound dehiscence were not significantly different in any of the analyses. CONCLUSION Pfannenstiel extraction is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid specimen extraction in the midline.
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Affiliation(s)
- Floris P J den Hartog
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sarah van Egmond
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marijn M Poelman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, Fortelny RH, Gök H, Harris HW, Hope W, Horne CM, Jensen TK, Köckerling F, Kretschmer A, López-Cano M, Malcher F, Shao JM, Slieker JC, de Smet GHJ, Stabilini C, Torkington J, Muysoms FE. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 2022; 109:1239-1250. [PMID: 36026550 PMCID: PMC10364727 DOI: 10.1093/bjs/znac302] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. METHODS A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. RESULTS Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. CONCLUSION These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
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Affiliation(s)
- Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Nadia A Henriksen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - George A Antoniou
- Department of Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros A Antoniou
- Mediterranean Hospital of Cyprus, Limassol, Cyprus.,Medical School, European University Cyprus, Nicosia, Cyprus
| | - Wichor M Bramer
- Medical Library, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - John P Fischer
- Department of Plastic Surgery, University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Rene H Fortelny
- Certified Hernia Center, Wilhelminenspital, Veinna, Austria.,Paracelsus Medical, University Salzburg, Salzburg, Austria
| | - Hakan Gök
- Hernia Istanbul®, Hernia Surgery Centre, Istanbul, Turkey
| | - Hobart W Harris
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - William Hope
- Department of Surgery, Novant/New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - Charlotte M Horne
- Department of Surgery, Penn State Health Department, Hershey, Pennsylvania, USA
| | - Thomas K Jensen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt-Hospital, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Alexander Kretschmer
- Klinikum der Ludwig-Maximillians-Universität München, Munchen, Germany.,Janssen Oncology, Los Angeles, CA, USA
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Unviversitat Autònoma de Barcelona, Barcelona, Spain
| | - Flavio Malcher
- Department of Surgery, NYU Langone Health/NYU Grossman School of Medicine, New York, New York, USA
| | - Jenny M Shao
- Division of Gastrointestinal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gijs H J de Smet
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Cesare Stabilini
- Department of Surgery, Policlinico San Martino IRCCS and Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Jared Torkington
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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34
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Xu S, Zhao X, He Z, Yang X, Ma J, Dong F, Zang L, Fingerhut A, Zhang L, Zheng M. A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis. Front Surg 2022; 9:963597. [PMID: 36406345 PMCID: PMC9666673 DOI: 10.3389/fsurg.2022.963597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background Laparoscopic colectomy is widely practiced for colon cancer, but many variations exist for anastomosis after laparoscopic colon cancer radical resection. Method We retrospectively analyzed 226 patients who underwent laparoscopic-assisted radical resection for left colon cancer with knotless hand-sewn end-to-end anastomosis (KHEA) technique with barbed V-loc™ suture material and compared perioperative outcomes, safety, and efficacy to those undergoing stapled anastomosis from 2010 to 2021. Results After the 1:2 propensity score matching, 123 participants with similar preoperative characteristics (age, body mass index, TNM stage, and tumor location) were enrolled in the study: 41 in the KHEA and 82 in the stapler group. Statistically significant differences were found in time to accomplish the anastomosis (mean 7.9 vs. 11.9 min, p < 0.001) and hospital costs (mean 46,569.71 vs. 50,915.35 CNY, p < 0.05) that differed between the KHEA and stapler group, respectively. No statistically significant difference was found in the mean delay to bowel function recovery (2.6 vs. 2.7 days, p = 0.466), duration of hospital stay (8.6 vs. 7.9 days, p = 0.407), or rate of postoperative complications (14.6% vs. 11.0%, p = 0.563). Anastomotic leakage occurred in 11 patients: 5 (12.2%) vs. 6 (7.3%) (p > 0.05) in the KHEA and stapler group, respectively. Conclusion KHEA is feasible and safe for anastomosis after laparoscopic left hemicolectomy. The KHEA technique could reduce operation time and hospital costs with complication rates comparable to stapling.
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Affiliation(s)
- Shining Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Dong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Section for Surgical Research and Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Luyang Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Minhua Zheng Luyang Zhang
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Minhua Zheng Luyang Zhang
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36
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McLemore EC, Lee L, Hedrick TL, Rashidi L, Askenasy EP, Popowich D, Sylla P. Same day discharge following elective, minimally invasive, colorectal surgery : A review of enhanced recovery protocols and early outcomes by the SAGES Colorectal Surgical Committee with recommendations regarding patient selection, remote monitoring, and successful implementation. Surg Endosc 2022; 36:7898-7914. [PMID: 36131162 PMCID: PMC9491699 DOI: 10.1007/s00464-022-09606-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND As enhanced recovery programs (ERPs) have continued to evolve, the length of hospitalization (LOS) following elective minimally invasive colorectal surgery has continued to decline. Further refinements in multimodal perioperative pain management strategies have resulted in reduced opioid consumption. The interest in ambulatory colectomy has dramatically accelerated during the COVID-19 pandemic. Severe restrictions in hospital capacity and fear of COVID transmission forced surgical teams to rethink strategies to further reduce length of inpatient stay. METHODS Members of the SAGES Colorectal Surgery Committee began reviewing the emergence of SDD protocols and early publications for SDD in 2019. The authors met at regular intervals during 2020-2022 period reviewing SDD protocols, safe patient selection criteria, surrogates for postoperative monitoring, and early outcomes. RESULTS Early experience with SDD protocols for elective, minimally invasive colorectal surgery suggests that SDD is feasible and safe in well-selected patients and procedures. SDD protocols are associated with reduced opioid use and prescribing. Patient perception and experience with SDD is favourable. For early adopters, SDD has been the natural evolution of well-developed ERPs. Like all ERPs, SDD begins in the office setting, identifying the correct patient and procedure, aligning goals and objectives, and the perioperative education of the patient and their supporting significant others. A thorough discussion with the patient regarding expected activity levels, oral intake, and pain control post operatively lays the foundation for a successful application of SDD programs. These observations may not apply to all patient populations, institutions, practice types, or within the scope of an existing ERP. However, if the underlying principles of SDD can be incorporated into an existing institutional ERP, it may further reduce the incidence of post operative ileus, prolonged LOS, and improve the effectiveness of oral analgesia for postoperative pain management and reduced opioid use and prescribing. CONCLUSIONS The SAGES Colorectal Surgery Committee has performed a comprehensive review of the early experience with SDD. This manuscript summarizes SDD early results and considerations for safe and stepwise implementation of SDD with a specific focus on ERP evolution, patient selection, remote monitoring, and other relevant considerations based on hospital settings and surgical practices.
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Affiliation(s)
- Elisabeth C McLemore
- Bernard J. Tyson Kaiser Permanente School of Medicine, Los Angeles Medical Center, Los Angeles, CA, 90027, USA.
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Colon and Rectal Surgery, Los Angeles Medical Center, 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA, 90027, USA.
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health, Charlottesville, VA, USA
| | | | - Erik P Askenasy
- Division of Colon and Rectal Surgery, University of Texas Health, Houston, TX, USA
| | - Daniel Popowich
- Division of Colon and Rectal Surgery, St. Francis Hospital, New York, NY, USA
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Al Dhaheri M, Ibrahim M, Al-Yahri O, Amer I, Khawar M, Al-Naimi N, Ahmed AA, Nada MA, Parvaiz A. Choice of specimen's extraction site affects wound morbidity in laparoscopic colorectal cancer surgery. Langenbecks Arch Surg 2022; 407:3561-3565. [PMID: 36219253 DOI: 10.1007/s00423-022-02701-7] [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: 01/05/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The choice for an ideal site of specimen extraction following laparoscopic colorectal surgery remains debatable. However, midline incision (MI) is usually employed for right and left-sided colonic resections while left iliac fossa or suprapubic transverse incision (STI) were reserved for sigmoid and rectal cancer resections. OBJECTIVE To compare the incidence of surgical site infection (SSI) and incisional hernia (IH) in elective laparoscopic colorectal surgery for cancer and specimen extraction via MI or STI. METHOD Prospectively collected data of elective laparoscopic colorectal cancer resections between January 2017 and December 2019 were retrospectively reviewed. MI was employed for right and left-sided colonic resections while STI was used for sigmoid and rectal resections. SSI is defined according to the US CDC criteria. IH was diagnosed clinically and confirmed by CT scan at 1 year. RESULTS A total of 168 patients underwent elective laparoscopic colorectal resections. MI was used in 90 patients while 78 patients had STI as an extraction site. Demographic and preoperative data is similar for two groups. The rate of IH was 13.3% for MI and 0% in the STI (p = 0.001). SSI was seen in 16.7% of MI vs 11.5% of STI (p = 0.34). Univariate and multivariate analysis showed that the choice of extraction site is associated with statistically significant higher incisional hernia rate. CONCLUSION MI for specimen extraction is associated with higher incidence of both SSI and IH. The choice of incision for extraction site is an independent predicative factor for significantly higher IH and increased SSI rates.
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Affiliation(s)
- Mahmood Al Dhaheri
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Mohanad Ibrahim
- General Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Omer Al-Yahri
- General Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ibrahim Amer
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mahwish Khawar
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Noof Al-Naimi
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | | | - Mohamed Abu Nada
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Amjad Parvaiz
- Colorectal Surgery Unit, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.,Champalimaud Foundation, Lisbon, Portugal
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Shimada G, Matsubara T, Sanbonmatsu M, Nakabayashi R, Miyachi Y, Taketa T, Suzuki A, Yokoi T, Kaido T. The first case of robotic-assisted transabdominal retrorectus repair for incisional hernia in Japan. Asian J Endosc Surg 2022; 16:305-311. [PMID: 36161525 DOI: 10.1111/ases.13131] [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: 07/04/2022] [Revised: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
Extraperitoneal mesh repair for ventral hernia has garnered attention and its rate has been increasing due to concerns for the potential complications of intraperitoneal mesh repair. Recently, robotic-assisted ventral hernia repair is highlighted as a solution to the technically demanding nature of laparoscopic transabdominal or enhanced-view totally extraperitoneal retrorectus ventral hernia repair. A 78-year-old man, who had undergone robot-assisted radical prostatectomy 10 months earlier, presented with an incisional hernia of European Hernia Society Classification M3W2, length 4 cm, width 5 cm with rectus diastasis. A right single-docking robotic-assisted transabdominal retrorectus repair was performed using a 21 by 14 cm self-gripping mesh and anterior wall reconstruction was done by 0 barbed nonabsorbable running suture. There were no complications and recurrence observed during a 7 months postoperative period. Single-docking robotic-assisted transabdominal retrorectus repair was considered a good option for midline moderate-size incisional hernias from the point of view of the ease of suturing, adequateness of dissection and prevention of bowel injury.
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Affiliation(s)
- Gen Shimada
- Hernia Center, St. Luke's International Hospital, Tokyo, Japan.,Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Taketo Matsubara
- Hernia Center, St. Luke's International Hospital, Tokyo, Japan.,Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Mariko Sanbonmatsu
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Rumi Nakabayashi
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yosuke Miyachi
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Taketa
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Akihiro Suzuki
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tadao Yokoi
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Toshimi Kaido
- Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan
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Lepiane P, Balla A, Licardie E, Saraceno F, Alarcón I, Scaramuzzo R, Guida A, Morales-Conde S. Extracorporeal Hand-Sewn vs. Intracorporeal Mechanic Anastomosis During Laparoscopic Right Colectomy. JSLS 2022; 26:JSLS.2022.00039. [PMID: 36071998 PMCID: PMC9385111 DOI: 10.4293/jsls.2022.00039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives To compare the outcomes of extracorporeal hand-sewn side-to-side isoperistaltic ileocolic anastomosis (EHSIA) versus intracorporeal mechanic side-to-side isoperistaltic ileocolic anastomosis (IMSIA) during laparoscopic right hemicolectomy for adenocarcinoma. Methods This is a retrospective propensity score-matched analysis of prospectively collected data. Fifty-four patients who underwent surgery with EHSIA (intervention group) were paired with 54 patients who underwent surgery with IMSIA (control group) based on patients' demographics and type of surgery (standard right hemicolectomy or extended right hemicolectomy). Results Fifty-four patients were included for each group. Statistically significant differences between groups were not observed in patients' demographics and type of surgery. Conversion occurred in three patients of the intervention group due to intra-abdominal adhesions for previous surgery (5.6%) (p = 0.079). Median operative time was statistically significant shorter in the control group in comparison to the intervention group (85 and 117.5 minutes, respectively, p ≤ 0.0001). In both groups one anastomotic leakage was observed (1.9%) (Clavien-Dindo grade III-a). In the control group one patient (1.9%) underwent reintervention for acute postoperative anemia (Clavien-Dindo grade III-b). Median number of harvested lymph-nodes was 17 and 12 (p ≤ 0.0001), in the intervention and the control group, respectively. Median hospital stay was statistically significant lower in the control group in comparison to the intervention group (5 and 6.5 days, respectively, p ≤ 0.013). Conclusion IMSIA showed lower operative time and hospital stay in comparison to EHSIA. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right hemicolectomy.
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Affiliation(s)
- Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain
| | - Rosa Scaramuzzo
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Anna Guida
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain
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40
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Inaguma G, Tajima Y, Hiro J, Hanai T, Katsuno H, Masumori K, Koide Y, Matsuoka H, Endo T, Kamiya T, Chong Y, Sato H, Maeda K, Uyama I, Suda K. Usefulness of laparoscopic right colectomy with intracorporeal anastomosis and preoperative weight reduction for ascending colon cancer in a severely obese patient. Asian J Endosc Surg 2022; 15:401-404. [PMID: 34935290 DOI: 10.1111/ases.13022] [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: 08/04/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
Obesity has been considered a risk factor for postoperative complications following colorectal cancer surgery. However, the usefulness of a combination of intracorporeal anastomosis and preoperative weight reduction for severely obese patients with colon cancer remains unclear. A 66-year-old man with a body mass index (BMI) of 43 kg/m2 presented with abdominal pain and iron deficiency anemia. Colonoscopy and computed tomography revealed advanced ascending colon cancer with regional lymph node metastasis and excessive abdominal fat. Preoperative diet-induced weight reduction was performed for severe obesity, which decreased his BMI to 39.7 kg/m2 after 1 month. Thereafter, curative resection was performed using intracorporeal anastomosis for reconstruction to achieve minimal colon and mesentery mobilization and a shorter incision. The patient was discharged from the hospital without complications. Laparoscopic right hemicolectomy combining intracorporeal anastomosis and preoperative weight reduction was extremely useful in the current patient with severe obesity and ascending colon cancer.
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Affiliation(s)
- Gaku Inaguma
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yosuke Tajima
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Gastrointestinal Surgery, Fujita Health University Okazaki Medical Center, Toyoake, Japan
| | - Koji Masumori
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Gastrointestinal Surgery, Fujita Health University Okazaki Medical Center, Toyoake, Japan
| | - Tadahiro Kamiya
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yongchol Chong
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Harunobu Sato
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Kotaro Maeda
- Fujita Health University Hospital International Medical Center, Toyoake, Japan
| | - Ichiro Uyama
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. Encuesta nacional a unidades de cirugía colorrectal sobre el cierre de pared abdominal. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Piozzi GN, Kim JS, Choo JM, Shin SH, Kim JS, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH. Da Vinci SP robotic approach to colorectal surgery: two specific indications and short-term results. Tech Coloproctol 2022; 26:461-470. [PMID: 35182278 DOI: 10.1007/s10151-022-02597-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Da Vinci® Single Port (dvSP) was recently developed. Its application in colorectal surgery is under investigation. The aim of this study was to explore the safety and feasibility of dvSP for intersphincteric (dvSP-ISR), right colectomy (dvSP-RC), and transverse colectomy (dvSP-TC). Surgical indication and short-term results were analyzed. METHODS All consecutive patients from a prospective database of patients who underwent dvSP-ISR, dvSP-RC, and dvSP-TC at Korea University Anam Hospital from November 2020 to December 2021, were analyzed. Perioperative, pathological, and oncological short-term outcomes were analyzed. RESULTS A total of 7 dvSP-ISR, 5 dvSP-RC, and 1 dvSP-TC were performed. Median age was 56.0 (55.0-61.0) years for the dvSP-ISR and 54.0 (44.7-63.5) years for the dvSP-RC/TC. Median body mass index was 22.8 (17.1-24.8) kg/m2 for the dvSP-ISR and 23.6 (20.8-26.9) kg/m2 for the dvSP-RC/TC. All dvSP-ISR patients received neoadjuvant long-course chemoradiotherapy, including one patient with squamocellular carcinoma who was treated with 5-fluorouracil (5-FU)/mitomycin. All other patients, excluding one dvSP-RC patient with Crohn's disease, had an adenocarcinoma. Median operation time was 280 (240-370) minutes for the dvSP-ISR and 220 (201-270) minutes for the dvSP-RC/TC. Estimated blood loss was insignificant. No intraoperative complications or conversions to multiport/open surgery was reported. Median post-operative stay was 7.0 (6.0-10.0) days for the dvSP-ISR and 5.0 (4.0-6.7) days for the dvSP-RC/TC. Quality of mesorectum was complete for six patients, and nearly complete for one. Median number of retrieved lymph nodes were 21 (17-25) for the dvSP-ISR and 28 (24-49) for the dvSP-RC/TC. Proximal and distal resection margins were tumor free. Four patients experienced post-operative complications not related to the platform which were: ileus, voiding dysfunction, infected pelvic hematoma, and wound infection. Median follow-up was 9 (6-11) months and 11 (7-17) months for the dvSP-ISR and dvSP-RC/TC, respectively. Two patients had systemic recurrence; all others were tumor free. CONCLUSIONS The dvSP platform is safe and feasible for intersphincteric resection with right lower quadrant access, and right/transverse colectomy with suprapubic access. Further studies are needed to evaluate benefit differences compared to multiport robotic platform.
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Affiliation(s)
- G N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J M Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Shin
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - T-H Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S-J Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-M Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Kim CH, Lee J, Lee SY, Heo SH, Jeong YY, Kim HR. Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery. World J Surg 2022; 46:916-924. [PMID: 35076822 DOI: 10.1007/s00268-021-06319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although off-midline incisions (unilateral low transverse or Pfannenstiel incision) have been reported to have a lower incidence of incisional hernia (IH) than periumbilical vertical incision for the purpose of specimen extraction, it is most commonly used in laparoscopic colon cancer surgery because off-midline incisions are associated with the limitation of colon exteriorization. This study aims to investigate the risk of IH after laparoscopic colectomy and compare midline vertical incision versus transverse incision focusing on the incidence of IH. METHODS Patients who underwent elective laparoscopic colectomy due to colon malignancy from June 2015 to May 2017 were included. All patients had either vertical (n = 429) or muscle splitting periumbilical transverse incisions (n = 125). RESULTS Median duration of the follow-up period was 23.6 months, during which IHs occurred in 12.1% patients. The incidence of hernia was significantly lower in the transverse group (3 vs. 64, 2.4% vs. 14.9%, p < 0.001). On multivariate analysis, BMI ≥ 23 [odds ratio (OR) 2.282, 95% confidence interval (CI) 1.245-4.182, p = 0.008], postoperative surgical site infection (OR 3.780, 95% CI 1.969-7.254, p < 0.001) and vertical incision (OR 7.113, 95% CI 2.173-23.287, p < 0.001) were independently related with increased incidence of IH. CONCLUSIONS A muscle splitting periumbilical transverse incision could significantly reduce the rate of IH in minimally invasive colon cancer surgery.
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Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea.
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Tschann P, Lechner D, Girotti PNC, Adler S, Rauch S, Presl J, Jäger T, Schredl P, Mittermair C, Szeverinski P, Clemens P, Weiss HG, Emmanuel K, Königsrainer I. Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery (SIL + 1 additional port)-is an umbilical midline approach really a problem? Langenbecks Arch Surg 2022; 407:1241-1249. [PMID: 35066629 DOI: 10.1007/s00423-021-02416-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Umbilical midline incisions for single incision- or reduced port laparoscopic surgery are still discussed controversially because of a higher rate of incisional hernia compared to conventional laparoscopic techniques. The aim of this study was to evaluate incidence and risk factors for incisional hernia after reduced port colorectal surgery. METHODS A total 241 patients underwent elective reduced port colorectal surgery between 2014 and 2020. Follow-up was achieved through telephone interview or clinical examination. The study collective was examined using univariate and multivariate analysis. RESULTS A total of 150 patients with complete follow-up were included into this study. Mean follow-up time was 36 (IQR 24-50) months. The study collective consists of 77 (51.3%) female and 73 (48.7%) male patients with an average BMI of 26 kg/m2 (IQR 23-28) and an average age of 61 (± 14). Indication for surgery was diverticulitis in 55 (36.6%) cases, colorectal cancer in 65 (43.3%) patients, and other benign reasons in 30 (20.0%) cases. An incisional hernia was observed 9 times (6.0%). Obesity (OR 5.8, 95% CI 1.5-23.1, p = 0.02) and pre-existent umbilical hernia (OR 161.0, 95% CI 23.1-1124.5, p < 0.01) were significant risk factors for incisional hernia in the univariate analysis. Furthermore, pre-existent hernia is shown to be a risk factor also in multivariate analysis. CONCLUSION We could demonstrate that reduced port colorectal surgery using an umbilical single port access is feasible and safe with a low rate of incisional hernia. Obesity and pre-existing umbilical hernia are significant risk factors for incisional hernia.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria.
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Paolo N C Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Stephanie Adler
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria
| | - Helmut G Weiss
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
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Al-Taher M, Okamoto N, Mutter D, Stassen LPS, Marescaux J, Diana M, Dallemagne B. International survey among surgeons on laparoscopic right hemicolectomy: the gap between guidelines and reality. Surg Endosc 2022; 36:5840-5853. [PMID: 35064320 PMCID: PMC8782220 DOI: 10.1007/s00464-022-09044-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/08/2022] [Indexed: 12/14/2022]
Abstract
Introduction To assess the current approaches and perioperative treatments of laparoscopic right hemicolectomy (LRHC) and to highlight similarities and differences with international guidelines and scientific evidence, we conducted a survey for surgeons across the globe. Methods All digestive and colorectal surgeons registered with the database of the Research Institute against Digestive Cancer (IRCAD) were invited to take part in the survey via email and through the social media networks of IRCAD. Results There were a total of 440 respondents from 78 countries. Most surgeons worked in the European region (38.6%) followed by the Americas (34.1%), the Eastern Mediterranean region (13.0%), the South-East Asian region (5.9%), the Western Pacific region (4.8%), and Africa (3.2%) respectively. Over half of the respondents performed less than 25% of right hemicolectomies laparoscopically where 4 ports are usually used by 68% of the surgeons. The medial-to-lateral, vessel-first approach is the approach most commonly used (74.1%). The most common extraction site was through a midline incision (53%) and an abdominal drain tube is routinely used by 52% of the surgeons after surgery. A total of 68.6% of the responding surgeons perform the majority of the anastomoses extracorporeally. Finally, we found that the majority of responders (60.7%) routinely used mechanical bowel preparations prior to LRHC. Conclusion Regarding several topics related to LRHC care, a discrepancy was observed between the current medical practice and the recommendations from RCTs and international guidelines and significant regional differences were observed. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09044-w.
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Ruiz-Tovar J, Boermeester MA, Bordeianou L, Chang GJ, Gorgun E, Justinger C, Lawson EH, Leaper DJ, Mahmoud NN, Mantyh C, McGee MF, Nfonsam V, Rubio-Perez I, Wick EC, Hedrick TL. Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery. J Am Coll Surg 2022; 234:1-11. [PMID: 35213454 PMCID: PMC8719508 DOI: 10.1097/xcs.0000000000000022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies have focused on the development and evaluation of care bundles to reduce the risk of surgical site infection (SSI) throughout the perioperative period. A focused examination of the technical/surgical aspects of SSI reduction during CRS has not been conducted. This study aimed to develop an expert consensus on intraoperative technical/surgical aspects of SSI prevention by the surgical team during colorectal surgery (CRS). STUDY DESIGN In a modified Delphi process, a panel of 15 colorectal surgeons developed a consensus on intraoperative technical/surgical aspects of SSI prevention undertaken by surgical personnel during CRS using information from a targeted literature review and expert opinion. Consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement. RESULTS In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements. The consensus panel supported the use of wound protectors/retractors, sterile incision closure tray, preclosure glove change, and antimicrobial sutures in reducing SSI along with wound irrigation with aqueous iodine and closed-incision negative pressure wound therapy in high-risk, contaminated wounds. CONCLUSIONS Using a modified Delphi method, consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking. This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS.
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Affiliation(s)
- Jaime Ruiz-Tovar
- From the Department of Surgery, Universidad Rey Juan Carlos, Madrid, Spain (Ruiz-Tovar)
| | - Marja A Boermeester
- the Department of Surgery, Free University Hospital, Amsterdam, The Netherlands (Boermeester)
| | - Liliana Bordeianou
- the Department of Surgery, Massachusetts General Hospital, Boston, MA (Bordeianou)
| | - George J Chang
- the Department of Colon and Rectal Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX (Chang)
| | - Emre Gorgun
- the Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH (Gorgun)
| | - Christoph Justinger
- the Department of General and Visceral Surgery, Klinikum Karlsruhe, Karlsruhe, Germany and Albert-Ludwigs-University Freiburg, Freiburg, Germany (Justinger)
| | - Elise H Lawson
- the Division of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, WI (Lawson)
| | - David J Leaper
- Emeritus Professor of Surgery, University of Newcastle, Newcastle upon Tyne, UK (Leaper)
| | - Najjia N Mahmoud
- the Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA (Mahmoud)
| | - Christopher Mantyh
- the Department of Surgery, Duke University Medical Center, Durham, NC (Mantyh)
| | - Michael F McGee
- the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (McGee)
| | - Valentine Nfonsam
- the Department of Surgery, University of Arizona, Tucson, AZ (Nfonsam)
| | - Ines Rubio-Perez
- the General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain (Rubio-Perez)
| | - Elizabeth C. Wick
- the Department of Surgery, University of California, San Francisco, San Francisco, CA (Wick)
| | - Traci L Hedrick
- the Department of Surgery, University of Virginia Health System, Charlottesville, VA (Hedrick)
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Clarke EM, Rahme J, Larach T, Rajkomar A, Jain A, Hiscock R, Warrier S, Smart P. Robotic versus laparoscopic right hemicolectomy: a retrospective cohort study of the Binational Colorectal Cancer Database. J Robot Surg 2021; 16:927-933. [PMID: 34709537 DOI: 10.1007/s11701-021-01319-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
Robotic right hemicolectomy (RRC) may have technical advantages over the conventional laparoscopic right colectomy (LRC) due to higher degrees of rotation, articulation, and tri-dimensional imaging. There is growing literature describing advantages of RRC compared to LRC; however, there is a lack of evidence about safety, oncologic quality of surgery and cost. This study aimed to analyse complication rates, length of stay and nodal harvest in patients undergoing minimally invasive right hemicolectomy for colon cancer from a prospective Australasian colorectal cancer database. This was a retrospective cohort study using nearest neighbour matching. The Binational Colorectal Cancer Audit (BCCA) provided the data for analysis. The primary outcome was length of stay. Secondary outcomes were harvested lymph node count, anastomotic leak, postoperative haemorrhage, abdominal abscess, postoperative ileus, wound infections and non-surgical complications. 4977 patients who underwent robotic (n = 146) or laparoscopic (n = 4831) right hemicolectomy for right-sided colon cancer were included. For RRC, LOS was shorter (5 vs 6.9 days, p = 0.01) and nodal harvest was higher (22 vs 19, p = 0.04). For RRC, surgical complications (5.9% vs 14.2%, p < 0.004) and non-surgical complications (4.6% vs 11.7%, p = 0.007) were lower though there was no difference in return to theatre or inpatient death. Robotic right hemicolectomy is associated shorter LOS and marginally higher lymph node count, though this may reflect anastomotic technique rather than surgical platform. Longer term studies are required to establish differences in overall survival, incisional hernia rates and cost effectiveness.
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Affiliation(s)
- Edward M Clarke
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.
| | - Jessica Rahme
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Tomas Larach
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Amrish Rajkomar
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
| | - Anshini Jain
- Department of Surgery, Eastern Health, Box Hill, Melbourne, VIC, 3128, Australia
| | - Richard Hiscock
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
| | - Philip Smart
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.,General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
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48
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Meyer J, Simillis C, Joshi H, Xanthis A, Ashcroft J, Buchs N, Ris F, Davies RJ. Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis. Int J Surg Protoc 2021; 25:216-219. [PMID: 34616959 PMCID: PMC8462477 DOI: 10.29337/ijsp.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery. The objective is to determine if the choice of extraction site modulates the incidence of incisional hernia (IH). Methods/design A systematic review will be performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase and CENTRAL will be searched to look for original studies reporting the incidence of IH after minimally invasive colorectal surgery. Studies will be excluded from the analysis if: 1) they do not report original data, 2) the outcome of interest (incidence of incisional hernia) is not clearly reported and does not allow to extrapolate and/or calculate the required data for network meta-analysis, 3) they include pediatric patients, 4) they include a patients' population with a conversion rate to laparotomy >10%, 5) they do not compare at least two different extraction sites for the operative specimen, 6) they report patients who underwent pure (and not hybrid) natural orifice transluminal endoscopic surgery (NOTES). Network meta-analysis will be performed to determine the incidence of IH per extraction site. Discussion By determining which specimen extraction site leads to reduced rate of IH, this systematic review and network meta-analysis will help colorectal surgeons to choose their extraction site and reduce the morbidity and costs associated with IH. Registration The systematic review and meta-analysis protocol is registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with number CRD42021272226. Highlights Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery, and the choice of the site may probably modulate the incidence of incisional hernia.The present protocol aims to design a systematic review which will identify original studies comparing two extraction sites during minimally invasive colorectal surgery in terms of incidence of incisional hernia.Network meta-analysis will be performed to determine the incidence of IH per extraction site.
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Affiliation(s)
- Jeremy Meyer
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB.,Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Constantinos Simillis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Heman Joshi
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Athanasios Xanthis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - James Ashcroft
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Nicolas Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
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Incisional hernia after minimally invasive gastrectomy in gastric cancer patients. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:84-90. [PMID: 35600790 PMCID: PMC8965979 DOI: 10.7602/jmis.2021.24.2.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/08/2022]
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50
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Simianu VV, Curran T, Gaertner WB, Sklow B, Kuntz KM, Kwaan MR, Madoff RD, Jensen CC. A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy. J Gastrointest Surg 2021; 25:1512-1523. [PMID: 32394122 DOI: 10.1007/s11605-020-04615-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic surgery is increasingly used for proctectomy, but the cost-effectiveness of this approach is uncertain. Robotic surgery is considered more expensive than open or laparoscopic approaches, but in certain situations has been demonstrated to be cost-effective. We examined the cost-effectiveness of open, laparoscopic, and robotic approaches to proctectomy from societal and healthcare system perspectives. METHODS We developed a decision-analytic model to evaluate one-year costs and outcomes of robotic, laparoscopic, and open proctectomy based on data from the available literature. The robustness of our results was tested with one-way and multi-way sensitivity analyses. RESULTS Open proctectomy had increased cost and lower quality of life (QOL) compared with laparoscopy and robotic approaches. In the societal perspective, robotic proctectomy costs $497/case more than laparoscopy, with minimal QOL improvements, resulting in an incremental cost-effectiveness ratio (ICER) of $751,056 per quality-adjusted life year (QALY). In the healthcare sector perspective, robotic proctectomy resulted in $983/case more and an ICER of $1,485,139/QALY. One-way sensitivity analyses demonstrated factors influencing cost-effectiveness primarily pertained to the operative cost and the postoperative length of stay (LOS). In a probabilistic sensitivity analysis, the cost-effective approach to proctectomy was laparoscopic in 42% of cases, robotic in 39%, and open in 19% at a willingness-to-pay (WTP) of $100,000/QALY. CONCLUSIONS Laparoscopic and robotic proctectomy cost less and have higher QALY than the open approach. Based on current data, laparoscopy is the most cost-effective approach. Robotic proctectomy can be cost-effective if modest differences in costs or postoperative LOS can be achieved.
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Affiliation(s)
- Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
| | - Thomas Curran
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bradford Sklow
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Karen M Kuntz
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Mary R Kwaan
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert D Madoff
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Christine C Jensen
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
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