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Larkins K, Mohan H, Apte SS, Chen V, Rajkomar A, Larach JT, Smart P, Heriot A, Warrier S. A systematic review and meta-analysis of robotic resections for diverticular disease. Colorectal Dis 2022; 24:1105-1116. [PMID: 35723895 DOI: 10.1111/codi.16227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023]
Abstract
AIM Resection of diverticular disease can be technically challenging. Tissue planes can be difficult to identify intraoperatively due to inflammation or fibrosis. Robotic surgery may improve identification of tissue planes and dissection which can facilitate difficult minimally invasive resections. This systematic review and meta-analysis evaluates the role of robotic surgery compared to laparoscopic surgery in diverticular resection. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA statement. The search was completed using PubMed, OVID MEDLINE and EMBASE. A total of 490 articles were retrieved, and studies reporting primary outcomes for robotic diverticular resection were included in the final analysis. A meta-analysis of studies comparing robotic and laparoscopic surgery was performed on rate of conversion to open surgery and complications. RESULTS Fifteen articles (8 cohort studies and 7 case series) reporting 3711 robotic diverticular resections were analysed. In comparison to laparoscopic, robotic surgery for diverticular disease was associated with a reduced conversion to open and a longer operating time. Meta-analysis showed robotic resection was associated with a lower conversion rate compared to laparoscopic surgery (OR: 0.57; 95% CI: 0.49-0.66, p < 0.001). There was no significant difference in grade III and above complications (OR: 0.74; 95% CI: 0.49-1.13, p = 0.17). Operating time was longer with a robotic approach (Hedge's G: 0.43; 95% CI: 0.04-0.81, p = 0.03). CONCLUSION Robotic resection is a feasible and safe option in diverticular disease. Although associated with a longer operating time, robotic surgery may render diverticular disease resectable with a minimally invasive approach that would have otherwise necessitated a laparotomy. Randomised controlled data is required to better define the role of robotic surgery for diverticular disease resections.
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Affiliation(s)
- Kirsten Larkins
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Vicky Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amrish Rajkomar
- Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Colorectal Surgery, Epworth HealthCare, East Melbourne, Victoria, Australia
| | - Philip Smart
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Satish Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia
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Evolution and literature review of robotic general surgery resident training 2002-2018. Updates Surg 2018; 70:363-368. [PMID: 30054818 DOI: 10.1007/s13304-018-0573-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
The University of Illinois purchased their first da Vinci System in September of 2002. Within the first calendar year, their program began orienting trainees to the da Vinci Standard System to make its inclusion in their clinical training run more smoothly. During the ensuring 16 years, their program has evolved into more frequent resident orientations, lectures, and courses. The program has grown over the course of different versions of the da Vinci System. Currently, their program houses three Xi and two Si systems. Led by Dr. Crawford and Mr. Dwyer they have formalized their curriculum using a systematic progression of skill acquisition. The lecture will detail the program's organic development over the last 16 years. It will also explain the scientific measurement tools recently applied to the curriculum.
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Abstract
BACKGROUND Robotic surgery has potential advantages in rectal and pelvic surgery, in which the dissection is performed within a confined operative field. However, the position of robotic colonic surgery remains largely undefined with limited insight of whether it offers any potential advantages over open or laparoscopic colon surgery. OBJECTIVES The aim of this systematic review was to compare the short-term outcomes of the published robotic colonic surgery with those of laparoscopic colonic surgery. DATA SOURCES The search was performed in September 2012 with the use of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. The search terms used were "colorectal," "colon," "colectomy," and "robotic/robot." DATA SELECTION All studies reporting outcomes on robotic colonic resection were included in the review process. Colonic robotic data were compared with data on the short-term outcomes of laparoscopic colonic surgery from a Cochrane review and 4 main randomized controlled trials. INTERVENTIONS A comparison was conducted of robotic colonic surgery vs standard laparoscopic colonic surgery. MAIN OUTCOME MEASURES Short-term outcomes and the complication profile of colonic robotic surgery were compared with conventional multiple-port laparoscopic colonic surgery. RESULTS Fifteen robotic colonic surgery articles with 351 patients (173 males, 178 females) were considered for analysis. The operative time and financial cost of robotic colonic surgery was greater than standard laparoscopic colonic surgery with comparable short-term outcomes and early postoperative complications profile. CONCLUSIONS The present evidence on robotic colonic surgery has shown both feasibility and a safety profile comparable to standard laparoscopic colonic surgery. However, operative time and cost were greater in robotic colonic surgery, with no difference in the length of postoperative stay in comparison with standard laparoscopic colonic surgery. Whether the general surgical community should embark on a new learning curve for robotic colonic surgery can only be answered in the light of future studies.
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Alasari S, Min BS. Robotic colorectal surgery: a systematic review. ISRN SURGERY 2012; 2012:293894. [PMID: 22655207 PMCID: PMC3359666 DOI: 10.5402/2012/293894] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 01/10/2012] [Indexed: 01/05/2023]
Abstract
Aim. Robotic colorectal surgery may be a way to overcome the limitations of laparoscopic surgery. It is an emerging field; so, we aim in this paper to provide a comprehensive and data analysis of the available literature on the use of robotic technology in colorectal surgery. Method. A comprehensive systematic search of electronic databases was completed for the period from 2000 to 2011. Studies reporting outcomes of robotic colorectal surgery were identified and analyzed. Results. 41 studies (21 case series, 2 case controls, 13 comparative studies 1 prospective comparative, 1 randomized trial, 3 retrospective analyses) were reviewed. A total of 1681 patients are included in this paper; all of them use Da Vinci except 2 who use Zeus. Short-term outcome has been evaluated with 0 mortality and191 total major and minor complications. Pathological results were not analyzed in all studies and only 20 out of 41 provide data about the pathological results. Conclusion. Robotic surgery is safe and feasible option in colorectal surgery and a promising field; however, further prospective randomized studies are required to better define its role.
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Affiliation(s)
- Sami Alasari
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
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Schreuder HWR, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RHM. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 2011; 119:137-49. [PMID: 21981104 DOI: 10.1111/j.1471-0528.2011.03139.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. OBJECTIVES To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. SEARCH STRATEGY A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed. SELECTION CRITERIA We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism. DATA COLLECTION AND ANALYSIS Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation. MAIN RESULTS We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme. AUTHORS' CONCLUSIONS Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes.
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Affiliation(s)
- H W R Schreuder
- Division of Women and Baby, Department of Gynaecological Oncology, University Medical Centre Utrecht, The Netherlands.
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Kanji A, Gill RS, Shi X, Birch DW, Karmali S. Robotic-assisted colon and rectal surgery: a systematic review. Int J Med Robot 2011; 7:401-7. [PMID: 22113977 DOI: 10.1002/rcs.432] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/07/2011] [Accepted: 08/12/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Colorectal surgery is one of the most common procedures performed by general surgeons, with an increasing number being performed laparoscopically. Robotic technology is emerging in the ongoing evolution in minimally invasive surgery. This study systematically reviews the literature regarding the safety and feasibility of robotic-assisted colorectal surgery. METHODS A comprehensive search of electronic databases was completed for the period 2000 to 2010. Two independent reviewers assessed the studies for relevance and inclusion, and extracted data. RESULTS After an initial screen of 347 titles, 20 studies met the inclusion criteria. A total of 854 patients were included with a mean age of 61 years and a body mass index of 25.5 kg/m(2) . Major complications included 27 anastamotic leaks (27/766 = 3.5%), 10 post-operative bleeds (1.1%) and 14 post-operative infections (1.6%). There were no mortalities reported. CONCLUSIONS This systematic review demonstrates that robotic-assisted colorectal surgery is emerging as a safe and feasible option in colorectal surgery.
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Affiliation(s)
- Aliyah Kanji
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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One hundred and two consecutive robotic-assisted minimally invasive colectomies--an outcome and technical update. J Gastrointest Surg 2011; 15:1195-204. [PMID: 21604093 DOI: 10.1007/s11605-011-1549-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 04/18/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to review 102 consecutive robotic colectomies at our institution. We evaluated the 8-year experience of one surgeon (DLC) in Peoria, IL using the da Vinci system. METHODS An IRB-approved retrospective review was performed. Results were compared with the literature. Changes in technique over the years were evaluated. RESULTS One hundred and two robotic colectomies, right (59) and sigmoid (43), were performed. Mean age is 63.5 years and mean BMI 27.4 kg/m². Preoperative indications are polyps (53), diverticular disease (27), cancer (19), and carcinoid (3). Mean total case time (TCT) for all cases is 219.6 ± 45.1 (50-380) min, and mean robot operating time (ROT) is 126.6 ± 41.6 (12-306) min. Operative times for Right: Port setup time (PST) 32.4 ± 10.5 (20-64) min, ROT 145.2 ± 39.6 (53-306) min, TCT 212.3 ± 46.4 (50-380) min; times for sigmoid: PST 31.2 ± 9.6 (10-57) min, ROT 101.2 ± 29.2 (12-165) min, TCT 229.7 ± 41.6 (147-323) min. Median length of stay for all patients is 3 (2-27) days. The overall complication rate is 18.6%, the overall conversion rate 8.8%, and the anastomotic leak rate is 0.98%. Residents PGY 1-5 participated in 61 cases (59.8%). CONCLUSION We report our updated procedural sequence and technical alterations. Experience has allowed residents to evolve to be primary surgeons. We add our results to the current robotic literature.
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Huettner F, Dynda D, Ryan M, Doubet J, Crawford DL. Robotic-assisted minimally invasive surgery; a useful tool in resident training--the Peoria experience, 2002-2009. Int J Med Robot 2011; 6:386-93. [PMID: 20687050 DOI: 10.1002/rcs.342] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to review the use of robotic-assisted general surgery at our institution. We evaluated the 8 year experience of one minimally invasive surgery (MIS) fellowship-trained surgeon in Peoria, IL, performing 240 cases of foregut, colon, solid organ and biliary surgery using the da Vinci system, with resident assistance. Foregut and colon procedures are the fifth and sixth most commonly performed procedures of the senior author annually. METHODS An IRB-approved retrospective review of prospectively collected data representing 124 foregut and 102 colon operations was performed. Data analysed were procedure performed and indications for surgery, gender, age, body mass index (BMI), estimated blood loss (EBL), port set-up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions and resident involvement were recorded. Fourteen cases were excluded from the data review. Statistical analysis using the ANOVA test was applied. A specific review of resident participation was performed. RESULTS Times for 226 foregut and colon cases were: PST 31.2 ± 9.4 (range 10-64) min, ROT 119.3 ± 41.5 (range 12-306) min, and TCT 194.8 ± 50.3 (range 50-380) min. The EBL was 48.6 ± 55.0 (range 5-500) ml, BMI 28.5 ± 4.7 (range 15.4-46.8) kg/m(2) , and median LOS 2.0 (range 0-27) days. The overall complication rate was 13.3%. No deaths occurred. Over the 8 year study period the number of cases participated in by residents was 0, 16, 22, 15, 29, 26, 28 and 10 (as of June 2009), respectively. CONCLUSION This series demonstrates the technical feasibility and safety of robotic surgery for the foregut and colon in a clinical setting where the surgeon does far more of other types of MIS. This series compares favorably with the literature. Incorporation of robotic training in the curriculum has allowed residents to learn robotic techniques in an effective manner.
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Affiliation(s)
- Franziska Huettner
- Department of Surgery, University of Illinois College of Medicine at Peoria, IL 61606, USA
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