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Bianchi G, Gavriilidis P, Martínez-Pérez A, de’Angelis GL, Uzzan M, Sobhani I, Coccolini F, Schena CA, Carra MC, Spinoglio G, de’Angelis N. Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature. Front Surg 2022; 9:991704. [PMID: 36061042 PMCID: PMC9428340 DOI: 10.3389/fsurg.2022.991704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Robotic surgery has been progressively implemented for colorectal procedures but is still limited for multiquadrant abdominal resections. The present study aims to describe our experience in robotic multiquadrant colorectal surgeries and provide a systematic review and meta-analysis of the literature investigating the outcomes of robotic total proctocolectomy (TPC), total colectomy (TC), subtotal colectomy (STC), or completion proctectomy (CP) compared to laparoscopy. Methods At our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches. Results In our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04–0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42–190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7–59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing. Conclusions Our experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown.
Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022303016.
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Affiliation(s)
- Giorgio Bianchi
- Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
- Department of medicine and surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Paschalis Gavriilidis
- Department of surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
- Correspondence: Gian Luigi de'Angelis
| | - Mathieu Uzzan
- Department of Gastroenterology, APHP-Henri Mondor University Hospital, Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, APHP-Henri Mondor University Hospital, Creteil, France
- EC2M-EA7375 Research Team, Henri Modor Campus, Paris East University, Creteil, France
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Carlo Alberto Schena
- Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
| | | | - Giuseppe Spinoglio
- IRCAD Faculty Member Robotic and Colorectal Surgery-IRCAD, Strasbourg, France
| | - Nicola de’Angelis
- Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
- EC2M-EA7375 Research Team, Henri Modor Campus, Paris East University, Creteil, France
- University Paris-Est, UPEC, Créteil, France
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Parc Y, Klouche M, Bennis M, Lefèvre JH, Shields C, Tiret E. The continent ileostomy: an alternative to end ileostomy? Short and long-term results of a single institution series. Dig Liver Dis 2011; 43:779-83. [PMID: 21719365 DOI: 10.1016/j.dld.2011.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/17/2011] [Accepted: 05/24/2011] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Total proctocolectomy, ensuring eradication of all diseased colorectal mucosa is the treatment of choice for ulcerative colitis, familial adenomatous polyposis. Before the era of ileal pouch anal anastomosis, definitive ileostomy was required. The aim of this study is to define both early and late morbidity and the functional result of continent ileostomy. METHODS All patients' chart who had a continent ileostomy in our department were reviewed. The functional result was evaluated in 43 patients. RESULTS Forty-nine patients (34 women) with a mean age of 42 years (range: 17-69) underwent a continent ileostomy, 32 following a restorative proctocolectomy. The mean follow-up was 20.5 (range: 3-34) years. Seventeen patients (35%) experienced an early postoperative complication requiring reintervention in two patients. There was no mortality, and conversion to an end ileostomy was not required. Twenty-two patients developed late complications requiring 50 reoperations. The mean number of catheterisations per 24h was 4.4. The SF36 questionnaire showed values close to those of the general population. CONCLUSION Continent ileostomy carries a significant risk of non-severe complications. In selected patients, it represents a valuable alternative to an end ileostomy, in particular when restorative proctocolectomy has failed.
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Affiliation(s)
- Yann Parc
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
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