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Noda A, Okuya K, Akizuki E, Miyo M, Ishii M, Miura R, Ichihara M, Toyota M, Ito T, Ogawa T, Kimura A, Takemasa I. A first report of right-hemicolectomy for ascending colon cancer in Japan with the da Vinci SP surgical robot system. Surg Case Rep 2024; 10:125. [PMID: 38771441 PMCID: PMC11109069 DOI: 10.1186/s40792-024-01922-w] [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: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The da Vinci SP robotic surgical system received regulatory approval for use in colorectal cancer surgery in Japan in April 2023. Given the advantages of the precision of a robot and the postoperative cosmesis of single-site surgery, the system is expected to be further utilized for minimally invasive surgeries, in addition to the curative and safety-assured laparoscopic technique. CASE PRESENTATION A 73-year-old man presented at our hospital with positive fecal occult blood. He was diagnosed with cT2N0M0 (Stage I) ascending colon cancer and underwent a right hemicolectomy, which was performed with the da Vinci SP system. The operation was performed safely, and the patient was discharged without complications. Pathology findings showed that complete mesocolic excision was achieved. CONCLUSIONS Herein, we report the first colorectal cancer surgery performed using the da Vinci SP system in Japan. The use of this robotic surgical system with access forms for right hemicolectomy is safe and oncologically appropriate.
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Affiliation(s)
- Ai Noda
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryo Miura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Momoko Ichihara
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Maho Toyota
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tatsuya Ito
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tadashi Ogawa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Akina Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 S1 W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan.
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ElSherbiney M, Khawaja AH, Noureldin K, Issa M, Varma A. Single incision laparoscopy versus conventional multiport laparoscopy for colorectal surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl 2023; 105:709-720. [PMID: 37843129 PMCID: PMC10618036 DOI: 10.1308/rcsann.2022.0132] [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] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION There has been an increase in colorectal cancer resections worldwide and in the UK. Initially conducted as an open procedure, this was replaced with the conventional multiport technique. Laparoscopic colectomy became the standard surgical technique in 1991. With innovation in surgical technology, single incision laparoscopy (SIL) has attracted more attention as the possible next step in colorectal resection. The aim of this review was to compare outcomes between SIL and conventional laparoscopy (CL). METHODS A literature search was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The PubMed®, MEDLINE®, Embase®, Google Scholar™ and Cochrane Library databases were used to extract randomised controlled trials (RCTs) published between January 2000 and May 2021. Statistical analysis was performed with RevMan software. RESULTS A total of 11 RCTs were extracted with 1,370 patients (686 SIL, 684 CL). There was no significant difference between SIL and CL for operative time (standardised mean difference [SMD]: 0.01, 95% confidence interval [CI]: -0.19 to 0.22, z=0.11, p=0.91), length of hospital stay (SMD: -0.10, 95% CI: 0.22 to 0.02, z=1.61, p=0.11) or overall complications (odds ratio [OR]: 0.99, 95% CI: 0.75 to 1.30, z=0.09, p=0.93). SIL had a shorter mean incision (SMD: -0.99, 95% CI: -1.35 to -0.62, z=5.25, p<0.00001). Patients undergoing SIL had a higher conversion rate to CL or an open approach (OR: 3.10, 95% CI: 0.95 to 10.14, z=1.87, p=0.06) but this just missed statistical significance. CONCLUSIONS SIL can be considered a safe alternative to CL if performed by experienced surgeons.
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Affiliation(s)
| | - A H Khawaja
- Nottingham University Hospitals NHS Trust, UK
| | - K Noureldin
- Wirral University Teaching Hospital NHS Foundation Trust, UK
| | - M Issa
- Dudley Group NHS Foundation Trust, UK
| | - A Varma
- United Lincolnshire Hospitals NHS Trust, UK
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Li FH, Zeng DX, Chen L, Xu CF, Tan L, Zhang P, Xiao JW. Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: A meta-analysis of randomized controlled trials and propensity-score matched studies. Front Oncol 2022; 12:997894. [PMID: 36324593 PMCID: PMC9621120 DOI: 10.3389/fonc.2022.997894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Single-incision laparoscopy surgery (SILS) is a new laparoscopic technique that has emerged in the past decade. Whether it has advantages over conventionl laparoscopy surgery (CLS) is inconclusive. This article aimed to compare the short- and long-term outcomes of single-incision laparoscopic surgery and conventional laparoscopic surgery for colorectal cancer through high-quality literature text mining and meta-analysis. Methods Relevant articles were searched on the PubMed, Embase, and Cochrane Library databases from January 2012 to November 2021. All data was from randomized controlled trials (RCTs) in order to increase the confidence of the analytical results.The main outcomes were intraoperative and postoperative complications. Results A total of 10 RCTs were included, involving 1609 patients. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the postoperative complications, operation time, postoperative hospital stay, number of lymph nodes removed, readmission, reoperation, complication level I- II, complication level IIIa, complication level IIIb, prolonged Ileus, blood loss, infection, anastomotic leakage and operation time. The results showed that SILS group had a higher rate of intraoperative complications, but it had lower incision length and better cosmetic effects. Conclusion These results indicate that SILS did not have a comprehensive and obvious advantage over the CLS. On the contrary, SILS has higher intraoperative complications, which may be related to the more difficulty of SILS operation, but SILS still has better cosmetic effects, which is in line with the concept of surgical development. Therefore, the SILS needs to be selected in patients with higher cosmetic requirements and performed by more experienced surgeons.
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Suo Lang DJ, Ci Ren YZ, Bian Ba ZX. Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas. World J Clin Cases 2021; 9:10919-10926. [PMID: 35047602 PMCID: PMC8678858 DOI: 10.12998/wjcc.v9.i35.10919] [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: 08/12/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon cancer is associated with a higher incidence among residents in high-altitude areas. Hypoxic environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes, thereby increasing the inflammatory factors, inhibiting the body’s innate immunity and increasing the risk of colon cancer.
AIM To examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas.
METHODS Ninety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method, with 46 patients in each group. Minimally invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy group. Operative conditions, inflammatory index pre- and post-surgery, immune function index and complication probability were measured.
RESULTS Operative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less (all P < 0.05) in the minimally invasive group than in the laparotomy group. The number of lymph nodes dissected was not significantly different. Before surgery, there were no significant differences in serum C-reactive protein, interleukin-6 and tumor necrosis factor-α levels between the groups, whereas after surgery, the levels were significantly higher in the minimally invasive group (26.98 ± 6.91 mg/L, 146.38 ± 11.23 ng/mL and 83.51 ± 8.69 pg/mL vs 41.15 ± 8.39 mg/L, 186.79 ± 15.36 ng/mL and 110.65 ± 12.84 pg/mL, respectively, P < 0.05). Furthermore, before surgery, there were no significant differences in CD3+, CD4+ and CD4+/CD8+ levels between the groups, whereas after surgery, the levels decreased in both groups, being significantly higher in the minimally invasive group (55.61% ± 4.39%, 35.45% ± 3.67% and 1.30 ± 0.35 vs 49.68% ± 5.33%, 31.21% ± 3.25% and 1.13 ± 0.30, respectively, P < 0.05). Complication probability was significantly lower in the minimally invasive group (4.35% vs 17.39%, P < 0.05).
CONCLUSION Laparoscopic minimally invasive procedures reduce surgical trauma and alleviate the inflammatory response and immune dysfunction caused by invasive operation. It also shortens recovery time and reduces complication probability.
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Affiliation(s)
- Duo-Ji Suo Lang
- Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lasa 850000, Tibet Autonomous Region, China
| | - Yang-Zhen Ci Ren
- Department of Internal Medicine, The Tibet Autonomous Region Centers for Disease Control and Prevention, Lasa 850000, Tibet Autonomous Region, China
| | - Zha-Xi Bian Ba
- Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lasa 850000, Tibet Autonomous Region, China
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Yuan Y, Jian J, Jing H, Yan R, You F, Fu X, Du L, Li W. Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis. Front Surg 2021; 8:704986. [PMID: 34497828 PMCID: PMC8419430 DOI: 10.3389/fsurg.2021.704986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Although the advantages of single-incision laparoscopic surgery have been reported in several meta-analyses, the low quality of studies included in the meta-analyses limits the reliability of such a conclusion. In recent years, the number of randomized controlled trials on the efficacy of SILS in colorectal cancer has been on the rise. This update systematic review and meta-analysis of RCTs aims to compare efficacy and safety of SILS and CLS in the patients with colorectal cancer. Methods: Relevant data was searched on the CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Cochrane CENTRAL databases from inception until February 5th, 2021. All RCTs comparing SILS and CLS were included. The main outcomes were 30 days of mortality, postoperative complications, intraoperative complications, whereas secondary outcomes were the number of lymph nodes removed, duration of hospital stay, intraoperative blood loss, abdominal incision length, reoperation, readmission, conversion to laparotomy, operation time and anastomotic leakage. Results: A total of 10 RCTs were included, involving 1,133 participants. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the 30 days mortality rate. The results showed that SILS group had a lower rate of postoperative complications (RR = 0.67, 95% CI: 0.49-0.92), higher rate of intraoperative complications (RR = 2.26, 95%CI: 1.00-5.10), shorter length of abdominal incision (MD = -2.01, 95% CI:-2.42-1.61) (cm), longer operation time (MD = 11.90, 95% CI: 5.37-18.43) (minutes), shorter hospital stay (MD = -1.12, 95% CI: -1.89-0.34) (days) compared with CLS group. However, intraoperative blood loss (MD = -8.23, 95% CI: -16.75-0.29) (mL), number of lymph nodes removed (MD = -0.17, 95% CI: -0.79-0.45), conversion to laparotomy (RR=1.31, 95% CI: 0.48-3.60), reoperation (RR = 1.00, 95% CI: 0.30-3.33) and readmission (RR =1.15, 95% CI: 0.12-10.83) and anastomotic leakage were not significantly different between the two groups. Conclusion: These results indicate that SILS did not has a comprehensive and obvious advantage over the CLS. Surgeons and patients should carefully weigh the pros and cons of the two surgical procedures. Further RCTs are needed to prove long-term outcomes of SILS in colorectal cancer.
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Affiliation(s)
- Ye Yuan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianing Jian
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hailiang Jing
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengming You
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linke Du
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Chengdu, China.,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Suzuki Y, Tei M, Wakasugi M, Nakahara Y, Naito A, Mikamori M, Furukawa K, Ohtsuka M, Moon JH, Imasato M, Asaoka T, Kishi K, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis. Surg Endosc 2021; 36:1027-1036. [PMID: 33638106 DOI: 10.1007/s00464-021-08367-4] [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: 10/11/2020] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Long-term outcomes of single-incision laparoscopic colectomy (SILC) for colon cancer (CC), as practiced in real-world settings, especially in relation to disease stage, have not been established. We examined, retrospectively, both short- and long-term outcomes of SILC versus those of multiport laparoscopic colectomy (MPLC) performed for CC in a propensity-score-matched cohort. METHODS The study involved 263 patient pairs matched 1:1 from among 691 patients who, between January 2008 and May 2014, underwent either SILC or MPLC for a primary solitary CC at our hospital. Short-term and long-term operative outcomes were compared between the two groups. RESULTS Operation time was the only surgical outcome that varied significantly between the two groups (p = 0.0004). Overall 5-year cancer-specific survival (CSS) in the SILC group was 93.7 (95% CI 89.6-96.2)%, and CSS per pathological stage (I, II and III) was 98.5 (90.0-99.8)%, 96.0 (88.2-98.7)%, and 88.3 (79.6-93.6)%, respectively, whereas overall 5-year CSS in the MPLC group was 93.3 (89.4-95.9)%, and CSS per pathological stage was 100%, 95.4 (88.3-98.3)%, and 84.1 (74.1-90.8)% (p = 0.5278, 0.2679, 0.7666, and 0.9073), respectively. Overall 3-year disease-free survival (DFS) in the SILC group was 94.0 (90.2-96.4)%, and 3-year DFS per pathological stage was 98.6 (90.4-99.8)%, 90.1 (81.4-95.0)%, and 79.0 (69.4-86.2)%, respectively, whereas overall 3-year DFS in the MPLC group was 93.2 (89.4-95.7)%, and 3-year DFS per pathological disease stage was 100%, 94.5 (87.4-97.7)% and 75.5 (64.7-83.8)% (p = 0.2829, 0.7401, 0.4335 and 0.8518), respectively. Thus, oncological outcomes did not differ significantly between groups. Incisional hernia occurred in 21 (8.0%) SILC group patients and 17 (6.5%) MPLC group patients, without a significant between-group difference (p = 0.6139). CONCLUSION Our data indicate that perioperative and oncological outcomes of SILC performed for CC are comparable to those of MPLC performed for CC.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Jeong Ho Moon
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
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