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de’Angelis N, Marchegiani F, Martínez-Pérez A, Biondi A, Pucciarelli S, Schena CA, Pellino G, Kraft M, van Lieshout AS, Morelli L, Valverde A, Lupinacci RM, Gómez-Abril SA, Persiani R, Tuynman JB, Espin-Basany E, Ris F. Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study. BJS Open 2024; 8:zrae044. [PMID: 38805357 PMCID: PMC11132137 DOI: 10.1093/bjsopen/zrae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/11/2024] [Accepted: 04/01/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME). METHODS Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival. RESULTS A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival. CONCLUSION In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.
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Affiliation(s)
- Nicola de’Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Annabel S van Lieshout
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alain Valverde
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Renato Micelli Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Segundo A Gómez-Abril
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eloy Espin-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frederic Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Tou S, Au S, Clancy C, Clarke S, Collins D, Dixon F, Dreher E, Fleming C, Gallagher AG, Gomez-Ruiz M, Kleijnen J, Maeda Y, Rollins K, Matzel KE. European Society of Coloproctology guideline on training in robotic colorectal surgery (2024). Colorectal Dis 2024; 26:776-801. [PMID: 38429251 DOI: 10.1111/codi.16904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Samson Tou
- Department of Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Derby, UK
| | | | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Steven Clarke
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Danielle Collins
- Department of Colorectal Surgery, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Frances Dixon
- Department of Colorectal Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Elizabeth Dreher
- Department of Urology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Christina Fleming
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | | | - Marcos Gomez-Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Yasuko Maeda
- Department of Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katie Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Klaus E Matzel
- Section of Coloproctology, Department of Surgery, University of Erlangen-Nürnberg, FAU, Erlangen, Germany
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Larkins K, Quirke N, Ong HI, Mohamed JE, Heriot A, Warrier S, Mohan H. The deconstructed procedural description in robotic colorectal surgery. J Robot Surg 2024; 18:147. [PMID: 38554192 PMCID: PMC10981632 DOI: 10.1007/s11701-024-01907-9] [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: 01/08/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024]
Abstract
Increasing robotic surgical utilisation in colorectal surgery internationally has strengthened the need for standardised training. Deconstructed procedural descriptions identify components of an operation that can be integrated into proficiency-based progression training. This approach allows both access to skill level appropriate training opportunities and objective and comparable assessment. Robotic colorectal surgery has graded difficulty of operative procedures lending itself ideally to component training. Developing deconstructed procedural descriptions may assist in the structure and progression components in robotic colorectal surgical training. There is no currently published guide to procedural descriptions in robotic colorectal surgical or assessment of their training utility. This scoping review was conducted in June 2022 following the PRISMA-ScR guidelines to identify which robotic colorectal surgical procedures have available component-based procedural descriptions. Secondary aims were identifying the method of development of these descriptions and how they have been adapted in a training context. 20 published procedural descriptions were identified covering 8 robotic colorectal surgical procedures with anterior resection the most frequently described procedure. Five publications included descriptions of how the procedural description has been utilised for education and training. From these publications terminology relating to using deconstructed procedural descriptions in robotic colorectal surgical training is proposed. Development of deconstructed robotic colorectal procedural descriptions (DPDs) in an international context may assist in the development of a global curriculum of component operating competencies supported by objective metrics. This will allow for standardisation of robotic colorectal surgical training and supports a proficiency-based training approach.
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Affiliation(s)
- Kirsten Larkins
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Ned Quirke
- University College Dublin School of Medicine, Dublin, Ireland
| | - Hwa Ian Ong
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
- Department of Colorectal Surgery, Austin Health, Heidelberg, Australia.
| | - Jade El Mohamed
- International Medical Robotics Academy, North Melbourne, VIC, Australia
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Satish Warrier
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Department of Colorectal Surgery, Alfred Health, Melbourne, VIC, Australia
| | - Helen Mohan
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Department of Colorectal Surgery, Austin Health, Heidelberg, Australia
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Frego N, Ruvolo CC, Mottrie A. Opening up the Market to New Robotic Platforms: The Best Way To Handle New Options. Eur Urol 2024; 85:190-192. [PMID: 37394406 DOI: 10.1016/j.eururo.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Nicola Frego
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudia Collà Ruvolo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
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Vaughan-Shaw PG, Joel AS, Farah M, Ofoezie F, Harji D, Liane M, Choudhary S, Royle JT, Holtham S, Farook G. Evaluation of an established colorectal robotic programme at an NHS district general hospital: audit of outcomes and systematic review of published data. Langenbecks Arch Surg 2023; 408:416. [PMID: 37874420 DOI: 10.1007/s00423-023-03152-4] [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: 01/11/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Robotic-assisted surgery (RAS) offers potential advantages over traditional surgical approaches. This study aimed to assess outcomes from a district general hospital (DGH) robotic colorectal programme against published data. MATERIALS AND METHODS The robotic programme was established following simulator, dry/wet lab training, and proctoring. We performed a case series analysing technical, patient, and oncological outcomes extracted from a prospective database of colorectal RAS cases (2015-2022). A registered systematic review (PROSPERO CRD42022300773; PubMed, Web of Science, EMBASE) of single-centre colorectal series from established robotic centres (n>200 cases) was completed and compared to local data using descriptive summary statistics. Risk of bias assessment was performed using an adapted version of the Cochrane ROBINS-I tool. RESULTS Two hundred thirty-two RAS cases were performed including 122 anterior resections, 56 APERs, 19 rectopexies, and 15 Hartmann's procedures. The median duration was 325 (IQR 265-400) min. Blood loss was < 100 ml in 97% of cases with 2 (0.9%) cases converted to open. Complications (Clavien-Dindo 3-5) occurred in 19 (8%) patients, with 3 (1.3%) deaths in < 30 days. Length of stay was 7 (IQR 5-11) days. In 169 rectal cancer cases, there were 9 (5.3%) cases with a positive circumferential or distal margin and lymph node yield of 17 (IQR 13-24). A systematic review of 1648 abstracts identified 13 studies from established robotic centres, totaling 4930 cases, with technical, patient, and oncological outcomes comparable to our own case series. CONCLUSIONS Outcomes from our robotic colorectal programme at a UK DGH are comparable with the largest published case series from world-renowned centres. Training and proctoring together with rolling audit must accompany the expansion of robotic surgery to safeguard outcomes.
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Affiliation(s)
| | - Abraham S Joel
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Mohamed Farah
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Frank Ofoezie
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Deena Harji
- Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK
| | - Maren Liane
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Saif Choudhary
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - James T Royle
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Stephen Holtham
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
| | - Golam Farook
- Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK.
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Zaepfel S, Marcovei R, Fernandez-de-Sevilla E, Sourrouille I, Honore C, Gelli M, Faron M, Benhaim L. Robotic-assisted surgery for mid and low rectal cancer: a long but safe learning curve. J Robot Surg 2023; 17:2099-2108. [PMID: 37219783 DOI: 10.1007/s11701-023-01624-9] [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: 02/13/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
The number of robotic-assisted procedures for rectal cancer is rising. The risk of this procedure when performed by surgeon with limited robotic experience is unknown and the precise duration of the learning curve debated. We, therefore, aimed to analyze the learning curve and its related safety in a single center before the development of mentoring programs. We prospectively recorded all robotic procedures performed for colorectal cancer between 2015 and 2020 by a single surgeon. Operative times for partial and total proctectomy were analyzed. The learning curve was defined by comparison with the standard duration of the laparoscopic procedure performed in expert centers (published in GRECCAR 5 and GRECCAR 6 trials) and calculated using a cumulative summation for learning curve test (LC-CUSUM). Among the 174 patients operated for colorectal cancer, we analyzed the outcomes of the 89 patients operated by partial and total robotic proctectomy. To reach repeatedly the same surgical duration as laparoscopic procedure for partial or complete proctectomy, the LC-CUSUM identified a learning curve of 57 patients. A severe morbidity in this population, defined by Clavien-Dindo classification ≥ 3, was observed in 15 cases (16.8%) with an anastomotic leak rate of 13.5%. The rate of completeness of mesorectal excision was 90% and the mean number of harvested lymph nodes was 15 (± 9). Using operative time as end-point, the learning curve of rectal cancer robotic surgery identified a cut-off of 57 patients. The technic remained safe with acceptable morbidity and oncological outcomes.
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Affiliation(s)
- Sophie Zaepfel
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Raluca Marcovei
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Elena Fernandez-de-Sevilla
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Isabelle Sourrouille
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Charles Honore
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France
| | - Leonor Benhaim
- Department of Surgical Oncology, Gustave Roussy Cancer Center, 39 rue Camille Desmoulins, 94800, Villejuif, France.
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Equipe Labellisée Ligue Nationale Contre le Cancer, CNRS SNC 5096, 15 rue de l'école de Médecine, 75006, Paris, France.
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Fleming C, Fernandez B, Boissieras L, Cauvin T, Denost Q. Integrating a tumour appropriate transanal or robotic assisted approach to total mesorectal excision in high-volume rectal cancer practice is safe and cost-effective. J Robot Surg 2023; 17:1979-1987. [PMID: 37099264 DOI: 10.1007/s11701-023-01577-z] [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: 07/07/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
Total mesorectal excision (TME) is accepted as the gold standard for oncological resection in rectal cancer. The best approach to TME is debated and often surgeons will select a preferred approach. In this study, we aimed to describe how both robotic (R-TME) and transanal (TaTME) TME can be integrated into high-volume rectal cancer surgeon practice with a comparison of clinical and oncological outcomes and cost analysis. A prospective comparative cohort study was performed in a high-volume rectal cancer centre comparing the previous 50 R-TME and 50 TaTME performed by the same surgeon. A comparison of tumour characteristics was performed to highlight a specific role for each technique. Clinical outcomes (operative duration, length of stay (LOS) and perioperative morbidity), cancer quality indicators (resection margin and completeness of TME) and cost analysis were compared. Statistical analysis was performed using IBM SPSS, version 20. R-TME was preferred in mid-rectal cancer, compared to TaTME preferred in low rectal cancer (9 cm vs. 5 cm, p < 0.001). Operative duration was longer in R-TME compared to TaTME (265 vs. 179 min, p < 0.001). Major complications (CD III-IV complications) were experienced in 10% of R-TME and 14% of TaTME (p = 0.476). A 98% (n = 49) clear R0 resection margin was achieved with both R-TME and TaTME and mesorectum quality defined as 'complete' in 86% (n = 43) in R-TME and 82% (n = 41) in TaTME. Length of hospital stay was shorter in R-TME (5 vs. 7 days, p = 0.624). An overall difference of €131 was observed favouring TaTME. In high-volume rectal cancer surgery practice, both R-TME and TaTME can be practised and tailored according to patients and tumour characteristics, with comparable clinical and cancer outcomes and is cost-effective.
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Affiliation(s)
| | | | - Lara Boissieras
- Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France
| | - Thomas Cauvin
- Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, 220 Rue Mandron, 33000, Bordeaux, France.
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Azevedo JM, Panteleimonitis S, Mišković D, Herrando I, Al-Dhaheri M, Ahmad M, Qureshi T, Fernandez LM, Harper M, Parvaiz A. Textbook Oncological Outcomes for Robotic Colorectal Cancer Resections: An Observational Study of Five Robotic Colorectal Units. Cancers (Basel) 2023; 15:3760. [PMID: 37568576 PMCID: PMC10417291 DOI: 10.3390/cancers15153760] [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: 04/23/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the 'desirable' or 'ideal' postoperative clinical and oncological outcomes from both a patient's and doctor's point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. METHODS We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized-no conversion to open, no complication with a Clavien-Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of "ideal" practice called textbook oncological outcomes. RESULTS A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. CONCLUSIONS Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.
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Affiliation(s)
- José Moreira Azevedo
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal
| | - Sofoklis Panteleimonitis
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
- St. Mark’s Hospital, London NW10 7NS, UK;
| | | | - Ignacio Herrando
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
| | | | - Mukhtar Ahmad
- Poole Hospital NHS Trust, Longfleet Road, Poole BH15 2JB, UK; (M.A.); (T.Q.)
| | - Tahseen Qureshi
- Poole Hospital NHS Trust, Longfleet Road, Poole BH15 2JB, UK; (M.A.); (T.Q.)
| | | | - Mick Harper
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
| | - Amjad Parvaiz
- Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal (L.M.F.); (A.P.)
- School of Health and Care Professions, University of Portsmouth, St. Andrews Court, St. Michael’s Road, Portsmouth PO1 2PR, UK;
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Wang Y, Wang L, Liang M, Xu Z, Xue Y, Liu G. Verification of blood flow path reconstruction mechanism in distal sigmoid colon and rectal cancer after high IMA ligation through preoperative and postoperative comparison by manual subtraction CTA. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1269-1274. [PMID: 36658053 DOI: 10.1016/j.ejso.2023.01.012] [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: 11/27/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We aimed to investigate manual subtraction computed tomography angiography (MS-CTA) to further confirm the distribution and classification of LCA (left colic artery) ascending/descending branches, then observe the postoperative blood flow path to illustrate how the above branches evolved to postoperative blood path. MATERIAL AND METHODS 89 patients with distal sigmoid and rectal cancer were referred in our observation and underwent MS-CTA between June 2020 and March 2022. We classified the distribution of LCA and confirmed whether there exists AMCA (accessory middle colic artery). Then we planned blood flow path based on the classification of LCA branches before operation. High ligation was applied in regular radical surgery. During operation, we carefully protect the bifurcation of ascending and descending LCA. Then we compared the planned blood flow path with the actual postoperative blood flow path to verify the mechanism we proposed previously. RESULTS Of 89 patients, 82 cases met our criteria, we summarized 6 distribution pattens of LCA ascending and descending branches. These preoperative pattens are consistent with the inspection during operation. The postoperative blood flow path of 6 pattens is evolved from the above adjacent anastomotic branches and is consistent with the planned blood flow path. We also found 2 cases with IMA stenosis and 1 case with SMA stenosis under pathological condition, and their compensatory blood flow path is in accordance with our theory. The rate of the anastomotic leakage in our study group is relatively low (7.3%). CONCLUSION MS-CTA could confirm the distribution of LCA and AMCA, display accurate postoperative blood reconstruction path after IMA high ligation, and it further verified the mechanism we proposed previously, which is the proximal anastomotic branches forming new blood flow path from high-pressure area to the low-pressure area. This mechanism might be helpful for performing accurate laparoscopic sigmoid and rectal cancer surgery.
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Affiliation(s)
- Ying Wang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Lei Wang
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Manfei Liang
- Medical Science and Technology Innovation Center, Shandong First Medical University, Jinan, Shandong, PR China
| | - Zhongkai Xu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Yiheng Xue
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Guoqin Liu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China.
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10
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Harji D, Houston F, Burke J, Griffiths B, Tilney H, Miskovic D, Evans C, Khan J, Soomro N, Bach SP. The current status of robotic colorectal surgery training programmes. J Robot Surg 2023; 17:251-263. [PMID: 35657506 DOI: 10.1007/s11701-022-01421-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
Robotic-assisted colorectal surgery (RACS) is steadily increasing in popularity with an annual growth in the number of colorectal procedures undertaken robotically. Further upscaling of RACS requires structured and standardised robotic training to safeguard high-quality clinical outcomes. The aims of this systematic review were to assess the structure and assessment metrics of currently established RACS training programmes. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was performed. Searches were performed of the Ovid Medline, Embase and Web of Science databases between 2000 and 27th November 2021 to identify studies reporting on training curricula in RACS. Core components of training programmes and their relevant outcome assessment metrics were extracted. Thirteen studies were identified, with all training programmes designed for the da Vinci platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Common elements of multimodal programmes included theoretical knowledge (76.9%), case observation (53.8%), simulation (100%) and proctored training (76.9%). Robotic skills acquisition was assessed primarily during the simulation phase (n = 4, 30.1%) and proctoring phase (n = 10, 76.9%). Performance metrics, consisting of time or assessment scores for VR simulation were only mandated in four (30.1%) studies. Objective assessment following proctored training was variably reported and employed a range of assessment metrics, including direct feedback (n = 3, 23.1%) or video feedback (n = 8, 61.5%). Five (38.4%) training programmes used the Global Assessment Score (GAS) forms. There is a broad consensus on the core multimodal components across current RACS training programmes; however, validated objective assessment is limited and needs to be appropriately standardised to ensure reproducible progression criteria and competency-based metrics are produced to robustly assess progression and competence.
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Affiliation(s)
- Deena Harji
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England.
| | | | - Joshua Burke
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Ben Griffiths
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Henry Tilney
- Department of Colorectal Surgery, Frimley Health NHS Foundation Trust, Frimley, Surrey, England
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Danilo Miskovic
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Naeem Soomro
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon P Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
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11
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Hu Y, Michaels AD, Khot R, Schenk WG, Hanks JB, Smith PW. A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach. Am Surg 2023; 89:261-266. [PMID: 33908805 DOI: 10.1177/00031348211011151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Thyroid ultrasounds extend surgeons' outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound proficiency metric through a collaborative Delphi approach. METHODS Clinical faculty experienced in thyroid ultrasound participated on a Delphi panel to design the thyroid Ultrasound Proficiency Scale (UPS-Thyroid). Participants proposed items under the categories of Positioning, Technique, Image Capture, Measurement, and Interpretation. In subsequent rounds, participants voted to retain, revise, or exclude each item. The process continued until all items had greater than 70% consensus for retention. The UPS-Thyroid was pilot tested across 5 surgery residents with moderate ultrasound experience. Learning curves were assessed with cumulative sum. RESULTS Three surgeons and 4 radiologists participated on the Delphi panel. Following 3 iterative Delphi rounds, the panel arrived at >70% consensus to retain 14 items without further revisions or additions. The metric included the following items on a 3-point scale for a maximum of 42 points: Positioning (1 item), Technique (4 items), Image Capture (2 items), Measurement (2 items), and Interpretation (5 items). A pilot group of 5 residents was scored against a proficiency threshold of 36 points. Learning curve inflection points were noted at between 4 to 7 repetitions. CONCLUSIONS A multidisciplinary Delphi approach generated consensus for a thyroid ultrasound proficiency metric (UPS-Thyroid). Among surgery residents with moderate ultrasound experience, basic proficiency at thyroid ultrasound is feasible within 10 repetitions.
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Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, 12265University of Maryland Baltimore, Baltimore, MD, USA
| | - Alex D Michaels
- Division of Minimally-Invasive Surgery, Department of Surgery, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rachita Khot
- Division of Body Imaging, Department of Radiology and Medical Imaging, 12349University of Virginia, Charlottesville, VA, USA
| | - Worthington G Schenk
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, 12349University of Virginia, Charlottesville, VA, USA
| | - John B Hanks
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, 12349University of Virginia, Charlottesville, VA, USA
| | - Philip W Smith
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, 12349University of Virginia, Charlottesville, VA, USA
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12
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Harji D, Aldajani N, Cauvin T, Chauvet A, Denost Q. Parallel, component training in robotic total mesorectal excision. J Robot Surg 2022; 17:1049-1055. [PMID: 36515819 DOI: 10.1007/s11701-022-01496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
There has been widespread adoption of robotic total mesorectal excision (TME) for rectal cancer in recent years. There is now increasing interest in training robotic novice surgeons in robotic TME surgery using the principles of component-based learning. The aims of our study were to assess the feasibility of delivering a structured, parallel, component-based, training curriculum to surgical trainees and fellows. A prospective pilot study was undertaken between January 2021 and May 2021. A dedicated robotic training pathway was designed with two trainees trained in parallel per each robotic case based on prior experience, training grade and skill set. Component parts of each operation were allocated by the robotic trainer prior to the start of each case. Robotic proficiency was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and the EARCS Global Assessment Score (GAS). Three trainees participated in this pilot study, performing a combined number of 52 TME resections. Key components of all 52 TME operations were performed by the trainees. GEARS scores improved throughout the study, with a mean overall baseline score of 17.3 (95% CI 15.1-1.4) compared to an overall final assessment mean score of 23.8 (95% CI 21.6-25.9), p = 0.003. The GAS component improved incrementally for all trainees at each candidate assessment (p < 0.001). Employing a parallel, component-based approach to training in robotic TME surgery is safe and feasible and can be used to train multiple trainees of differing grades simultaneously, whilst maintaining high-quality clinical outcomes.
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Affiliation(s)
- Deena Harji
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Nour Aldajani
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Thomas Cauvin
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Alexander Chauvet
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Quentin Denost
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
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13
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Fleming CA, Ali O, Clements JM, Hirniak J, King M, Mohan HM, Nally DM, Burke J. Surgical trainee experience and opinion of robotic surgery in surgical training and vision for the future: a snapshot study of pan-specialty surgical trainees. J Robot Surg 2022; 16:1073-1082. [PMID: 34826106 PMCID: PMC8616984 DOI: 10.1007/s11701-021-01344-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robotic surgery is well established across multiple surgical specialities in the United Kingdom (UK) and Republic of Ireland (ROI). We aimed to elucidate current surgical trainee experience of and attitudes to robotic surgery in a surgical training programme across the UK and ROI to determine the future role of robotic surgery in international surgical training programmes. Methods: A pan-specialty trainee cross-sectional study was performed on behalf of the Association of Surgeons in Training (ASiT) using mixed-methodology. Round 1: a digital questionnaire was disseminated to all ASiT members. Round 2: 'live-polling' was performed prior to and following the Robotic Surgery plenary session convened at the ASiT 2020 International Conference (Birmingham). Data analysis was performed using a combination of quantitative and qualitative methods. RESULTS Three hundred and four responses were analysed (n = 244 digital questionnaire, n = 60 live-polling). Overall, 73.8% (n = 180) of trainees would value greater access to robotic surgery training. 73.4% (n = 179) believed that robotic surgery was important for the future of their desired specialty and 77.2% (n = 156) believed it should be incorporated into formal surgical training. Qualitative analysis identified that trainees believe that robotic training should have a formal role in surgical training. Perceived disadvantages of robotic surgery experience in surgical training included expense and the current impact of consultant robotic learning curves on training. CONCLUSION Current surgical trainees desire greater access to robotic surgery in surgical training. Robotic surgery is developing an increasing role in current surgical practice and it is important that it is introduced in a timely, evidence-based fashion to surgical trainees at an appropriate stage of training.
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Affiliation(s)
- Christina A Fleming
- Association of Surgeon in Training Council, London, UK. .,Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Dublin, Ireland.
| | - Oroog Ali
- Association of Surgeon in Training Council, London, UK.,Queen Elizabeth Hospital, Gateshead, UK
| | - Joshua M Clements
- Association of Surgeon in Training Council, London, UK.,Belfast City Hospital, Belfast, Northern Ireland
| | - Johnathan Hirniak
- Association of Surgeon in Training Council, London, UK.,St George's University of London, London, UK
| | - Martin King
- Association of Surgeon in Training Council, London, UK.,Causeway Hospital, Coleraine, Northern Ireland
| | - Helen M Mohan
- Association of Surgeon in Training Council, London, UK.,St. Vincent's University Hospital, Dublin 4, Dublin, Ireland
| | - Deirdre M Nally
- Association of Surgeon in Training Council, London, UK.,Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Dublin, Ireland
| | - Josh Burke
- Association of Surgeon in Training Council, London, UK.,St. James's Teaching Hospital Trust, Leeds, UK
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14
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Bianchi G, Memeo R, Ferraro V, Madaro A, Schena CA, De' Angelis N. Rectal adenocarcinoma with synchronous liver metastasis: Robotic liver and rectal resection with partial mesorectal excision: A Video Vignette. Colorectal Dis 2022; 24:1251-1252. [PMID: 35490344 DOI: 10.1111/codi.16161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/01/2022] [Accepted: 04/23/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Giorgio Bianchi
- Unit of Digestive Surgery, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Riccardo Memeo
- Unit of HPB and Oncologic Surgery, Ospedale Regionale "F. Miulli", Bari, Italy
| | - Valentina Ferraro
- Unit of HPB and Oncologic Surgery, Ospedale Regionale "F. Miulli", Bari, Italy
| | - Andrea Madaro
- Unit of Minimally Invasive and Robotic Digestive Surgery, Ospedale Regionale "F. Miulli", Bari, Italy
| | | | - Nicola De' Angelis
- Unit of Digestive Surgery, Henri Mondor Hospital, AP-HP, Créteil, France.,Unit of Minimally Invasive and Robotic Digestive Surgery, Ospedale Regionale "F. Miulli", Bari, Italy.,University of Paris Est Créteil (UPEC), Créteil, France
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15
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Crolla RM, Coffey JC, Consten EJC. The Mesentery in Robot-Assisted Total Mesorectal Excision. Clin Colon Rectal Surg 2022; 35:298-305. [PMID: 35975108 PMCID: PMC9365460 DOI: 10.1055/s-0042-1743583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In recent decades, surgery for rectal cancer has evolved from an operation normally performed under poor vision with a lot of blood loss, relatively high morbidity, and mortality to a safer operation. Currently, minimally invasive rectal procedures are performed with limited blood loss, reduced morbidity, and minimal mortality. The main cause is better knowledge of anatomy and adhering to the principle of operating along embryological planes. Surgery has become surgery of compartments, more so than that of organs. So, rectal cancer surgery has evolved to mesorectal cancer surgery as propagated by Heald and others. The focus on the mesentery of the rectum has led to renewed attention to the anatomy of the fascia surrounding the rectum. Better magnification during laparoscopy and improved optimal three-dimensional (3D) vision during robot-assisted surgery have contributed to the refinement of total mesorectal excision (TME). In this chapter, we describe how to perform a robot-assisted TME with particular attention to the mesentery. Specific points of focus and problem solving are discussed.
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Affiliation(s)
- Rogier M.P.H. Crolla
- Department of Surgery, Laparoscopic and Robotic Gastrointestinal/Oncological Surgeon, Amphia Hospital, Breda, The Netherlands
| | - J. Calvin Coffey
- Department of Surgery, University Hospitals Group Limerick, Limerick, Ireland
| | - Esther J. C. Consten
- Department of Surgery, Laparoscopic and Robotic Gastrointestinal/Oncological Surgeon, Academic Medical Center Groningen, Groningen, The Netherlands
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16
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Bianchi G, Ludovico GM, Memeo R, de'Angelis N. Robotic supralevator posterior pelvic exenteration for locally advanced rectal cancer after neoadjuvant chemoradiotherapy - A Video Vignette. Colorectal Dis 2022; 24:671. [PMID: 35094469 DOI: 10.1111/codi.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/22/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Giorgio Bianchi
- Unit of Digestive Surgery, Henri Mondor Hospital, AP-HP, Créteil, France
| | | | - Riccardo Memeo
- Unit of HPB and Oncologic Surgery, Ospedale Regionale "F. Miulli", Bari, Italy
| | - Nicola de'Angelis
- Unit of Digestive Surgery, Henri Mondor Hospital, AP-HP, Créteil, France.,University of Paris Est, UPEC, Créteil, France
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17
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Rückbeil O, Sebestyen U, Schlick T, Krüger CM. [Structured Implementation and Modular In-house Training as Key Success Factors in Robotically Assisted Surgery - Evaluation Using the Example of Colorectal Surgery]. Zentralbl Chir 2021; 147:35-41. [PMID: 34607387 DOI: 10.1055/a-1552-4236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To demonstrate the applicability of structured implementation of robotic assisted surgery (RAS) and to evaluate a modular training procedure during the implementation phase in in-house mentoring. METHOD Execution of a self-defined PDCA (PDCA: Plan-Do-Check-Act) implementation cycle accompanied by prospective data collection of patient characteristics, operation times, complications, conversion rates and postoperative length of stay of a modularly defined training operation (robotic assisted rectosigmoid resection - RARSR). RESULTS Evaluation of 100 consecutive cases distributed among 3 trainees and an in-house mentor as internal control group. Presentation of qualitatively safe and successful implementation with a short learning curve of the training operation with balanced patient characteristics. CONCLUSIONS Structured implementation enables the safe introduction of RAS in visceral surgery. In this context, modular training operations can facilitate the adoption of RAS by users under everyday conditions. For the first time, we demonstrate this within an in-house mentoring approach.
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Affiliation(s)
- Oskar Rückbeil
- Chirurgie/Zentrum für Robotik, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Uwe Sebestyen
- Chirurgie/Zentrum für Robotik, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Tilman Schlick
- Chirurgie/Zentrum für Robotik, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Colin M Krüger
- Chirurgie/Zentrum für Robotik, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
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18
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Wang Y, Shu W, Ouyang A, Wang L, Sun Y, Liu G. The New Concept of Physiological "Riolan's Arch" and the Reconstruction Mechanism of Pathological Riolan's Arch After High Ligation of the Inferior Mesenteric Artery by CT Angiography-Based Small Vessel Imaging. Front Physiol 2021; 12:641290. [PMID: 34239446 PMCID: PMC8257958 DOI: 10.3389/fphys.2021.641290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Due to the complexity of anatomical relationship between superior mesenteric artery (SMA) and left colic artery (LCA), there is no unified anatomical concept of "Riolan's arch." There is no consensus as to tie off the inferior mesenteric artery (IMA) at its origin or just below the origin of the left colic artery during radical surgery of sigmoid colon and rectal cancers. The aim of the study is to investigate the anatomy of shortcut anastomotic branches (adjacent branches) of SMA at splenic flexure and to explore how the shortcut pathway (Riolan's arch) was formed, as the compensation of anastomotic branches between MCA and LCA under pathological conditions and the reconstruction and the mechanism of pathological Riolan's arch after high ligation of the inferior mesenteric artery. Methods Between January 2018 and May 2020, patients with colorectal cancer who underwent CTA before surgery were enrolled in the study. The anatomy of shortcut anastomotic branch of SMA and LCA was investigated by volume rendering technique (VR) and maximum-intensity projection (MIP). GE's small vessel extraction technology (selected VR) was used to directly display these shortcut anastomotic branches on a map and to establish their three-dimensional anatomical classification. Then, we used the axonometric drawing to make the model more exact. Next, combining with some cases of pathological Riolan's arch and basing on hydrodynamic principle, we speculate the mechanism of collateral circulation. Finally, based on the retrospective study of high ligation cases and combined principles of fluid mechanics, we show how these shortcut anastomotic branches evolved into Riolan's arch. Results We report the classification of the ascending branch of LCA (which approaches the splenic flexure) and the left branch of MCA, display these shortcut anastomotic branches on a map, and establish their three-dimensional anatomical classification. We found that Riolan's arch is a shortcut pathway for the compensation of anastomotic branches, between MCA and LCA under pathological conditions, and that the formation mechanism of shortcut path accords with the principle of hydrodynamics. Conclusions Our results show the mechanism of pathological Riolan's arch formation and provide new anatomic thinking for the battle between high and low ligation of IMA in colorectal cancer surgery.
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Affiliation(s)
- Ying Wang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Weibin Shu
- Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Aimie Ouyang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lei Wang
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuping Sun
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guoqin Liu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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19
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Vining CC, Skowron KB, Hogg ME. Robotic gastrointestinal surgery: learning curve, educational programs and outcomes. Updates Surg 2021; 73:799-814. [PMID: 33484423 DOI: 10.1007/s13304-021-00973-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
The use of the robotic platform for gastrointestinal surgery was introduced nearly 20 years ago. However, significant growth and advancement has occurred primarily in the last decade. This is due to several advantages over traditional laparoscopic surgery allowing for more complex dissections and reconstructions. Several randomized controlled trials and retrospective reviews have demonstrated equivalent oncologic outcomes compared to open surgery with improved short-term outcomes. Unfortunately, there are currently no universally accepted or implemented training programs for robotic surgery and robotic surgery experience varies greatly. Additionally, several limitations to the robotic platform exist resulting in a distinct learning curve associated with various procedures. Therefore, implementation of robotic surgery requires a multidisciplinary team approach with commitment and investment from clinical faculty, operating room staff and hospital administrators. Additionally, there is a need for wider distribution of educational modules to train more surgeons and reduce the associated learning curve. This article will focus on the implementation of the robotic platform for surgery of the pancreas, stomach, liver, colon and rectum with an emphasis on the associated learning curve, educational platforms to develop proficiency and perioperative outcomes.
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Affiliation(s)
- Charles C Vining
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kinga B Skowron
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building, Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA.
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20
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Chang TP, Chok AY, Tan D, Rogers A, Rasheed S, Tekkis P, Kontovounisios C. The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review. J Clin Med 2021; 10:jcm10071518. [PMID: 33916490 PMCID: PMC8038538 DOI: 10.3390/jcm10071518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022] Open
Abstract
Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered.
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Affiliation(s)
- Tou Pin Chang
- Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK; (T.P.C.); (A.R.); (S.R.); (P.T.)
| | - Aik Yong Chok
- Department of Surgery and Cancer, Imperial College, London W2 1NY, UK; (A.Y.C.); (D.T.)
| | - Dominic Tan
- Department of Surgery and Cancer, Imperial College, London W2 1NY, UK; (A.Y.C.); (D.T.)
| | - Ailin Rogers
- Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK; (T.P.C.); (A.R.); (S.R.); (P.T.)
| | - Shahnawaz Rasheed
- Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK; (T.P.C.); (A.R.); (S.R.); (P.T.)
| | - Paris Tekkis
- Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK; (T.P.C.); (A.R.); (S.R.); (P.T.)
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London SW3 6JJ, UK; (T.P.C.); (A.R.); (S.R.); (P.T.)
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Correspondence:
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21
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de'Angelis N, Beghdadi N, Bianchi G, Brunetti F, Dagorno C. Indocyanine green fluorescence-guided robotic total mesorectal excision with handsewn coloanal anastomosis for rectal cancer - a video vignette. Colorectal Dis 2021; 23:768-769. [PMID: 33340197 DOI: 10.1111/codi.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, Ospedale Generale Regionale 'F. Miulli', Bari, Italy.,University of Paris Est, UPEC, Créteil, France
| | - Nassiba Beghdadi
- University of Paris Est, UPEC, Créteil, France.,Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Creteil, France
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, Ospedale Generale Regionale 'F. Miulli', Bari, Italy
| | - Francesco Brunetti
- Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Creteil, France
| | - Claire Dagorno
- Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Creteil, France
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22
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Müller C, Laengle J, Riss S, Bergmann M, Bachleitner-Hofmann T. Surgical Complexity and Outcome During the Implementation Phase of a Robotic Colorectal Surgery Program-A Retrospective Cohort Study. Front Oncol 2021; 10:603216. [PMID: 33665163 PMCID: PMC7923881 DOI: 10.3389/fonc.2020.603216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Robotic surgery holds particular promise for complex oncologic colorectal resections, as it can overcome many limitations of the laparoscopic approach. However, similar to the situation in laparoscopic surgery, appropriate case selection (simple vs. complex) with respect to the actual robotic expertise of the team may be a critical determinant of outcome. The present study aimed to analyze the clinical outcome after robotic colorectal surgery over time based on the complexity of the surgical procedure. Methods All robotic colorectal resections (n = 85) performed at the Department of Surgery, Medical University of Vienna, between the beginning of the program in April 2015 until December 2019 were retrospectively analyzed. To compare surgical outcome over time, the cohort was divided into 2 time periods based on case sequence (period 1: patients 1–43, period 2: patients 44–85). Cases were assigned a complexity level (I-IV) according to the type of resection, severity of disease, sex and body mass index (BMI). Postoperative complications were classified using the Clavien-Dindo classification. Results In total, 47 rectal resections (55.3%), 22 partial colectomies (25.8%), 14 abdomino-perineal resections (16.5%) and 2 proctocolectomies (2.4%) were performed. Of these, 69.4% (n = 59) were oncologic cases. The overall rate of major complications (Clavien Dindo III-V) was 16.5%. Complex cases (complexity levels III and IV) were more often followed by major complications than cases with a low to medium complexity level (I and II; 25.0 vs. 5.4%, p = 0.016). Furthermore, the rate of major complications decreased over time from 25.6% (period 1) to 7.1% (period 2, p = 0.038). Of note, the drop in major complications was associated with a learning effect, which was particularly pronounced in complex cases as well as a reduction of case complexity from 67.5% to 45.2% in the second period (p = 0.039). Conclusions The risk of major complications after robotic colorectal surgery increases significantly with escalating case complexity (levels III and IV), particularly during the initial phase of a new colorectal robotic surgery program. Before robotic proficiency has been achieved, it is therefore advisable to limit robotic colorectal resection to cases with complexity levels I and II in order to keep major complication rates at a minimum.
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Affiliation(s)
- Catharina Müller
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Laengle
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Thomas Bachleitner-Hofmann
- Department of Surgery, Division of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
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Tou S, Gómez Ruiz M, Gallagher AG, Matzel KE. European expert consensus on a structured approach to training robotic-assisted low anterior resection using performance metrics. Colorectal Dis 2020; 22:2232-2242. [PMID: 32663361 PMCID: PMC7818231 DOI: 10.1111/codi.15269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Abstract
AIM The aim was to develop and operationally define 'performance metrics' that characterize a reference approach to robotic-assisted low anterior resection (RA-LAR) and to obtain face and content validity through a consensus meeting. METHOD Three senior colorectal surgeons with robotic experience and a senior behavioural scientist formed the Metrics Group. We used published guidelines, training materials, manufacturers' instructions and unedited videos of RA-LAR to deconstruct the operation into defined, measurable components - performance metrics (i.e. procedure phases, steps, errors and critical errors). The performance metrics were then subjected to detailed critique by 18 expert colorectal surgeons in a modified Delphi process. RESULTS Performance metrics for RA-LAR had 15 procedure phases, 128 steps, 89 errors and 117 critical errors in women, 88 errors and 118 critical errors in men. After the modified Delphi process the final performance metrics consisted of 14 procedure phases, 129 steps, 88 errors and 115 critical errors in women, 87 errors and 116 critical errors in men. After discussion by the Delphi panel, all procedure phases received unanimous consensus apart from phase I (patient positioning and preparation, 83%) and phase IV (docking, 94%). CONCLUSION A robotic rectal operation can be broken down into procedure phases, steps, with errors and critical errors, known as performance metrics. The face and content of these metrics have been validated by a large group of expert robotic colorectal surgeons from Europe. We consider the metrics essential for the development of a structured training curriculum and standardized procedural assessment for RA-LAR.
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Affiliation(s)
- S. Tou
- Department of Colorectal SurgeryRoyal Derby HospitalUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - M. Gómez Ruiz
- Cirugía Colorrectal – Cirugía General y del Aparato DigestivoHospital Universitario Marqués de ValdecillaSantanderSpain
| | | | - K. E. Matzel
- Section of ColoproctologyDepartment of SurgeryUniversity of Erlangen‐Nürnberg, FAUErlangenGermany
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24
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Franke F, Moeller T, Mehdorn AS, Beckmann JH, Becker T, Egberts JH. Ivor-Lewis oesophagectomy: A standardized operative technique in 11 steps. Int J Med Robot 2020; 17:1-10. [PMID: 32979300 DOI: 10.1002/rcs.2175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
SYNOPSIS Standardization of robotic oesophagectomy can benefit both patients and surgeons by decreasing complications, shortening the learning curve and improving surgical training. BACKGROUND Thoraco-abdominal oesophagectomy with lymphadenectomy is the cornerstone of curative therapy for oesophageal carcinoma. To reduce post-operative morbidity, minimally invasive technology has become increasingly established. Conventional thoraco-laparoscopic procedures, however, are limited by their technical feasibility. These limitations can be overcome using robot-assisted technology. METHODS Robotic Ivor-Lewis oesophageal resection has gradually been implemented in our clinic from 2013. We have performed over 250 robot-assisted minimally invasive oesophagectomies and more than 2000 robotic procedures overall. This experience allowed us to establish a standardized operative technique. RESULTS We identified 11 operative steps as key elements for oesophageal resection, which should help implementation of this technique and allow surgeons to approach this complex procedure with greater confidence. CONCLUSION Standardization is fundamental to the establishment of a new surgical technique and is a key element in the learning curve of Ivor-Lewis oesophageal resection. Standardization can lead to better reproducibility of results, and thus to improved quality.
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Affiliation(s)
- Frederike Franke
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thorben Moeller
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne-Sophie Mehdorn
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan Henrik Beckmann
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Becker
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
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Huang S, Chen M, Deng Y, Wang X, Lu X, Jiang W, Huang Y, Chi P. Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic-assisted mesorectal excision and intersphincteric resection respectively in different ways. Colorectal Dis 2020; 22:1130-1138. [PMID: 32040248 DOI: 10.1111/codi.15012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
Abstract
AIM Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery. METHODS We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection. RESULTS For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR. CONCLUSION It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.
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Affiliation(s)
- S Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - M Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Y Deng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - X Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - X Lu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - W Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Y Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - P Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Melstrom KA, Kaiser AM. Role of minimally invasive surgery for rectal cancer. World J Gastroenterol 2020; 26:4394-4414. [PMID: 32874053 PMCID: PMC7438189 DOI: 10.3748/wjg.v26.i30.4394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer is one of the most common malignancies worldwide. Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy (total mesorectal excision). This has traditionally been performed transabdominally through an open incision. Over the last thirty years, minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach. There are currently three resective modalities that complement the traditional open operation: (1) Laparoscopic surgery; (2) Robotic surgery; and (3) Transanal total mesorectal excision. In addition, there are several platforms to carry out transluminal local excisions (without lymphadenectomy). Evidence on the various modalities is of mixed to moderate quality. It is unreasonable to expect a randomized comparison of all options in a single trial. This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks, recovery and complications, oncological and functional outcomes.
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Affiliation(s)
- Kurt A Melstrom
- Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States
| | - Andreas M Kaiser
- Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States
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Propensity score-matched analysis comparing laparoscopic to robotic surgery for colorectal cancer shows comparable clinical and oncological outcomes. J Robot Surg 2020; 15:389-396. [DOI: 10.1007/s11701-020-01116-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
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Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital. J Robot Surg 2020; 15:135-142. [DOI: 10.1007/s11701-020-01087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
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Fleming CA, Westby D, Ullah MF, Mohan HM, Sehgal R, Bolger JC, O’Leary DP, McNamara E, Korpanty G, El Bassiouni M, Condon E, Coffey JC, Peirce C. A review of clinical and oncological outcomes following the introduction of the first robotic colorectal surgery programme to a university teaching hospital in Ireland using a dual console training platform. J Robot Surg 2020; 14:889-896. [DOI: 10.1007/s11701-020-01073-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
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Perez D, Wöstemeier A, Ghadban T, Stein H, Gomez-Ruiz M, Izbicki JR, Soh Min B. Standardisierte Zugangsoptionen für die kolorektale Chirurgie mit dem Da-Vinci-Xi-System. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s00740-020-00334-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Rolinger J, Jansen K, von Keller J, Axt S, Falch C, Kirschniak A, Wilhelm P. [Robotic Assisted Proctocolectomy with Ileal Pouch-Anal Anastomosis in a Case of Suspected Hereditary Polyposis]. Zentralbl Chir 2020; 146:23-28. [PMID: 32000267 DOI: 10.1055/a-1084-4159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Various forms of hereditary polyposis have been described in the literature. Classical familial adenomatous polyposis (FAP) is a rare, autosomal dominantly inherited disease which is caused by a germline mutation in the adenomatous polyposis coli gene (APC). Patients with this diagnosis successively develop multiple polyps of the colon. Left untreated, FAP almost inevitably leads to malignant transformation. INDICATION We present the case of a 37-year-old patient with histologically confirmed, stenotic adenocarcinoma of the descending colon and an initially suspected hereditary polyposis due to multiple polyps in the descending and sigmoid colon. METHODS The video describes the preoperative imaging as well as endoscopic findings and demonstrates the technique of a two-stage, robotically assisted proctocolectomy with ileal pouch-anal anastomosis (IPAA) and the creation of a temporary loop ileostomy. CONCLUSIONS With respect to the surgical treatment of classic FAP, restorative proctocolectomy (RPC) with ileal J-pouch construction can be regarded as an established standard procedure, despite controversy regarding various technical aspects. Minimally invasive strategies should be considered as an equivalent option compared to conventional techniques.
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Affiliation(s)
- Jens Rolinger
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
| | - Kai Jansen
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
| | - Johannes von Keller
- Facharzt für Gastroenterologie, Gastroenterologische Schwerpunktpraxis, Tübingen, Deutschland
| | - Steffen Axt
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
| | - Claudius Falch
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
| | - Andreas Kirschniak
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
| | - Peter Wilhelm
- Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Deutschland
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[Standardized access options for colorectal surgery with the da Vinci Xi system]. Chirurg 2019; 90:1003-1010. [PMID: 31089749 DOI: 10.1007/s00104-019-0973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Performing colorectal surgery with previous da Vinci system generations presented some limitations that caused uncertainty for surgeons as they began to apply robotic technologies. The da Vinci Xi system is designed to overcome these limitations and to enable multiquadrant colorectal surgery. OBJECTIVE The design concept of the da Vinci Xi system and the standardized access for colorectal surgery are explained. MATERIAL AND METHODS The da Vinci Xi system applies an overhead boom that maximizes the arm workspace, minimizes interference and makes the port placement universal for standardized access. Colorectal approaches have been validated in numerous cadaver models confirming the reproducibility of the standardized access. RESULTS Standardized access with a straight-line port placement is possible in all colorectal applications. For right-sided hemicolectomy, a transverse abdominal approach as well as a suprapubic port placement are possible. Utilizing the same principles, left-sided colectomy, sigmoid colectomy and low anterior resections can be performed. Proctocolectomy is enabled through boom rotation and a second docking. Only minor arm-to-arm interferences occurred and were easily manageable by the bedside assistant. None of the approaches required rearrangement of the patient cart or swapping arms to different port locations. CONCLUSION The da Vinci Xi system enables a standardized access for colorectal surgery through a universal straight-line port placement. Learning this standard principle once enables the surgeon to apply it to all colorectal surgeries and shorten the learning curve as well as minimizing stress for both novices and experienced robotic surgeons learning a new surgical robotic platform.
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