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Ito A, Omura Y, Hiro J, Tsujimura K, Hattori Y, Kamishima M, Kobayashi Y, Inaguma G, Chong Y, Masumori K, Otsuka K, Uyama I, Suda K. Robot-assisted low anterior resection in a patient with rectal cancer who had a urinary reservoir: A case report. Asian J Endosc Surg 2024; 17:e13304. [PMID: 38499010 DOI: 10.1111/ases.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
Undergoing another surgery after a previous abdominal procedure can sometimes result in significant abdominal adhesions. We present a case of robot-assisted low anterior resection in a patient with rectal cancer who had a urinary reservoir. A 65-year-old male patient underwent robot-assisted total bladder resection and creation of a urinary reservoir for bladder cancer in 2013. He presented with melena. Thus, the findings revealed advanced low rectal cancer. The robot-assisted low anterior resection was performed in 2022. Extensive adhesions were observed in the pelvic space. The indocyanine green function was appropriately used, and the robotic surgery was completed without injury to the urinary reservoir or major complications. The surgical time was 510 min, and the blood loss volume was 15 mL. The patient had been recurrence free for 12 months following the surgery. Robot-assisted surgery can be beneficial for patients with rectal cancer with significant pelvic adhesions.
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Affiliation(s)
- Ayaka Ito
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yusuke Omura
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Junichiro Hiro
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | - Yutaka Hattori
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | | | - Gaku Inaguma
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yongchol Chong
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Koki Otsuka
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan
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Patient experiences of left-sided colorectal resection by robotic, conventional laparoscopic and open approaches: a qualitative study. Tech Coloproctol 2023:10.1007/s10151-023-02764-8. [PMID: 36790541 DOI: 10.1007/s10151-023-02764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Robotic surgery (RS) is increasingly employed in colorectal surgical practice, widening the range of surgical techniques offered to patients. We investigated the perceptions of patients with colorectal cancer in relation to RS, open surgery (OS) and conventional laparoscopic surgery (CLS), to identify ideas or assumptions which, in the context of shared surgeon-patient decision-making, may affect the resultant choice of surgical technique. We also investigated salient factors affecting patients' perioperative experience, including those of RS patients, to guide improvements in care and preoperative patient preparation. METHODS This study was conducted on patients who underwent resection of left-sided colorectal cancer at a large UK teaching hospital from November 2020 to July 2021. Purposive sampling was used to ensure a roughly equal proportion of patients who underwent RS, CLS and OS. The patients included in the study participated in semi-structured interviews six weeks postoperatively. The interview schedule allowed discussion around patients' experience of their surgery and postoperative recovery, and their perceptions of surgical techniques. Interview transcripts were coded manually using inductive thematic analysis, and analyst triangulation was employed to refine coding schemes and ensure reliability of emerging themes. RESULTS Twenty-seven patients were recruited to the study; RS n = 9 (median age 69 [range 60-80] years); CLS n = 10 (median age 72 [range 32-82] years; OS n = 8 (median age 71 [range 60-75] years). Patients understood the technological benefits of RS but were concerned by a risk of technological failure causing patient harm. OS was understood to be associated with more pain and longer recovery than RS or CLS. Patients perceived CLS to be more technically challenging compared with OS. Less pain and smaller wounds than expected were significant positive factors in the experience of RS and CLS patients specifically. Complications and emotional impact were significant factors in the experience of all groups, for which many patients felt underprepared. CONCLUSIONS Patients generally have a positive view of RS and technical innovation in surgery. Concerns mostly centred around failure of technology. Many patients felt unprepared for significant factors in their perioperative experience. Surgeons and healthcare providers should be prepared to address patients' perceptions and expectations of colorectal surgery preoperatively.
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Choi MS, Yun SH, Shin JK, Park YA, Huh JW, Cho YB, Kim HC, Lee WY. Single-Port Robot-Assisted Abdominoperineal Resection: A Case Review of the Fi rst Four Experiences. Ann Coloproctol 2021:ac.2021.00395.0056. [PMID: 34657409 PMCID: PMC8898626 DOI: 10.3393/ac.2021.00395.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
Recently, abdominoperineal resection (APR) using a robot has been demonstrated in other studies. However, there has been no report on APR for rectal cancer using the single-port robot (SPR) platform. In response to this research gap, we described the clinical experience of APR using a SPR. From April 2019 to March 2020, APR using a SPR platform was performed in a total of 4 patients. Three patients had a transumbilical approach, and 1 patient had a transstoma site approach. The average operation time was 307 minutes, and the patient docking time to the SPR platform was 133.5 minutes. There were no complications during the operation, and no laparoscopy or open conversion. No reoperation occurred within 30 days. Mild postoperative complications occurred in 2 patients. We found that APR has safety and feasibility in surgery using an SPR platform. There was no intraoperative event and severe postoperative complications.
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Affiliation(s)
- Moon Suk Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hu DP, Zhu XL, Wang H, Liu WH, Lv YC, Shi XL, Feng LL, Zhang WS, Yang XF. Robotic-assisted versus conventional laparoscopic surgery for colorectal cancer: Short-term outcomes at a single center. Indian J Cancer 2021; 58:225-231. [PMID: 33753624 DOI: 10.4103/ijc.ijc_86_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The robotic technique has been established as an alternative approach to laparoscopy for colorectal surgery. The aim of this study was to compare the short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and September 2018. We evaluated patient demographics, perioperative characteristics, and pathologic examinations. Short-term outcomes included time to passage of flatus and length of postoperative hospital stay. Results A total of 580 patients were included in the study. There were 271 patients in the robotic colorectal surgery (RCS) group and 309 in the laparoscopic colorectal surgery (LCS) group. The time to passage of flatus in the RCS group was 3.62 days shorter than the LCS group. The total costs were increased by 2,258.8 USD in the RCS group compared to the LCS group (P < 0.001). Conclusion The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of a shorter postoperative recovery time of bowel function and shorter hospital stays.
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Affiliation(s)
- Dong-Ping Hu
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
| | - Xiao-Long Zhu
- Department of Anorectal Surgery, Gansu Provincial Hospital; Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, P.R. China
| | - He Wang
- Department of Anorectal Surgery, Gansu Provincial Hospital; Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, P.R. China
| | - Wen-Han Liu
- Department of Anorectal Surgery, Gansu Provincial Hospital; Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, P.R. China
| | - Yao-Chun Lv
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
| | - Xin-Long Shi
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
| | - Li-Li Feng
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
| | - Wei-Sheng Zhang
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
| | - Xiong-Fei Yang
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, P.R. China
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Moloney R, O’Brien B, Coffey JC, Coffey A, Murphy F. Patients' Perceptions After Robot‐Assisted Surgery: An Integrative Review. AORN J 2020; 112:133-141. [DOI: 10.1002/aorn.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 12/25/2022]
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Chiu CC, Hsu WT, Choi JJ, Galm B, Lee MTG, Chang CN, Liu CYC, Lee CC. Comparison of outcome and cost between the open, laparoscopic, and robotic surgical treatments for colon cancer: a propensity score-matched analysis using nationwide hospital record database. Surg Endosc 2019; 33:3757-3765. [PMID: 30675661 DOI: 10.1007/s00464-019-06672-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are limited studies that compare the cost and outcome of robotic-assisted surgery to open and laparoscopic surgery for colon cancer treatment. We aimed to compare the three surgical modalities for colon cancer treatment. METHODS We performed a cohort study using the population-based Nationwide Inpatient Sample database. Patients with a primary diagnosis of colon cancer who underwent robotic, laparoscopic, or open surgeries between 2008 and 2014 were eligible for enrollment. We compared in-hospital mortality, complications, length of hospital stay, and cost for patients undergoing one of these three procedures using a multivariate adjusted logistic regression analysis and propensity score matching. RESULTS Of the 531,536 patients undergoing surgical treatment for colon cancer during the study period, 348,645 (65.6%) patients underwent open surgeries, 174,748 (32.9%) underwent laparoscopic surgeries, and 8143 (1.5%) underwent robotic surgeries. In-hospital mortality, length of hospital stay, wound complications, general medical complications, general surgical complications, and costs of the three surgical treatment modalities. Compared to those undergoing laparoscopic surgery, patients undergoing open surgery had a higher mortality rate (OR 2.98, 95% CI 2.61-3.40), more general medical complications (OR 1.77, 95% CI 1.67-1.87), a longer length of hospital stay (6.60 vs. 4.36 days), and higher total cost ($18,541 vs. $14,487) in the propensity score matched cohort. Mortality rate and general medical complications were equivalent in the laparoscopic and robotic surgery groups, but the median cost was lower in the laparoscopic group ($14641 vs. $16,628 USD). CONCLUSIONS Laparoscopic colon cancer surgery was associated with a favourable short-term outcome and lower cost compared with open surgery. Robot-assisted surgery had comparable outcomes but higher cost as compared to laparoscopic surgery.
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan, Republic of China
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan, Republic of China
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James J Choi
- Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Brandon Galm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meng-Tse Gabriel Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Chia-Na Chang
- Department of Radiation Oncology, Wan-Fang Hospital, Taipei, Taiwan, Republic of China
| | - Chia-Yu Carolyn Liu
- School of Health, McTimoney College of Chiropractic, BPP University, Abingdon, Oxfordshire, UK
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
- Health Data Science Research Group, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan, Republic of China.
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Moncayo S, Compagnon R, Caire F, Grosos C, Bahans C, Ilhero P, Fourcade L, Ballouhey Q. Transition effects from laparocscopic to robotic surgery skills in small cavities. J Robot Surg 2019; 14:525-530. [PMID: 31515680 DOI: 10.1007/s11701-019-01024-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
Conventional laparoscopic surgery (LS) is being challenged by the ever-increasing use of robotic surgery (RS) to perform reconstructive procedures. The purpose of this study was to assess the acquisition of skills in both techniques and the potential transfer of skills from one technique to the other when restricted spaces are involved. A preclinical randomized crossover study design was implemented. Twelve subjects performed two different reproducible drill procedures: "Thread the Ring" (TR) and "Transfer the Plot" (TP). To assess surgical proficiency in confined workspaces, these exercises were performed with LS and RS technology in a pediatric laparoscopic surgery (PLS) simulator. Each performance was recorded and evaluated by two reviewers using objective structured assessment of technical skills (OSATS). The times to complete the TP and the TR procedure were significantly shorter with RS compared to LS (64 s vs. 319 s; p < 0.0001 for both TP and TR). A significant transfer effect of skills between LS and RS was noted for the TP exercise (p = 0.006). The percentage improvement was greater overall with LS, meaning a higher number of trials were required to adequately master the procedure. This study demonstrated that RS performed significantly better compared to LS on pediatric simulation devices. A transfer effect was identified from LS to RS exclusively. The learning curves showed that progression was definitely longer with LS. These results, indicate that novice surgeons should be encouraged to persist with learning LS, and they support the use of a pediatric robotic simulation device.
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Affiliation(s)
- S Moncayo
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - R Compagnon
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - F Caire
- Service de Neurochirurgie, Hôpital Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - C Grosos
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - C Bahans
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - P Ilhero
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - L Fourcade
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - Q Ballouhey
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France.
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Nolan HR, Smith BE, Honaker MD. Operative time and length of stay is similar between robotic assisted and laparoscopic colon and rectal resections. J Robot Surg 2018; 12:659-664. [PMID: 29594757 DOI: 10.1007/s11701-018-0798-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/12/2018] [Indexed: 12/16/2022]
Abstract
Robotic-assisted surgery is increasingly being utilized for colorectal surgery. Data are scarce and contradictory when outcomes are compared between robotic and laparoscopic surgery. All patients undergoing minimally invasive colorectal surgery were compared from 2011 to 2016. Outcomes between the two groups were statistically analyzed. p < 0.05 was considered statistically significant. 185 patients underwent laparoscopic resection and 70 underwent robotic resection. Demographics, ASA score, and BMI were similar between the two groups (p > 0.05). There was no statistical difference in median length of stay between laparoscopic and robotic colon (both 4 days; p = 0.5) and rectal (6 vs 4.5 days; p = 0.2) resections. Median operative times were also similar between the two approaches for colon (150.5 vs 169.5 min, p = 0.2) and rectal (197.0 vs 231.5 min, p = 0.9) resections. There was also no difference in operative time between the two approaches for right (median = 137 vs 130.5 min; p = 0.9) and left (median = 162.0 vs 170.5 min; p = 0.6) colectomies. Robotic surgery results in similar operative times and length of stay as laparoscopic surgery for patients undergoing colon and rectal resections.
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Affiliation(s)
- Heather R Nolan
- Department of Surgery, The Medical Center of Central Georgia, Navicent Health, Mercer University School of Medicine, 800 1st St Suite 240, Macon, GA, 31220, USA
| | - Betsy E Smith
- Department of Surgery, The Medical Center of Central Georgia, Navicent Health, Mercer University School of Medicine, 800 1st St Suite 240, Macon, GA, 31220, USA
| | - Michael D Honaker
- Department of Surgery, The Medical Center of Central Georgia, Navicent Health, Mercer University School of Medicine, 800 1st St Suite 240, Macon, GA, 31220, USA.
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Sunil S, Restrepo J, Azin A, Hirpara D, Cleary S, Cleghorn MC, Wei A, Quereshy FA. Robotic simultaneous resection of rectal cancer and liver metastases. Clin Case Rep 2017; 5:1913-1918. [PMID: 29225824 PMCID: PMC5715581 DOI: 10.1002/ccr3.1138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/18/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022] Open
Abstract
Surgical resection is the only potential cure for colorectal cancer with synchronous liver metastases (SLM). Simultaneous resection of colorectal cancer and SLM using robotic‐assistance has been rarely reported. We demonstrate that robotic‐assisted simultaneous resection of colorectal cancer and SLMs is feasible, safe, and has potential to demonstrate good oncologic outcomes.
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Affiliation(s)
- Supreet Sunil
- Division of General Surgery University Health Network Toronto Ontario Canada
| | - Juliana Restrepo
- Division of General Surgery University Health Network Toronto Ontario Canada.,Division of General Surgery University of Toronto Toronto Ontario Canada
| | - Arash Azin
- Division of General Surgery University Health Network Toronto Ontario Canada.,Division of General Surgery University of Toronto Toronto Ontario Canada
| | - Dhruvin Hirpara
- Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Sean Cleary
- Division of General Surgery University Health Network Toronto Ontario Canada.,Division of General Surgery University of Toronto Toronto Ontario Canada
| | - Michelle C Cleghorn
- Division of General Surgery University Health Network Toronto Ontario Canada
| | - Alice Wei
- Division of General Surgery University Health Network Toronto Ontario Canada.,Division of General Surgery University of Toronto Toronto Ontario Canada
| | - Fayez A Quereshy
- Division of General Surgery University Health Network Toronto Ontario Canada.,Division of General Surgery University of Toronto Toronto Ontario Canada
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Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc 2017; 32:1405-1413. [DOI: 10.1007/s00464-017-5822-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022]
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Lee MTG, Chiu CC, Wang CC, Chang CN, Lee SH, Lee M, Hsu TC, Lee CC. Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database. Sci Rep 2017; 7:2006. [PMID: 28515452 PMCID: PMC5435696 DOI: 10.1038/s41598-017-02224-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
Limited data are available for the epidemiology and outcome of colorectal cancer in relation to the three main surgical treatment modalities (open, laparoscopic and robotic). Using the US National Inpatient Sample database from 2004 to 2012, we identified 1,265,684 hospitalized colorectal cancer patients. Over the 9 year period, there was a 13.5% decrease in the number of hospital admissions and a 43.5% decrease in in-hospital mortality. Comparing the trend of surgical modalities, there was a 35.4% decrease in open surgeries, a 3.5 fold increase in laparoscopic surgeries, and a 41.3 fold increase in robotic surgeries. Nonetheless, in 2012, open surgery still remained the preferred surgical treatment modality (65.4%), followed by laparoscopic (31.2%) and robotic surgeries (3.4%). Laparoscopic and robotic surgeries were associated with lower in-hospital mortality, fewer complications, and shorter length of stays, which might be explained by the elective nature of surgery and earlier tumor grades. After excluding patients with advanced tumor grades, laparoscopic surgery was still associated with better outcomes and lower costs than open surgery. On the contrary, robotic surgery was associated with the highest costs, without substantial outcome benefits over laparoscopic surgery. More studies are required to clarify the cost-effectiveness of robotic surgery.
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Affiliation(s)
- Meng-Tse Gabriel Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chia-Chun Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Na Chang
- Department of Radiation Oncology, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | | | | | - Tzu-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Feinberg AE, Elnahas A, Bashir S, Cleghorn MC, Quereshy FA. Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity. Can J Surg 2016; 59:262-7. [PMID: 27240135 PMCID: PMC4961489 DOI: 10.1503/cjs.016615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes. RESULTS There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion. CONCLUSION Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients.
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Affiliation(s)
- Adina E. Feinberg
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Elnahas, Cleghorn, Quereshy); the Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ont. (Bashir); and the Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont. (Quereshy)
| | - Ahmad Elnahas
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Elnahas, Cleghorn, Quereshy); the Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ont. (Bashir); and the Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont. (Quereshy)
| | - Shaheena Bashir
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Elnahas, Cleghorn, Quereshy); the Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ont. (Bashir); and the Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont. (Quereshy)
| | - Michelle C. Cleghorn
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Elnahas, Cleghorn, Quereshy); the Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ont. (Bashir); and the Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont. (Quereshy)
| | - Fayez A. Quereshy
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Elnahas, Cleghorn, Quereshy); the Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ont. (Bashir); and the Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont. (Quereshy)
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Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 2016; 30:5601-5614. [PMID: 27402096 DOI: 10.1007/s00464-016-4892-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Robotic surgery is positioned at the cutting edge of minimally invasive management of colorectal cancer. We performed a meta-analysis of data from randomized controlled trials (RCTs) and non-RCTs (NRCTs) that compared the clinicopathological outcomes of robotic-assisted colorectal surgery (RACS) with those of laparoscopic-assisted colorectal surgery (LACS). Inferences on the feasibility and the relative safety and efficacy have been drawn. METHODS A literature search for relevant studies was performed on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. Inter-group differences in the standardized mean differences and relative risk were assessed. Operation times, conversion rates to open surgery, estimated blood loss (EBL), early postoperative morbidity, and length of hospital stay (LHS) were compared. Oncologic outcomes assessed were number of lymph nodes harvested and lengths of proximal and distal resection margins. RESULTS Twenty-four studies (2 RCTs and 22 NRCTs [5 prospective plus 17 retrospective]) with a total of 3318 patients were included. Of these, 1466 (44.18 %) patients underwent RACS and 1852 (55.82 %) underwent LACS. Conversion rates, EBL and LHS were significantly lower, while the operation times and total costs were similar between RACS and LACS. Complication rates and oncological accuracy of resection showed no significant difference. CONCLUSION Based on this meta-analysis, RACS appears to be a promising surgical approach with its safety and efficacy comparable to that of LACS in patients undergoing colorectal surgery. Further studies are required to evaluate the long-term cost-efficiency as well as the functional and oncologic outcomes of RACS.
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