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Yang H, Zhou L. The urinary and sexual outcomes of robot-assisted versus laparoscopic rectal cancer surgery: a systematic review and meta-analysis. Surg Today 2024; 54:397-406. [PMID: 36943447 DOI: 10.1007/s00595-023-02671-3] [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: 08/10/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
To compare the urinary and sexual outcomes between robot-assisted rectal cancer (RC) surgery (RRCS) and laparoscopic RC surgery (LRCS) using a meta-analysis, searches were conducted of the Embase, PubMed, Cochrane Library, CNKI, and Wanfang databases. The International Prostate Symptom Score (IPSS) was the primary outcome. Eleven studies (790 patients with RRCS and 888 with LRCS) were included. The IPSS scores were significantly lower for RRCS than LRCS from baseline to 3 months (weighted mean difference [WMD] = - 1.21, 95% confidence interval [CI]: - 1.8,-0.62, I2 = 89.9%), to 6 months (WMD = - 1.13, 95% CI: - 1.74, - 0.52, I2 = 93.3%), and to 12 months (WMD = - 0.93, 95% CI: - 1.59, - 0.26, I2 = 93.8%). The International Index of Erectile Function (IIEF) scores were significantly higher for RRCS than LRCS from baseline to 3 months (WMD = 3.36, 95% CI: 1.28, 5.44, I2 = 92.7%). The female sexual function index (FSFI) scores were significantly higher for RRCS than LRCS from baseline to 3 months (WMD = 1.31, 95% CI: 0.87, 1.76, I2 = 0), to 6 months (WMD = 2.36, 95% CI: 1.93, 2.79, I2 = 24.3%), and to 12 months (WMD = 1.67, 95% CI: 0.41, 2.93, I2 = 90.9%). RRCS also achieved a better recovery of the urological and sexual function than LRCS for patients with RC. Larger-scale prospective randomized control trials are needed to verify these results.
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Affiliation(s)
- Hua Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lei Zhou
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.
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Sawada N, Akagi T, Shimomura M, Todate Y, Nagakari K, Takeshita H, Maruyama S, Takata M, Ichikawa N, Hida K, Iijima H, Yamaguchi S, Taketomi A, Naitoh T. Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection. Ann Gastroenterol Surg 2024; 8:464-470. [PMID: 38707236 PMCID: PMC11066495 DOI: 10.1002/ags3.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 05/07/2024] Open
Abstract
Background A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II-III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection. Aim This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR). Methods The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (Q and non-Q groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated. Results The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the Q group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups. Conclusion The participation of qualified surgeons in LAR is technically advantageous.
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Affiliation(s)
- Naruhiko Sawada
- Digestive Disease CenterShowa University Northern Yokohama HospitalYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Manabu Shimomura
- Hiroshima City North Medical Center Asa Citizens HospitalHiroshimaJapan
| | - Yukitoshi Todate
- Department of SurgerySouthern Tohoku General HospitalKoriyamaJapan
| | - Kunihiko Nagakari
- Department of Digestive and General SurgeryJuntendo University Urayasu HospitalUrayasuJapan
| | - Hiroaki Takeshita
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterNagasakiJapan
| | - Satoshi Maruyama
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Manabu Takata
- Department of SurgeryNagano Municipal HospitalNaganoJapan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Koya Hida
- Department of SurgeryKyoto University HospitalKyotoJapan
| | - Hiroaki Iijima
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Shigeki Yamaguchi
- Division of Colorectal Surgery, Department of SurgeryTokyo Women's Medical UniversityTokyoJapan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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Chikazawa K, Muro S, Yamaguchi K, Imai K, Kuwata T, Konno R, Akita K. Denonvilliers' fascia as a potential nerve-course marker for the female urinary bladder. Gynecol Oncol 2024; 184:1-7. [PMID: 38271772 DOI: 10.1016/j.ygyno.2024.01.025] [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: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES This study investigated the relationship between Denonvilliers' fascia (DF) and the pelvic plexus branches in women and explored the possibility of using the DF as a positional marker in nerve-sparing radical hysterectomy (RH). METHODS This study included eight female cadavers. The DF, its lateral border, and the pelvic autonomic nerves running lateral to the DF were dissected and examined. The pelvis was cut into two along the mid-sagittal line. The uterine artery, deep uterine veins, vesical veins, and nerve branches to the pelvic organs were carefully dissected. RESULTS The nerves ran sagitally, while the DF ran perpendicularly to them. The rectovaginal ligament was continuous with the DF, forming a single structure. The DF attached perpendicularly and seamlessly to the pelvic plexus. The pelvic plexus branches were classified into a ventral part branching to the bladder, uterus, and upper vagina and a dorsal part branching to the lower vagina and rectum as well as into four courses. Nerves were attached to the rectovaginal ligament and ran on its surface to the bladder ventral to the DF. The uterine branches split from the common trunk of these nerves. The most dorsal branch to the bladder primarily had a common trunk with the uterine branch, which is the most important and should be preserved in nerve-sparing Okabayashi RH. CONCLUSION The DF can be used as a marker for nerve course, particularly in one of the bladder branches running directly superior to the DF, which can be preserved in nerve-sparing Okabayashi RH.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan; Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Ken Imai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
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Yamasaki Y, Tokunaga M, Sakai Y, Kayasuga H, Nishihara T, Tadano K, Kawashima K, Haruki S, Kinugasa Y. Effects of a force feedback function in a surgical robot on the suturing procedure. Surg Endosc 2024; 38:1222-1229. [PMID: 38092971 DOI: 10.1007/s00464-023-10617-6] [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: 10/01/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Currently, widely used robotic surgical systems do not provide force feedback. This study aimed to evaluate the impact and benefits of a force feedback function on the suturing procedure. METHODS Twenty surgeons were recruited and divided into young (Y-group, n = 11) and senior (S-group, n = 9) groups, based on their years of surgical experience. The effect of the force feedback function on suturing quality was evaluated using an objective assessment system (A-LAP mini, Kyoto Kagaku Co., Ltd., Kyoto, Japan). Each participant completed the suturing task on intestinal model sheets with the robotic contact force feedback on and off. The task accomplishment time (s), maximal force (Newton, N) applied to the robotic forceps, and quality of suturing (assessed by A-LAP mini) were recorded as performance parameters. RESULTS In total, the maximal force applied to the robotic forceps was significantly decreased with the robotic force feedback switched on (median [interquartile range]: 2.8 N (2.3-3.2)) as compared with when the feedback was switched off (3.4 N (2.7-4.0), P < 0.001). The contact force feedback function did not affect the objectively assessed suturing score (18 points (17.7-19.0) versus 18 points (17.0-19.0), P = 0.421). The contact force feedback function slightly shortened the task accomplishment time in the Y-group (552.5 s (466.5-832) versus 605.5 s (476.2-689.7), P = 0.851) but not in the S-group (566 s (440.2-703.5) versus 470.5 s (419.7-560.2), P = 0.164). CONCLUSIONS With the contact force feedback function, the suturing task was completed with a smaller maximal force, while maintaining the quality of suturing. Because the benefits are more apparent in young surgeons, robots with the contact force feedback function will facilitate the educational process in novice surgeons.
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Affiliation(s)
- Yoshimi Yamasaki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yoshihiro Sakai
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | | | | | | | | | - Shigeo Haruki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Seike H, Nagata K, Yamana I, Fujikawa T. Preventing an 8-mm Port Site Hernia in Robot-Assisted Laparoscopic Surgery: Insights From Two Rare Cases and Future Preventive Measures. Cureus 2024; 16:e56609. [PMID: 38646374 PMCID: PMC11031640 DOI: 10.7759/cureus.56609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Port-site incisional hernia (PIH) is an uncommon complication that can arise subsequent to a laparoscopic procedure, potentially leading to severe adverse effects such as intestinal obstruction. We currently present two cases of incarcerated hernia that occurred at an 8-mm trocar site after robot-assisted laparoscopic surgery (RALS). While occurrences of an 8-mm port-site incisional hernia are infrequent, it is imperative to note that most PIH cases are due to inadequate fascial closure of the port site. Therefore, surgeons must pay attention to closing the fascia of an 8-mm trocar site following RALS.
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Affiliation(s)
| | - Keiji Nagata
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | - Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Obatake M, Hotchi M, Ishimura N, Kanzaki M, Yoshikawa M, Tokuda K, Watanabe M, Kotegawa H, Yoshiyama H, Ohtani H, Harada M. Propensity score-matched analysis of the short-term outcomes of robotic versus laparoscopic surgery for rectal cancer. Asian J Endosc Surg 2023. [PMID: 37076427 DOI: 10.1111/ases.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The advantages of robot-assisted rectal surgery (RARS) over conventional laparoscope-assisted rectal surgery (LARS) remain controversial. This study was performed to compare the short-term outcomes of RARS and LARS. METHODS We retrospectively analyzed data of 207 patients who had undergone either RARS (n = 97) or LARS (n = 110) for rectal cancer (RC) from 2018 to 2020. A 1:1 matched propensity score-matched analysis was performed and the surgical outcomes of the two groups compared. RESULTS After matching, a well-balanced cohort of 136 patients was analyzed (n = 68 in each group), and there was no significant difference in the median operative time. The RARS group had less intraoperative blood loss than the LARS group. There were no significant differences in length of postoperative hospital stay or complication rate between the two groups. In the subgroup of lower RC, defined as the inferior edge of the tumor being within the rectum distal to the peritoneal reflection, the rate of sphincter preservation was higher in the RARS group (81.8% vs. 44.4%, p = 0.021). CONCLUSION This study shows that RARS is a safe and feasible approach for RC compared with LARS, RARS having the advantage of more often preserving the sphincter.
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Affiliation(s)
- Masayoshi Obatake
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masanori Hotchi
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Naho Ishimura
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masayuki Kanzaki
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masato Yoshikawa
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kazunori Tokuda
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Miya Watanabe
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiroshi Kotegawa
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hirotsugu Yoshiyama
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiromi Ohtani
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masamitsu Harada
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
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Takemasa I, Hamabe A, Miyo M, Akizuki E, Okuya K. Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment. Ann Gastroenterol Surg 2022; 7:198-215. [PMID: 36998300 PMCID: PMC10043777 DOI: 10.1002/ags3.12646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard-of-care to the latest findings to help optimize treatment strategy.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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Lawrie L, Gillies K, Davies L, Torkington J, McGrath J, Kerr R, Immanuel A, Campbell M, Beard D. Current issues and future considerations for the wider implementation of robotic-assisted surgery: a qualitative study. BMJ Open 2022; 12:e067427. [PMID: 36368747 PMCID: PMC9660630 DOI: 10.1136/bmjopen-2022-067427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effective implementation of a fast-changing healthcare delivery innovation, such as robotic-assisted surgery (RAS), into a healthcare system, can be affected (both positively and negatively) by external contextual factors. As part of a wider project investigating ways to optimise the implementation of RAS, this qualitative study aimed to uncover current issues of RAS and predictions about the future of robotic surgery. We refer to 'current issues' as the topical and salient challenges and opportunities related to the introduction of RAS in the UK healthcare system, from the perspectives of key stakeholders involved in the delivery and implementation of RAS. DESIGN Semi-structured interviews and focus groups were conducted. A thematic analysis was conducted to summarise salient issues that were articulated by the participants. SETTING AND PARTICIPANTS The interview sample (n=35) comprised surgeons, wider theatre staff and other relevant personnel involved in the introduction and delivery of RAS services across the UK, including service managers and policymakers/commissioners. Two focus groups were also conducted with surgical trainees (n=7) and members of the public (n=8), respectively. RESULTS The results revealed a largely positive attitude towards the introduction of RAS technology and an expectation of continued rapid expansion. Areas perceived to be particularly pertinent and requiring ongoing attention were also highlighted, including the need to achieve improved quality control, expertise quantification and training issues and the need to educate the public. Issues of centralisation, service organisation and equity of access were also emphasised. CONCLUSIONS Our study has highlighted a range of issues perceived to be particularly pertinent to the current and future provision of RAS which should be addressed. The areas outlined can enable healthcare managers and surgeons to plan for the adoption and/or expansion of RAS services.
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Affiliation(s)
- Louisa Lawrie
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Loretta Davies
- RCS Surgical Interventional Trials Unit (SITU), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
| | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Richard Kerr
- Department of Neurosurgery, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Arul Immanuel
- Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Marion Campbell
- Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David Beard
- RCS Surgical Interventional Trials Unit (SITU), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
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A Comparative Analysis of Short-term Patient Outcomes After Laparoscopic Versus Robotic Rectal Surgery. Dis Colon Rectum 2022; 65:1274-1278. [PMID: 34907989 DOI: 10.1097/dcr.0000000000002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The popularity of robot-assisted colorectal surgery has risen over recent years; however, patient-related advantages over laparoscopic surgery remain uncertain. OBJECTIVE The goal of this study was to compare short-term patient outcomes following robotic and laparoscopic partial or complete rectal resections. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at 5 large tertiary care Kaiser Permanente medical centers across Southern California. PATIENTS There were 863 consecutive robotic and laparoscopic pelvic rectal surgeries, including low anterior resections, proctectomies with coloanal anastomosis, and abdominoperineal resections, performed between January 2010 and December 2019. MAIN OUTCOME MEASURES Short-term patient outcomes, including postoperative length of hospital stay, emergency department returns, and 30-day readmissions, and mortality. RESULTS A total of 458 surgical procedures were performed via robotic versus 405 via laparoscopic approaches. The robotic group had a higher proportion of male patients (57.4% vs 50.4%; p = 0.04) and a higher proportion of obese (27.1% vs 26.9%; p = 0.02) and overweight patients (36.9% vs 35.1%; p = 0.01). There was no difference in underlying comorbidities of diabetes or smoking, or in the rate of ileostomy creation. After adjusting for Charlson Comorbidity Index, no significant difference was found in emergency department returns between robotic and laparoscopic surgical patients ( p = 0.17). There were no significant outcome differences between the 2 groups with regards to length of stay during procedure, 30-day readmission, or death rates. LIMITATIONS This study was limited by the lack of randomization in its design, selection of patients for surgical approach, and training and familiarity with robotic rectal surgery. CONCLUSIONS This study shows length of stay during the procedure and postoperative 30-day readmission rates were generally similar between robotic and laparoscopic patients. Male patients and those with a higher BMI were more likely to have been operated via a robotic method. See Video Abstract at http://links.lww.com/DCR/B857 . UN ANLISIS COMPARATIVO DE LOS RESULTADOS A CORTO PLAZO DE LOS PACIENTES DESPUS DE LA CIRUGA RECTAL LAPAROSCPICA VERSUS LA ROBTICA ANTECEDENTES:La popularidad de la cirugía colorrectal asistida por robot ha aumentado en los últimos años. Sin embargo, las ventajas relacionadas con el paciente siguen siendo inciertas sobre la cirugía laparoscópica.OBJETIVO:Nuestro objetivo era comparar los resultados de los pacientes a corto plazo después de resecciones rectales completas o parciales robóticas y laparoscópicas.DISEÑO:Este fue un estudio de cohorte retrospectivo.AJUSTE:El estudio se llevó a cabo en cinco grandes centros médicos de Kaiser Permanente de atención terciaria en el sur de California.PACIENTES:Se realizaron 863 cirugías robóticas y laparoscópicas rectales pélvicas consecutivas, incluidas resecciones anteriores bajas, proctectomías con anastomosis coloanal y resecciones abdominoperineales, realizadas entre enero de 2010 y diciembre de 2019.PRINCIPALES MEDIDAS DE RESULTADO:Resultados de los pacientes a corto plazo, incluida la duración de la estancia hospitalaria después del procedimiento, los retornos al departamento de emergencias y los reingresos y la mortalidad a los 30 días.RESULTADOS:Se realizaron un total de 458 procedimientos quirúrgicos a través del robot versus 405 con laparoscopia. El grupo robótico tuvo una mayor proporción de pacientes masculinos (57,4 vs 50,4%, p = 0,04) y una mayor proporción de pacientes obesos (27,1 vs 26,9%, p = 0,02) y con sobrepeso (36,9 vs 35,1%, p = 0,01). No hubo diferencia en las comorbilidades subyacentes de la diabetes y el tabaquismo, y en la tasa de creación de ileostomía. Después de ajustar por el índice de comorbilidad de Charlson, no se encontraron diferencias significativas en los retornos al servicio de urgencias entre los pacientes robóticos y laparoscópicos ( p = 0,17). No hubo diferencias significativas en los resultados entre los dos grupos con respecto a la duración de la estadía durante el procedimiento, las tasas de readmisión a los 30 días y las tasas de muerte.LIMITACIONES:Falta de aleatorización en el diseño del estudio, selección de pacientes para abordaje quirúrgico, capacitación y familiaridad con la cirugía rectal robótica.CONCLUSIONES:Este estudio muestra la duración de la estadía durante el procedimiento y las tasas de reingreso a los 30 días después del procedimiento fueron generalmente similares entre los pacientes robóticos y laparoscópicos. Los pacientes masculinos y aquellos con un índice de masa corporal más alto tenían más probabilidades de haber sido operados mediante un método robótico. Consulte Video Resumen en http://links.lww.com/DCR/B857 . (Traducción-Dr Yolanda Colorado ).
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Robot-assisted techniques in vascular and endovascular surgery. Langenbecks Arch Surg 2022; 407:1789-1795. [PMID: 35226179 PMCID: PMC8884093 DOI: 10.1007/s00423-022-02465-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023]
Abstract
For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.
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He S, Yu S, Yuan G, Lu S, Li J, Tang B, Zhong F, Su H. Application of da Vinci robot and laparoscopy on repeat hepatocellular carcinoma. J Minim Access Surg 2022; 18:378-383. [PMID: 35708383 PMCID: PMC9306131 DOI: 10.4103/jmas.jmas_111_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Repeat laparoscopic liver resection has been used safely and effectively on hepatocellular carcinoma (HCC). However, few studies have been performed on repeat HCC surgery by a da Vinci robot. This study aims to evaluate the outcomes of the patients with repeat HCC treated using a da Vinci robot or laparoscopic system at a single centre. Methods: All of the patients with repeat HCC treated using a da Vinci robotic or laparoscopic system between April 2017 and April 2020 were included in this retrospective study. Results: There were 24 patients with a mean age of 56 years who underwent da Vinci robotic or laparoscopic surgery for treatment of repeat HCC who were included in this study. The operations lasted 152 ± 25 min and 142 ± 34 min. The average intraoperative blood loss was 284 ± 89 ml and 251 ± 92 ml. The average hospitalisation stay lasted 9 ± 2 days and 9 ± 3 days. The rates at which surgeons switched to open surgery were 9% and 23%. No serious perioperative or post-operative complications were encountered. Conclusion: Da Vinci robots can provide a precise dissection of the tissue under a perfect view. It is a technically feasible procedure for less rates at which surgeons switched to open surgery on repeat HCC.
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12
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Short-term outcomes of robotic-assisted versus conventional laparoscopic-assisted surgery for rectal cancer: a propensity score-matched analysis. J Robot Surg 2021; 16:323-331. [PMID: 33886065 DOI: 10.1007/s11701-021-01243-2] [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] [Received: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 01/02/2023]
Abstract
It remains controversial whether the advantages of robotic-assisted surgery are beneficial for rectal cancer (RC). The study aimed to evaluate the short-term outcomes of robotic-assisted rectal surgery (RARS) compared with those of conventional laparoscopic-assisted rectal surgery. We retrospectively analyzed 539 consecutive patients with stage I-IV RC who had undergone elective surgery between January 2010 and December 2020, using propensity score-matched analysis. After propensity score matching, we enrolled 200 patients (n = 100 in each groups). Before matching, significant group-dependent differences were observed in terms of age (p = 0.04) and body mass index (p < 0.01). After matching, clinicopathologic outcomes were similar between the groups, but estimated operative time was longer and postoperative lymphorrhea was more frequent in the RARS group. Estimated blood loss, rate of conversion to laparotomy, and incidence of anastomotic leakage or reoperation were significantly lower in the RARS group. No surgical mortality was observed in either group. No significant differences were observed in terms of positive resection margins or number of lymph nodes harvested. RARS was safe and technically feasible, and achieved acceptable short-term outcomes. The robotic technique showed some advantages in RC surgery that require validation in further studies.
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13
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Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases. J Robot Surg 2021; 16:179-187. [PMID: 33743145 DOI: 10.1007/s11701-021-01227-2] [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: 10/21/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Robotic-assisted laparoscopic surgery attempts to facilitate rectal surgery in the narrow space of the pelvis. The aim of this study is to compare the outcomes of robotic versus laparoscopic surgery for rectal cancer. Monocentric retrospective study including 300 patients who underwent robotic (n = 178) or laparoscopic (n = 122) resection between Jan 2009 and Dec 2017 for high, mid and low rectal cancer. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, except for sex and ASA status. There were no statistical differences between groups in the conversion rate to open surgery. Surgical morbidity and oncological quality did not differ in either group, except for the anastomosis leakage rate and the affected distal resection margin. There were no differences in overall survival rate between the laparoscopic and robotic group. Robotic surgery could provide some advantages over conventional laparoscopic surgery, such as three-dimensional views, articulated instruments, lower fatigue, lower conversion rate to open surgery, shorter hospital stays and lower urinary and sexual dysfunctions. On the other hand, robotic surgery usually implies longer operation times and higher costs. As shown in the ROLARR trial, no statistical differences in conversion rate were found between the groups in our study. When performed by experienced surgeons, robotic surgery for rectal cancer could be a safe and feasible option with no significant differences in terms of oncological outcomes in comparison to laparoscopic surgery.
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14
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Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity. World J Surg 2021; 44:3130-3140. [PMID: 32383054 DOI: 10.1007/s00268-020-05560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior randomized trials showed comparable short-term outcomes between open and minimally invasive proctectomy (MIP) for rectal cancer. We hypothesize that short-term outcomes for MIP have improved as surgeons have become more experienced with this technique. METHODS Rectal cancer patients who underwent elective abdominoperineal resection (APR) or low anterior resection (LAR) were included from the American College of Surgeons National Surgical Quality Improvement Program database (2016-2018). Patients were stratified based on intent-to-treat protocol: open (O-APR/LAR), laparoscopic (L-APR/LAR), robotic (R-APR/LAR), and hybrid (H-APR/LAR). Multivariable logistic regression analysis was used to assess the impact of operative approach on 30-day morbidity. RESULTS A total of 4471 procedures were performed (43.41% APR and 36.59% LAR); O-APR 42.72%, L-APR 20.99%, R-APR 16.79%, and H-APR 19.51%; O-LAR 31.48%, L-LAR 26.34%, R-LAR 17.48%, and H-LAR 24.69%. Robotic APR and LAR were associated with shortest length of stay and significantly lower conversion rate. After adjusting for other factors, lap, robotic and hybrid APR and LAR were associated with decreased risk of overall morbidity when compared to open approach. R-APR and H-APR were associated with decreased risk of serious morbidity. No difference in the risk of serious morbidity was observed between the four LAR groups. CONCLUSION Appropriate selection of patients for MIP can result in better short-term outcomes, and consideration for MIP surgery should be made.
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15
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Current status of robotic surgery in colorectal residency training programs. Surg Endosc 2021; 36:307-313. [PMID: 33523270 DOI: 10.1007/s00464-020-08276-y] [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] [Received: 08/16/2020] [Accepted: 12/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Robotic surgery (RS) has been increasingly incorporated into colorectal surgery (CRS) training. The degree to which RS has been integrated into CRS residency training is not well described. METHODS A web-based survey was sent to all 2019 accredited CRS residency programs within the United States and Canada. Program directors (PDs) were queried on how robotic surgery had been integrated into their program, specifics on RS curriculum and opinions on RS training during general surgery residency. We compared survey responses by program type (university-based, university-affiliated programs, or independent programs) and by geographic region. In addition, a chi-square test was used to evaluate differences in survey responses with respect to robotic curriculum components. RESULTS Of 66 programs, 42 (64%) responded to the survey. Of the responding programs, 35 (83%) were university-based or university-affiliated, while 7 (17%) were independent. Most programs were in the Midwest (33%). Forty-one (98%) reported having a surgical robot in use at their institution, with 95% reporting active participation of CRS residents in RS. While 74% of programs have a formal RS training curriculum for CRS residents, there was considerable variability in the curriculum elements employed by each institution, and the differences in proportions of these elements were significant (χ2 99.8, p < 0.001). The median operative approach to abdominopelvic cases was estimated to be 33% robotic, 40% laparoscopic and 20% open. There were no significant differences in the survey responses between university/university-affiliated and independent programs (p > 0.05) or among the different regions (p > 0.05). CONCLUSIONS This study demonstrated that almost all CRS residencies have integrated RS and have trainees operating at the robotic console. Most programs have a robotics curriculum and there are expanding indications for RS within CRS. This expansion calls for discussion on implementation of training standards such as curricular requisites, baseline competency assessments, and definitions of minimum case requirements to ensure adequate training.
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16
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Yamamoto S. Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews. Ann Gastroenterol Surg 2020; 4:628-634. [PMID: 33319152 PMCID: PMC7726682 DOI: 10.1002/ags3.12385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022] Open
Abstract
Regarding the surgical approaches for rectal cancer, many techniques have been reported in randomized controlled trials, meta-analyses, and reviews of comparisons between two techniques, e.g. open surgery vs laparoscopic surgery, laparoscopic surgery vs robotic surgery, or laparoscopic surgery vs transanal total mesorectal excision. Since robotic surgery and transanal total mesorectal excision were developed after laparoscopic surgery had become an established minimally invasive technique, they have each been compared with laparoscopic surgery. Therefore, a review was performed to compare the surgical outcomes of robotic surgery and transanal total mesorectal excision, and to perform such comparisons among ≥3 of the above mentioned approaches, in the expectation that this review will serve as a reference for aiding treatment selection in future. The results of the current review suggest that all of the examined procedures have advantages and disadvantages, but that there are no decisive factors that could be used to select one procedure over any other. At the present time it cannot be demonstrated that laparoscopic surgery, robotic surgery, transanal total mesorectal excision, or open surgery is superior to the other techniques, and it is important to select the best technique for each patient from among those that a surgeon can perform. It is also important to maintain a flexible attitude that allows new techniques to be adopted as needed in the future.
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Affiliation(s)
- Seiichiro Yamamoto
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
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17
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Takeyama H, Danno K, Nishigaki T, Yamashita M, Oka Y. Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST). Updates Surg 2020; 73:1093-1102. [PMID: 33079354 DOI: 10.1007/s13304-020-00901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023]
Abstract
In a narrow pelvic cavity, performing sufficient tumor-specific mesorectal excision (TSME) is difficult. Even in robot-assisted laparoscopic surgery (RALS), mesorectal division is difficult in a narrow pelvic cavity. To overcome this difficulty, we invented a novel method of mesorectal division. In this new approach, we switched the fenestrated bipolar forceps and the double-fenestrated forceps with each other so that both instruments were placed on the same (right) side of the patient. After the mesorectal fat and vessels were coagulated using the fenestrated bipolar forceps, coagulated tissues were divided using the monopolar scissors in the same direction. We named this technique the "simple switching technique (SST)". We retrospectively collected data and evaluated the usefulness of SST in 24 consecutive patients who underwent RALS TSME between July 2018 and January 2020. Twelve patients underwent SST, and 12 patients underwent other conventional surgical methods (non-SST). The median operation time for mesorectal division was 809.5 s (range 395-1491 s) in the SST group and 985.5 s (range 493-2353 s) in the non-SST group. The coefficient of variation for non-SST was 0.545, which was > 1.5 times the coefficient of 0.360 for SST. Although no significant differences were found for operation time for mesorectal division, the operation time for mesorectal division by SST tended to be shorter than by non-SST (P = 0.157). No significant differences were found regarding short-term outcomes between the groups. SST is feasible and can be an optional method of mesorectal division in RALS TSME.
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Affiliation(s)
- Hiroshi Takeyama
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
| | - Katsuki Danno
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Yoshio Oka
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
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18
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Al-Taher M, Okamoto N, Felli E, Agnus V, Barberio M, Gioux S, Bouvy N, Stassen L, Marescaux J, Diana M. Noninvasive Near-Infrared Fluorescence Imaging of the Ureter During Robotic Surgery: A Demonstration in a Porcine Model. J Laparoendosc Adv Surg Tech A 2020; 30:962-966. [DOI: 10.1089/lap.2020.0399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mahdi Al-Taher
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Vincent Agnus
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Manuel Barberio
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Sylvain Gioux
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Michele Diana
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
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19
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Lo BD, Zhang GQ, Stem M, Sahyoun R, Efron JE, Safar B, Atallah C. Do specific operative approaches and insurance status impact timely access to colorectal cancer care? Surg Endosc 2020; 35:3774-3786. [PMID: 32813058 DOI: 10.1007/s00464-020-07870-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The increased use of minimally invasive surgery in the management of colorectal cancer has led to a renewed focus on how certain factors, such as insurance status, impact the equitable distribution of both laparoscopic and robotic surgery. Our goal was to analyze surgical wait times between robotic, laparoscopic, and open approaches, and to determine whether insurance status impacts timely access to treatment. METHODS After IRB approval, adult patients from the National Cancer Database with a diagnosis of colorectal cancer were identified (2010-2016). Patients who underwent radiation therapy, neoadjuvant chemotherapy, had wait times of 0 days from diagnosis to surgery, or had metastatic disease were excluded. Primary outcomes were days from cancer diagnosis to surgery and days from surgery to adjuvant chemotherapy. Multivariable Poisson regression analysis was performed. RESULTS Among 324,784 patients, 5.9% underwent robotic, 47.5% laparoscopic, and 46.7% open surgery. Patients undergoing robotic surgery incurred the longest wait times from diagnosis to surgery (29.5 days [robotic] vs. 21.7 [laparoscopic] vs. 17.2 [open], p < 0.001), but the shortest wait times from surgery to adjuvant chemotherapy (48.9 days [robotic] vs. 49.9 [laparoscopic] vs. 54.8 [open], p < 0.001). On adjusted analysis, robotic surgery was associated with a 1.46 × longer wait time to surgery (IRR 1.462, 95% CI 1.458-1.467, p < 0.001), but decreased wait time to adjuvant chemotherapy (IRR 0.909, 95% CI 0.905-0.913, p < 0.001) compared to an open approach. Private insurance was associated with decreased wait times to surgery (IRR 0.966, 95% CI 0.962-0.969, p < 0.001) and adjuvant chemotherapy (IRR 0.862, 95% CI 0.858-0.865, p < 0.001) compared to Medicaid. CONCLUSION Though patients undergoing robotic surgery experienced delays from diagnosis to surgery, they tended to initiate adjuvant chemotherapy sooner compared to those undergoing open or laparoscopic approaches. Private insurance was independently associated not only with access to robotic surgery, but also shorter wait times during all stages of treatment.
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Affiliation(s)
- Brian D Lo
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - George Q Zhang
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Rebecca Sahyoun
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Chady Atallah
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA.
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20
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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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21
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Bokey L, Zhang M, Fingerhut A, Dent OF, Chapuis PH. Trans-anal total mesorectal excision - reflections on the introduction of a new procedure. Colorectal Dis 2020; 22:739-744. [PMID: 32533809 DOI: 10.1111/codi.15190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- L Bokey
- Department of Colorectal Surgery and Department of Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - M Zhang
- Department of Anatomy, University of Otago, Otago, New Zealand
| | - A Fingerhut
- Department of Surgery, Medical University of Graz, Graz, Austria.,Department of General Surgery, Shanghai Minimally Invasive Surgery Centre, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - O F Dent
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - P H Chapuis
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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22
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Olthof PB, Giesen LJX, Vijfvinkel TS, Roos D, Dekker JWT. Transition from laparoscopic to robotic rectal resection: outcomes and learning curve of the initial 100 cases. Surg Endosc 2020; 35:2921-2927. [PMID: 32556694 PMCID: PMC8116275 DOI: 10.1007/s00464-020-07731-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
Background Following several landmark trials, laparoscopic rectal resection has reached standard clinical practice. Current literature is undecided on the advantages of robotic rectal resection and little is known on its learning curve. This study aimed to compare the outcomes of the first 100 robotic rectal resections to the laparoscopic approach in a teaching hospital experienced in laparoscopic colorectal surgery. Methods A retrospective analysis was conducted of a prospective cohort of all consecutive rectal resections between January 2012 and September 2019 at a single center. All laparoscopic cases were compared to the robotic approach. Outcomes included operative time, morbidity, anastomotic leakage, and hospital stay. Results Out of the 326 consecutive resections, 100 were performed robotically and 220 laparoscopically, the remaining 6 open cases were excluded. Median operative time was lower for robotic cases (147 (121–167) versus 162 (120–218) minutes P = 0.024). Overall morbidity was lower in robotic cases (25% versus 50%, P < 0.001), while major morbidity was similar. Anastomotic leakage was observed in 11% (8/70) of robotic and 15% (18/120) of laparoscopic anastomoses, despite more anastomoses in the robotic group (70%, 70/100 versus 55%, 120/220, P = 0.001). Median length of stay was 4 (4–7) days after a robotic and 6 (5–9) days after a laparoscopic procedure. Discussion Implementation of a robotic rectal resection program in an experienced laparoscopic surgery center was associated with reduced operative time, length of stay, and fewer complications despite a learning curve.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | - Louis J X Giesen
- Department of Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Teddy S Vijfvinkel
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
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23
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Hara Y, Miura T, Sakamoto Y, Morohashi H, Nagase H, Hakamada K. Organ/space infection is a common cause of high output stoma and outlet obstruction in diverting ileostomy. BMC Surg 2020; 20:83. [PMID: 32345295 PMCID: PMC7189461 DOI: 10.1186/s12893-020-00734-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The objectives of this study are to identify causes of high-output stoma (HOS) and outlet obstruction (OO), which are major complications of diverting ileostomy. METHODS A retrospective analysis was performed in 103 patients who underwent colorectal surgery and diverting ileostomy between December 2015 and November 2018. RESULTS HOS was found in 32 patients (31.1%) and OO in 19 (18.4%). Organ/space surgical site infection (SSI), anastomotic leakage and OO were significant HOS-related factors in univariate analysis, and OO (odds ratio [OR] 3.39, p = 0.034) was a independent HOS-related factor in multivariate analysis. Organ/space SSI and male were significant OO-related factors in univariate analysis, and organ/space SSI (OR 3.77, p = 0.018) was a independent OO-related factor in multivariate analysis. The white blood cell (WBC) count on postoperative day (POD) 3 was significantly higher in the HOS group compared to the non-HOS group (9765 vs. 8130 /mL, p < 0.05), and the WBC count (9400 vs. 7475 /mL, p < 0.05) and C-reactive protein level (6.01 vs. 2.92 mg/L, p < 0.05) on POD 6 were significantly higher in the OO group compared to the non-OO group. CONCLUSION Organ/space infection is involved in the common pathology of HOS and OO. Decreased intestinal absorption due to intestinal edema caused by organ/space SSI and relative stenosis at the abdominal wall-penetrating site are major causes of HOS and OO.
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Affiliation(s)
- Yutaro Hara
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Hayato Nagase
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
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24
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25
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P. A year in review in Minerva Anestesiologica 2018. Minerva Anestesiol 2020; 85:206-220. [PMID: 30773000 DOI: 10.23736/s0375-9393.19.13597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital School of Medicine Campus Bio-Medico of Rome, Rome, Italy
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesiology and Intensive Care, Pitié-Salpètrière Hospital, Sorbonne University Paris, Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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Gerbaud F, Valverde A, Danoussou D, Goasguen N, Oberlin O, Lupinacci RM. Experience With Transitioning From Laparoscopic to Robotic Right Colectomy. JSLS 2020; 23:JSLS.2019.00044. [PMID: 31787837 PMCID: PMC6859890 DOI: 10.4293/jsls.2019.00044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives The number of robotic colorectal procedures performed has rapidly increased, but there are only sparse data available about the robotic learning curve of expert laparoscopic colorectal surgeons. Methods In this retrospective study, we reviewed 101 minimally invasive right colectomies consecutively performed by a single surgeon with 20 years of clinical practice fully dedicated to laparoscopic surgery. Thus, the last 59 laparoscopic resections were compared with the first 42 robotic resections. Results The duration of the procedure was longer in the robotic group, but the conversion rate was the same in both groups. There was no difference between groups in rates of overall and severe postoperative complications, reoperation, hospital length of stay, and readmission. Number of harvested lymph nodes and oncological quality of resection defined by the pathologist were the same. Conclusions This study suggests that the transition from the right laparoscopic colectomy with extracorporeal anastomosis to the robot-assisted right colectomy with intracorporeal anastomosis when performed by a surgeon with experience in laparoscopic colorectal surgery may not entail any increase on the morbidity rate or reduce the oncologic quality of the resection.
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Affiliation(s)
- Florent Gerbaud
- Service de Chirurgie Digestive, GH Diaconesses Croix Saint Simon
| | - Alain Valverde
- Service de Chirurgie Digestive, GH Diaconesses Croix Saint Simon
| | - Divya Danoussou
- Service de Chirurgie Digestive, GH Diaconesses Croix Saint Simon
| | - Nicolas Goasguen
- Service de Chirurgie Digestive, GH Diaconesses Croix Saint Simon
| | - Olivier Oberlin
- Service de Chirurgie Digestive, GH Diaconesses Croix Saint Simon
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Teaching robotic rectal cancer surgery at your workplace: does the presence of visiting surgeons in the operating room have a detrimental effect on outcomes? Surg Endosc 2019; 34:3936-3943. [PMID: 31598879 DOI: 10.1007/s00464-019-07164-4] [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: 03/27/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Surgery demonstration (SD) is considered to be a mainstay of surgical education, but controversy exists concerning the patient's safety. Indeed, the presence of visiting surgeons is a source of distraction and may have an impact on surgeon's performance. This study's objective was to evaluate possible differences in outcomes between robotic sphincter-saving rectal cancer surgery (RRCS) performed during routine surgical practice versus in the presence of visiting surgeons in the operating room (OR) with direct access to the surgeon. METHODS Retrospective case-matched studies were conducted from a prospectively collected database. 114 patients (38 with the presence of visiting surgeons) who underwent RRCS between January 2013 and September 2018 were included. Patients were matched in a 1:2 basis after propensity score analysis using five criteria: gender, body mass index, preoperative chemoradiation, type of mesorectum excision, and synchronous liver metastasis. RESULTS There was no difference between the two groups with regard to mean operating time, estimated blood loss, conversion, and hospital stay. Also, overall (44% vs. 40%; P = 0.6), major morbidity (26% vs. 19%; P = 0.5), and unplanned reoperation (17% vs. 15%; P = 1.0) rates were not statistically different. No difference was noted with regard to the quality of mesorectum excision, or positive rate of circumferential and distal longitudinal resection margins. The mean number of harvested lymph nodes (17 vs. 14.5; P = 0.04) was lower in the SD group and the number of patients with < 12 harvested lymph nodes (31% vs. 16%; P = 0.09) was greater after SD although it did not reach statistical significance. No differences were observed in disease-free or overall survival. CONCLUSIONS The presence of visiting surgeons in the OR seems not to interfere in the quality of rectal resection and does not compromise patient's short-term outcome and survival. However, mild differences in the extent of lymphadenectomy were observed and the surgeons performing SD may be aware of this.
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Kakeji Y. Surgery: To what extent can we operate? Ann Gastroenterol Surg 2018; 2:398-399. [PMID: 30460341 PMCID: PMC6236103 DOI: 10.1002/ags3.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
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