Robotic CME in obese patients: advantage of robotic ultrasound scan for vascular dissection

Preoperative CT-Scan Angiography Reconstruction Before Right Colectomy with Complete Mesocolon Excision: A Systematic Review and Meta-analysis

BACKGROUND

Complete mesocolon excision (CME) and central vascular ligation for right colonic cancers have been developed to improve oncological outcomes. However, it has been linked with a higher risk of morbidity and technical difficulties in operating near major vessels. This study investigated the impact of preoperative surgical planning utilizing CT reconstruction on surgical outcomes in right colectomy with CME.

METHODS

This systematic review and meta-analysis followed PRISMA and AMSTAR 2 guidelines. The analysis included clinical trials and observational studies comparing outcomes after preoperative CT scan reconstruction (navigation group) vs. no preoperative CT reconstruction (control group).

RESULTS

Four eligible studies (published between 2013 and 2023) were included, comprising 420 patients (203 in the navigation group and 217 in the control group). Preoperative navigation was associated with significantly lower blood loss (SMD = - 77.50; 95% CI [- 126.77, - 28.22], p = 0.002), shorter operative time (SMD = - 24.44; 95% CI [- 33.33, - 15.55], p < 0.00001), and a higher number of harvested lymph nodes (SMD = 1.39; 95% CI [0.58, 2.20], p = 0.0007). There was no statistically significant difference between the two groups in terms of overall morbidity (OR = 0.82; 95% CI [0.28, 2.40], p = 0.71), intraoperative complications (OR = 1.39; 95% CI [0.37, 5.26], p = 0.63), anastomotic leak (OR = 1.10; 95% CI [0.16, 7.63], p = 0.92), or hospital stay (SMD = - 0.06; 95% CI [- 0.48, 0.37], p = 0.80).

CONCLUSION

Preoperative navigation using CT reconstruction could help better delineate the complex vascular anatomy of the right colon. It may reduce operative time and increase the yield of harvested lymph nodes.

Ultrasound-guided robotic surgical procedures: a systematic review

INTRODUCTION

Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable, especially for robotic surgery. Being able to see through parenchyma and into vascular structures enables to avoid unnecessary dissection by providing a thorough assessment at every stage without the need for contrast media or ionising radiation. The limitations of restricted angulation and access within the abdominal cavity during laparoscopy can be overcome by robotic handling of miniaturised ultrasound probes and the use of various and specific frequencies will meet tissue- and organ-specific characteristics. The aim of this systematic review was to assess the reported applications of intraoperative ultrasound-guided robotic surgery and to outline future perspectives.

METHODS

The study adhered to the PRISMA guidelines. PubMed, Google Scholar, ScienceDirect and ClinicalTrials.gov were searched up to October 2023. Manuscripts reporting data on ultrasound-guided robotic procedures were included in the qualitative analysis.

RESULTS

20 studies met the inclusion criteria. The majority (53%) were related to the field of general surgery during liver, pancreas, spleen, gallbladder/bile duct, vascular and rectal surgery. This was followed by other fields of oncological surgery (42%) including urology, lung surgery, and retroperitoneal lymphadenectomy for metastases. Among the studies, ten (53%) focused on locating tumoral lesions and defining resection margins, four (15%) were designed to test the feasibility of robotic ultrasound-guided surgery, while two (10.5%) aimed to compare robotic and laparoscopic ultrasound probes. Additionally two studies (10.5%) evaluated the robotic drop-in probe one (5%) assessed the hepatic tissue consistency and another one (5%) aimed to visualize the blood flow in the splenic artery.

CONCLUSION

The advantages of robotic instrumentation, including ergonomics, dexterity, and precision of movements, are of relevance for robotic intraoperative ultrasound (RIOUS). The present systematic review demonstrates the virtue of RIOUS to support surgeons and potentially reduce minimally invasive procedure times.