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Brachini G, Cirillo B, Matteucci M, Cirocchi R, Tebala GD, Cavaliere D, Giacobbi L, Papa V, Solaini L, Avenia S, D’Andrea V, Davies J, Fedeli P, De Santis E. A Systematic Review of Varying Definitions and the Clinical Significance of Fredet's Fascia in the Era of Complete Mesocolic Excision. J Clin Med 2023; 12:6233. [PMID: 37834876 PMCID: PMC10573991 DOI: 10.3390/jcm12196233] [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: 05/07/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Fredet's fascia represents a crucial landmark for vascular surgical anatomy, especially in minimally invasive complete mesocolic excision (CME) for right-sided colon adenocarcinoma. Fredet's fascia allows access to the gastrocolic trunk of Henle (GCTH), the most critical step in both open and minimally invasive right-sided CME techniques. Despite this, a recent workshop of expert surgeons on the standardization of the laparoscopic right hemicolectomy with CME did not recognize or include the term of Fredet's fascia or area. Hence, we undertook a systematic review of articles that include the terms "Fredet's fascia or area", or synonyms thereof, with special emphasis on the types of articles published, the nationality, and the relevance of this area to surgical treatments. METHODS We conducted a systematic review up to 15 July 2022 on PubMed, WOS, SCOPUS, and Google Scholar. RESULTS The results of the study revealed that the term "Fredet's fascia" is poorly used in the English language medical literature. In addition, the study found controversial and conflicting data among authors regarding the definition of "Fredet's fascia" and its topographical limits. CONCLUSIONS Knowledge of Fredet's fascia's surgical relevance is essential for colorectal surgeons to avoid accidental injuries to the superior mesenteric vascular pedicle during minimally invasive right hemicolectomies with CME. In order to avoid confusion and clarify this fascia for future use, we suggest moving beyond the use of the eponymous term by using a "descriptive term" instead, based on the fascia's anatomic structure. Fredet's fascia could, therefore, be more appropriately renamed "sub-mesocolic pre-duodenopancreatic fascia".
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Affiliation(s)
- Gioia Brachini
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Bruno Cirillo
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | | | - Davide Cavaliere
- General Surgical Department, Ospedale Degli Infermi Faenza, 48018 Faenza, Italy;
| | - Lorenza Giacobbi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | - Veronica Papa
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, 80132 Napoli, Italy;
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, 47121 Forlì, Italy;
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.C.); (L.G.); (S.A.)
| | - Vito D’Andrea
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University, Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
- University of Cambridge, Cambridge CB2 0QQ, UK
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Elena De Santis
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (V.D.); (E.D.S.)
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Tian Y, Xiong D, Xu M, Fan Q, Zheng H, Shen H, Huang B, Wang L, Li C, Zhang A, Liu B, Li F, Gao F, Tong W. Robotic versus laparoscopic right hemicolectomy with complete mesocolic excision: a retrospective multicenter study with propensity score matching. Front Oncol 2023; 13:1187476. [PMID: 37333806 PMCID: PMC10273266 DOI: 10.3389/fonc.2023.1187476] [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] [Received: 03/16/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Objective During the past decade, the concept of complete mesocolic excision (CME) has been developed in an attempt to minimize recurrence for right-sided colon cancer. This study aims to compare outcomes of robotic versus laparoscopic right hemicolectomy with CME for right-sided colon cancer. Methods We performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142). Results Before propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943). Conclusion Despite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.
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Affiliation(s)
- Yue Tian
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Dehai Xiong
- Department of Colorectum, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Ming Xu
- Department of Colorectum, The 940Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, China
| | - Qi Fan
- Department of Colorectum, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Huichao Zheng
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Haode Shen
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Bin Huang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Li Wang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Chunxue Li
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Anping Zhang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Baohua Liu
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Fan Li
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Feng Gao
- Department of Colorectum, The 940Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, China
| | - Weidong Tong
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
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Jin Q, Long D, Liu C, Jiang Y, Zhou W, Yao H, Liu K. A propensity score matching study of totally robotic right hemicolectomy versus robot-assisted right hemicolectomy. J Robot Surg 2022; 17:905-914. [DOI: 10.1007/s11701-022-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
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Zhang Y, Feng H, Wang S, Gu Y, Shi Y, Song Z, Deng Y, Ji X, Cheng X, Zhang T, Zhao R. Short- and long-term outcomes of robotic- versus laparoscopic-assisted right hemicolectomy: A propensity score-matched retrospective cohort study. Int J Surg 2022; 105:106855. [PMID: 36030038 DOI: 10.1016/j.ijsu.2022.106855] [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: 05/04/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to retrospectively compare the short- and long-term outcomes of robotic- and laparoscopic-assisted right hemicolectomies. MATERIALS AND METHODS Patients who underwent right hemicolectomy with either robotic (46 patients) or laparoscopic (186 patients) surgery between January 2016 and December 2018 were analyzed retrospectively using propensity score matching (PSM). RESULTS After matching, the robotic group included 45 patients (out of 46) and the laparoscopic group included 100 patients (out of 186). Compared to the laparoscopic group, the robotic group had shorter median times to first flatus (2 vs. 4 days; p < 0.01) and a liquid diet (4 vs. 5 days; p < 0.01) and shorter median postoperative hospital stays (7 vs. 8 days; p < 0.01). There were no significant differences in other short-term or oncological outcomes between the two groups. The 3-year overall survival and disease-free survival rates were equivalent. CONCLUSIONS Robotic-assisted right hemicolectomy had the advantages of a quick recovery of bowel functions and an earlier postoperative discharge and was non-inferior to laparoscopic-assisted right hemicolectomy in all other outcomes.
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Affiliation(s)
- Yaqi Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaodong Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifei Gu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, China
| | - Yi Shi
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, China
| | - Zijia Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Deng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Giuliani G, Guerra F, Coletta D, Giuliani A, Salvischiani L, Tribuzi A, Caravaglios G, Genovese A, Coratti A. Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Colorectal Dis 2022; 37:101-109. [PMID: 34599362 DOI: 10.1007/s00384-021-04038-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Minimally invasive surgery has been universally accepted as a valid option for the treatment of diverticular disease, provided specific expertise is available. Over the last decade, there has been a growing interest in the application of robotic approaches for diverticular disease. We aimed at evaluating whether robotic colectomy may offer some advantages over the laparoscopic approach for surgical treatment of diverticular disease by meta-analyzing the available data from the medical literature. METHODS The PubMed/Medline, EMBASE, and Web Of Sciences electronic databases were searched for literature up to December 2020. Inclusion criteria considered all comparative studies evaluating robotic versus laparoscopic colectomy for diverticulitis eligible. The conversion rate to the open approach was evaluated as the primary outcome. RESULTS The data of 4177 patients from nine studies were included in the analysis. There were no significant differences in the baseline characteristics. Patients undergoing laparoscopic colectomy compared to those who underwent surgery with a robotic approach had a significantly higher risk of conversion into an open procedure (12.5% vs. 7.4%, p < 0.00001) and abbreviated hospital stay (p < 0.0001) at the price of a longer operating time (p < 0.00001). CONCLUSION Compared with conventional laparoscopic surgery, the robotic approach offers significant advantages in terms of conversion rate and shortened hospital stay for the treatment of diverticular disease. However, because of the lack of available evidence, it is impossible to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy.
| | - Francesco Guerra
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Emergency Department - Emergency and Trauma Surgery Unit, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.,Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Salvischiani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Angela Tribuzi
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Giuseppe Caravaglios
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Alfredo Genovese
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
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Right colectomy with intracorporeal anastomosis for cancer: a prospective comparison between robotics and laparoscopy. J Robot Surg 2021; 16:655-663. [PMID: 34368911 DOI: 10.1007/s11701-021-01290-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
Robotics in right colectomy are still under debate. Available studies compare different techniques of ileocolic anastomosis but results are non-conclusive. Our study aimed to compare intraoperative outcomes, and short-term postoperative results between robotic and standard laparoscopic right colectomies for cancer with intracorporeal anastomosis (ICA) fashioned with the same technique. All consecutive patients scheduled for laparoscopic or robotic right hemicolectomies with ICA for cancer in two hospitals, one of which is a tertiary care centre, were prospectively enrolled in our prospective observational study, from April 2018 to December 2019. ICA was fashioned with the same stapled hand-sewn technique. Continuous and categorical variables were analysed using t test and chi-squared test as required. Statistical significance was set at p < 0.05. Forty patients underwent laparoscopic surgery, and 48 underwent robotic right colectomy and were included in the intention-to-treat analysis. Operative time was not statistically different between the two groups (robotic group 265.9 min vs laparoscopic group 254.2 min, p = 0.29). The robotic group had a significantly shorter time for stump oversewing (ileum reinforcement: robotic group 9.3 min vs laparoscopic group 14.2 min, p < 0.001; colon reinforcement: robotic 7.7. min, laparoscopy 13.9 min, p < 0.001) and for ICA (robotic 31.6 min vs laparoscopy 43.0, p < 0.001). One patient underwent extracorporeal anastomosis in the robotic group. The short-term outcomes were comparable between standard laparoscopic and robotic right colectomies with ICA. The limitation of the study is its small sample size and the fact that it was done in two institutions under the supervision of one person. Our data demonstrate that intracorporeal ileocolic anastomosis is safe, and faster and easier with robotic systems. Robotics can facilitate more challenging ICA in minimally invasive surgery.
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Mlambo B, Shih IF, Li Y, Wren SM. The impact of operative approach on postoperative outcomes and healthcare utilization after colectomy. Surgery 2021; 171:320-327. [PMID: 34362589 DOI: 10.1016/j.surg.2021.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND To evaluate national trends in adoption of different surgical approaches for colectomy and compare clinical outcomes and resource utilization between approaches. METHODS Retrospective study of patients aged ≥18 years who underwent elective inpatient left or right colectomy between 2010 and 2019 from the Premier Healthcare Database. Patients were classified by operative approach: open, minimally invasive: either laparoscopic or robotic. Postoperative outcomes assessed within index hospitalization include operating room time, hospital length of stay, rates of conversion to open surgery, reoperation, and complications. Post-discharge readmission, hospital-based encounters, and costs were collected to 30 days post-discharge. Multivariable regression models were used to compare outcomes between operative approaches adjusted for patient baseline characteristics and clustering within hospitals. RESULTS Among 206,967 patients, the robotic approach rates increased from 2.1%/1.6% (2010) to 32.6%/26.8% (2019) for left/right colectomy, offset by a decrease in both open and laparoscopic approaches. Median length of stay for both left and right colectomies was significantly longer in open (6 days) and laparoscopic (5 days) compared to robotic surgery (4 days; all P values <.001). Robotic surgery compared to open and laparoscopic was associated with a significantly lower conversion rate, development of ileus, overall complications, and 30-day hospital encounters. Robotic surgery further demonstrated lower mortality, reoperations, postoperative bleeding, and readmission rates for left and right colectomies than open. Robotic surgery had significantly longer operating room times and higher costs than either open or laparoscopic. CONCLUSIONS Robotic surgery is increasingly being used in colon surgery, with outcomes equivalent and in some domains superior to laparoscopic.
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Affiliation(s)
- Busisiwe Mlambo
- Department of Surgery, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Yanli Li
- Intuitive Surgical, Inc, Sunnyvale, CA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
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Hannan E, Feeney G, Ullah MF, Ryan C, McNamara E, Waldron D, Condon E, Coffey JC, Peirce C. Robotic versus laparoscopic right hemicolectomy: a case-matched study. J Robot Surg 2021; 16:641-647. [PMID: 34338996 PMCID: PMC9135878 DOI: 10.1007/s11701-021-01286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022]
Abstract
The current gold standard surgical treatment for right colonic malignancy is the laparoscopic right hemicolectomy (LRH). However, laparoscopic surgery has limitations which can be overcome by robotic surgery. The benefits of robotics for rectal cancer are widely accepted but its use for right hemicolectomy remains controversial. The aim of this study was to compare outcomes in patients undergoing robotic right hemicolectomy (RRH) and LRH in a university teaching hospital. Demographic, perioperative and postoperative data along with early oncological outcomes of patients who underwent RRH and LRH with extracorporeal anastomosis (ECA) were identified from a prospectively maintained database. A total of 70 patients (35 RRH, 35 LRH) were identified over a 4-year period. No statistically significant differences in estimated blood loss, conversion to open surgery, postoperative complications, anastomotic leak, 30-day reoperation, 30-day mortality, surgical site infection or lengths of stay were demonstrated. Surgical specimen quality in both groups was favourable. The mean duration of surgery was longer in RRH (p < < 0.00001). A statistically significant proportion of RRH patients had a higher BMI and ASA grade. The results demonstrate that RRH is safe and feasible when compared to LRH, with no statistical difference in postoperative morbidity, mortality and early oncological outcomes. A difference was noted in operating time, however was influenced by training residents in docking the robot and a technically challenging cohort of patients. Operative time has shortened with further experience. Incorporating an intracorporeal anastomosis technique in RRH offers the potential to improve outcomes compared to LRH.
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Affiliation(s)
- Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.
| | - Gerard Feeney
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Mohammad Fahad Ullah
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Claire Ryan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Emma McNamara
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - David Waldron
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Eoghan Condon
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - John Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
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Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:881-892. [PMID: 33170319 DOI: 10.1007/s00384-020-03797-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). METHODS We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). RESULTS Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88-1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67-13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17-2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06-1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29-3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86-7.06, p = 0.09; OR 1.23, 95% CI 0.78-1.94, p = 0.38). CONCLUSION Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
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BIANCHI PP, GIULIANI G, SALAJ A, FERRARO L, OPOCHER E, TOTI F, FORMISANO G. Bottom-up suprapubic approach for robotic right colectomy: technical aspects and preliminary outcomes. Minerva Surg 2021; 76:129-137. [DOI: 10.23736/s2724-5691.20.08664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Affiliation(s)
- Yinin Hu
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Formisano G, Giuliani G, Salaj A, Salvischiani L, Ferraro L, Luca MD, Bianchi PP. Robotic elective colectomy for diverticular disease: short-term outcomes of 80 patients. Int J Med Robot 2020; 17:e2204. [PMID: 33185931 DOI: 10.1002/rcs.2204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aimed to evaluate the impact of the robotic approach on the minimally invasive elective treatment of diverticular disease. METHODS Data from patients who underwent elective robotic colectomy for diverticular disease from January 2015 to February 2020 were prospectively collected and retrospectively analysed. Intraoperative and 30-day postoperative outcomes were the variables assessed. RESULTS A total of 80 patients (71% with prior complicated diverticulitis) met the inclusion criteria. Mean operative time was 241 min, one intraoperative complication (1.2%) was observed, the conversion rate was 2.5%. Mean hospital stay was 6.4 days and overall 30-day complication rate was 22.5%. Fourteen patients (17.5%) had minor complications, while major postoperative complications occurred in four patients (5%). Anastomotic leak rate was 3.9% and the 30-day readmission rate was 3.7%. CONCLUSIONS Robotic colectomy for diverticular disease has proven to be feasible and safe, with low intraoperative complications, conversion, and anastomotic leak rates.
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Affiliation(s)
- Giampaolo Formisano
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Giuseppe Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Adelona Salaj
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Lucia Salvischiani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Luca Ferraro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Martina De Luca
- Department of Surgery, Andosilla Hospital AUSL Viterbo, Viterbo, Italy
| | - Paolo Pietro Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
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Giuliani G, Formisano G, Milone M, Salaj A, Salvischiani L, Bianchi PP. Full robotic Hartmann's reversal: technical aspects and preliminary experience. Colorectal Dis 2020; 22:1734-1740. [PMID: 32643856 DOI: 10.1111/codi.15249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic Hartmann's reversal (HR) is a major abdominal operation that is associated with considerable morbidity and mortality. The robotic approach, with its intrinsic advantages, could potentially overcome the technical complexity of laparoscopy. The aim of this study was to evaluate the short-term results of a series of 24 robotic HR cases. METHOD The data from 24 patients who underwent robotic HR between September 2016 and July 2019 at two different institutions were prospectively collected and retrospectively analysed. A full robotic single-docking reversal procedure with intracorporeal anastomosis was performed in all patients. RESULTS The mean age and body mass index of the patients were 69 years and 26 kg/m2 , respectively. Of the patients, 58% were ≥ 70 years old and 42% had comorbidities (mean Charlson Comorbidity Index 3). The mean operating time was 240 min. There were no cases of conversion to the open or laparoscopic approach. No diverting loop ileostomies were constructed. The mean length of hospital stay was 6 days. Minor complications were recorded in three patients. Neither major complications nor 30-day readmissions were registered. CONCLUSIONS Robotic HR is a feasible and safe procedure. The robotic approach has low rates of major complications and conversion and could potentially increase the number of patients undergoing HR.
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Affiliation(s)
- G Giuliani
- Department of Surgery, Unit of General and Minimally Invasive Surgery, Ospedale Misericordia, Grosseto, Italy
| | - G Formisano
- Department of Surgery, Unit of General and Minimally Invasive Surgery, Ospedale Misericordia, Grosseto, Italy
| | - M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Salaj
- Department of Surgery, Unit of General and Minimally Invasive Surgery, Ospedale Misericordia, Grosseto, Italy
| | - L Salvischiani
- Department of Surgery, Unit of General and Minimally Invasive Surgery, Ospedale Misericordia, Grosseto, Italy
| | - P P Bianchi
- Department of Surgery, Unit of General and Minimally Invasive Surgery, Ospedale Misericordia, Grosseto, Italy
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Jin HY, Lee CS, Lee YS. Laparoscopic extended right hemicolectomy with D3 lymph node dissection using a new articulating instrument. Tech Coloproctol 2020; 25:235-237. [PMID: 32926244 PMCID: PMC7884364 DOI: 10.1007/s10151-020-02345-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/03/2020] [Indexed: 01/12/2023]
Affiliation(s)
- H Y Jin
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - C S Lee
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Y S Lee
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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15
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Li J, Zhu S, Juan J, Yi B. Preliminary exploration of robotic complete mesocolic excision for colon cancer with the domestically produced Chinese minimally invasive Micro Hand S surgical robot system. Int J Med Robot 2020; 16:1-8. [PMID: 32865308 DOI: 10.1002/rcs.2148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Jianmin Li
- School of Mechanical Engineering Tianjin University Tianjin China
| | - Shaihong Zhu
- Department of General Surgery Third Xiangya Hospital Central South University Changsha Hunan China
| | - Jiang Juan
- Department of General Surgery Third Xiangya Hospital Central South University Changsha Hunan China
| | - Bo Yi
- Department of General Surgery Third Xiangya Hospital Central South University Changsha Hunan China
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Tagliabue F, Burati M, Chiarelli M, Fumagalli L, Guttadauro A, Arborio E, De Simone M, Cioffi U. Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study. World J Gastrointest Surg 2020; 12:287-297. [PMID: 32774767 PMCID: PMC7385514 DOI: 10.4240/wjgs.v12.i6.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Laparoscopic right hemicolectomy (LRH) is considered technically challenging. Robotic surgery has been introduced to overcome this technical limitation, but it is related to high costs. To maximize the benefits of such surgery, only selected patients are candidates for this technique. In addition, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities, who are usually more prone to post-operative complications.
AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.
METHODS We retrospectively analyzed 123 minimally invasive procedures (68 LRHs vs 55 RRHs) for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019. The surgical procedures were performed according to standardized techniques. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. Secondary outcomes were time to first flatus (TFF) and time to first stool evacuation. The robotic technique was considered the exposure and the laparoscopic technique was considered the control. Routine demographic variables were obtained, including age at time of surgery and gender. Body mass index and American Society of Anesthesiologists physical status were registered. The age-adjusted Charlson Comorbidity Index (ACCI) was calculated; the tumor-node-metastasis system, intra-operative variables and post-operative complications were recorded. Post-operative follow-up was 180 d.
RESULTS LOS, TFF, and time to first stool were significantly shorter in the robotic group: Median 6 [interquartile range (IQR) 5-8] vs 7 (IQR 6-10.5) d, P = 0.028; median 2 (IQR 1-3) vs 3 (IQR 2-4) d, P < 0.001; median 4 (IQR 3-5) vs 5 (IQR 4-6.5) d, P = 0.005, respectively. Following multivariable analysis, the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function; in addition the dichotomous variables of age over 75 years and ACCI more than 7 were significant predictors of hospital stay. No outcomes were significantly associated with Clavien-Dindo grading. Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS (median 6 -IQR 5-8- vs 7 -IQR 6-12- d, P = 0.013) and later TFF (median 2 -IQR 1-3- vs 3 -IQR 2-4- d, P = 0.008), while patients with ACCI more than 7 were only associated with a prolonged hospital stay (median 7 -IQR 5-8- vs 7 -IQR 6-14.5- d, P = 0.036).
CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach, but older age and several comorbidities tend to reduce its benefits.
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Affiliation(s)
- Fulvio Tagliabue
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Morena Burati
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Luca Fumagalli
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Monza 20900, Italy
| | - Elisa Arborio
- Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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Ferri V, Quijano Y, Nuñez J, Caruso R, Duran H, Diaz E, Fabra I, Malave L, Isernia R, d'Ovidio A, Agresott R, Gomez P, Isojo R, Vicente E. Robotic-assisted right colectomy versus laparoscopic approach: case-matched study and cost-effectiveness analysis. J Robot Surg 2020; 15:115-123. [PMID: 32367439 DOI: 10.1007/s11701-020-01084-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to compare clinical and oncological outcomes of robot-assisted right colectomy with those of conventional laparoscopy-assisted right colectomy, reporting for the first time in literature, a cost-effectiveness analysis. METHODS This is a case-matched prospective non-randomized study conducted from October 2013 to October 2017 at Sanchinarro University Hospital, Madrid. Patients with right-sided colonic adenocarcinoma or adenoma, not suitable endoscopic resection were treated with robot-assisted right colectomy and a propensity score-matched (1:1) was used to balance preoperative characteristics of a laparoscopic control group. Perioperative, postoperative, long-term oncological results and costs were analysed, and quality-adjusted life years (QALY), and the cost-effectiveness ratio (ICER) were calculated. The primary end point was to compare the cost-effectiveness differences between both groups. A willingness-to-pay of 20,000 and 30,000 per QALY was used as a threshold to recognize which treatment was most cost effective. RESULTS Thirty-five robot-assisted right colectomies were included and a group of 35 laparoscopy-assisted right colectomy was selected. Compared with the laparoscopic group, the robotic group was associated with longer operation times (243 min vs. 179 min, p < 0.001). No significant difference was observed in terms of total costs between the robotic and laparoscopic groups (9455.14 vs 8227.50 respectively, p = 0.21). At a willingness-to-pay threshold of 20,000 and 30,000, there was a 78.78-95.04% probability that the robotic group was cost effective relative to laparoscopic group. CONCLUSION Robot-assisted right colectomy is a safe and feasible technique and is a cost-effective procedure.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain.
| | - Yolanda Quijano
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Luisi Malave
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Roberta Isernia
- Division of General Surgery, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Angelo d'Ovidio
- Division of General Surgery, Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Ruben Agresott
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Patricio Gomez
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Rigoberto Isojo
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
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18
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Zeng Y, Wang G, Liu Y, Li Z, Yi B, Zhu S. The "Micro Hand S" Robot-Assisted Versus Conventional Laparoscopic Right Colectomy: Short-Term Outcomes at a Single Center. J Laparoendosc Adv Surg Tech A 2020; 30:363-368. [PMID: 32013727 DOI: 10.1089/lap.2019.0714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To evaluate the safety and feasibility of using the Micro Hand S surgical robot for right colectomy by comparing the short-term efficacy of robot-assisted and laparoscopic right colectomy (LRC). Methods: Data from a total of 22 patients who underwent right colectomy from January 2018 to February 2019 in the Department of Gastrointestinal Surgery, in the Third Xiangya Hospital of Central South University, were collected retrospectively. This included 10 patients who underwent robot-assisted right colectomy with the Micro Hand S surgical robot (RRC group [Shangdong Wego Surgical Robot Co., LTD, Weihai, China]) and 12 patients who underwent LRC group. The operation time, blood loss, number of lymph nodes dissected, time to first flatus, comprehensive complication index (CCI), and postoperative hospital stay were compared. Results: Compared with the LRC group, the RRC group had a lower CCI (11.7 ± 8.3 versus 19.9 ± 6.4, P < .05), shorter hospital stay (11.4 ± 3.3 versus 15.2 ± 4.7 days, P < .05). The differences were statistically significant. Conclusion: The Micro Hand S robot-assisted right colectomy is safe and feasible.
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Affiliation(s)
- Yijia Zeng
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yong Liu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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19
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Jurowich C, Lichthardt S, Kastner C, Haubitz I, Prock A, Filser J, Germer CT, Wiegering A. Laparoscopic versus open right hemicolectomy in colon carcinoma: A propensity score analysis of the DGAV StuDoQ|ColonCancer registry. PLoS One 2019; 14:e0218829. [PMID: 31246985 PMCID: PMC6597089 DOI: 10.1371/journal.pone.0218829] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To assess whether laparoscopy has any advantages over open resection for right-sided colon cancer. Summary background data Right hemicolectomy can be performed using either a conventional open or a minimally invasive laparoscopic technique. It is not clear whether these different access routes differ with regard to short-term postoperative outcomes. Methods Patients documented in the German Society for General and Visceral Surgery StuDoQ|ColonCancer registry who underwent right hemicolectomy were analyzed regarding early postoperative complications according to Clavien-Dindo (primary endpoint), operation (OP) time, length of postoperative hospital stay (LOS), MTL30 and number of lymph nodes retrieved (secondary endpoints). Results A total of 4.997 patients were identified as undergoing oncological right hemicolectomy without additional interventions. Of these, 4.062 (81.3%) underwent open, 935 (18.7%) laparoscopic surgery. Propensity score analysis showed a significantly shorter LOS (OR: 0.55 CI 95%0.47-.64) and a significantly longer OP time (OR2.32 CI 1.98–2.71) for the laparoscopic route. Risk factors for postoperative complications, anastomotic insufficiency, ileus, reoperation and positive MTL30 were higher ASA status, higher age and increasing BMI. The surgical access route (open / lap) had no influence on these factors, but the laparoscopic group did have markedly fewer lymph nodes retrieved. Conclusion The present registry-based analysis could detect no relevant advantages for the minimally invasive laparoscopic access route. Further oncological analyses are needed to clarify the extent to which the smaller lymph node harvest in the laparoscopic group is accompanied by a poorer oncological outcome.
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Affiliation(s)
- Christian Jurowich
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting / Burghausen, Altötting, Germany
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- * E-mail: (AW); (CJ)
| | - Sven Lichthardt
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Caroline Kastner
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Imme Haubitz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Andre Prock
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting / Burghausen, Altötting, Germany
| | - Jörg Filser
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting / Burghausen, Altötting, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
- * E-mail: (AW); (CJ)
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20
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Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience. Surg Endosc 2019; 34:557-563. [PMID: 31011862 DOI: 10.1007/s00464-019-06796-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic right hemicolectomy is a commonly performed procedure. Little is known on how to perform the enterotomy closure after stapled side-to-side intracorporeal anastomosis. METHOD A multicentric case-controlled study has been designed to compare different ways to fashion enterotomy closure: double layer versus single layer, sewn versus stapled, and robotic versus laparoscopic approach. Furthermore, additional characteristics including sutures' materials, interrupted versus running suture and the presence of deep corner suture has been investigated. RESULTS We collected data for 1092 patients who underwent right hemicolectomy at ten centers. We analyzed 176 robotic against 916 laparoscopic anastomosis: no significant differences were found in terms of bleedings (p = 0.455) and anastomotic leak (p = 0.405). We collected data from 126 laparoscopic sewn single-layer versus 641 laparoscopic sewn double-layer anastomosis: a significant reduction was recorded in terms of leaks in double-layer group (p = 0.02). About double-layer characteristics, we found a significant reduction of bleedings (p = 0.008) and leaks (p = 0.017) with a running suture; similarly, a reduction of bleedings (p = 0.001) and leaks (p = 0.005) was observed with the usage of deep corner closure. The presence of a barbed suture thread seemed to significantly reduce both bleedings (p = 0.001) and leaks (p = 0.001). We found no significant differences in terms of bleedings (p = 0.245) and anastomotic leak (p = 0.660) comparing sewn versus stapled anastomosis. CONCLUSIONS Fashioning a stapled ileocolic intracorporeal anastomosis, we can recommend the adoption of a double-layer enterotomy closure using a running barbed suture in the first layer. Totally, stapled closure and robotic assistance have to be considered a non-inferior alternative.
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Yozgatli TK, Aytac E, Ozben V, Bayram O, Gurbuz B, Baca B, Balik E, Hamzaoglu I, Karahasanoglu T, Bugra D. Robotic Complete Mesocolic Excision Versus Conventional Laparoscopic Hemicolectomy for Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:671-676. [PMID: 30807257 DOI: 10.1089/lap.2018.0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Robotic technique has been proposed to overcome the limitations of laparoscopic surgery. In this study, we aimed at determining whether robotic complete mesocolic excision (CME) for right-sided colon cancer can be safe and effective as conventional laparoscopic right hemicolectomy (CLRH). Materials and Methods: Between February 2015 and September 2017, patients undergoing robotic right CME and CLRH with curative intent for right-sided colon cancer were included. Patient characteristics, short-term and histopathological outcomes were compared between the groups. Results: Ninety-six patients (robotic, n = 35) were included in this study. The operative time (286 ± 77 versus 132 ± 40 minutes, P = .0001) was significantly longer in the robotic group. There were no conversions in either group. No significant differences existed between the groups regarding the mean estimated blood loss, time to first flatus, length of hospital stay (6 ± 3 versus 6 ± 3 days, P = .64), and follow-up times (robotic 15 ± 8 versus laparoscopic 16 ± 10 months P = .11). Overall complication rates (n = 10 [29%] versus n = 15 [25%], P = .67) were similar. In the robotic group, vascular injury occurred in 2 patients, and both were repaired robotically. The mean number of harvested lymph nodes was significantly higher (41 ± 12 versus 33 ± 10, P = .04) and length between the vascular tie and colonic wall was longer (13 ± 3.5 versus 11 ± 3, P = .02) in the robotic group. Conclusion: Although robotic right CME seems equally safe to CLRH in terms of short-term morbidity, future prospective randomized trials are needed to define its role for treatment of right colectomy.
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Affiliation(s)
- Tahir K Yozgatli
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Onur Bayram
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Gurbuz
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
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22
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Ma S, Chen Y, Chen Y, Guo T, Yang X, Lu Y, Tian J, Cai H. Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis. Asian J Surg 2018; 42:589-598. [PMID: 30503268 DOI: 10.1016/j.asjsur.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
To assess the clinical efficacy and safety of robotic-assisted right colectomy (RRC) with conventional laparoscopic right colectomy (LRC) by performing a systematic review and meta-analysis of the published studies. All published literature for comparative studies reporting preoperative outcomes of RRC and LRC were searched. We searched the databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, Web of Science and Chinese Biomedical Database (CBM) from 1973 to 2018. The censor date was up to January 2018. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated. All calculations and statistical tests were performed using Stata 12.0 software. A total of 7769 patients with colon cancer enrolled in 13 trials were divided into a study group (n = 674) and a control group (n = 7095). Meta-analysis suggested significantly greater length of hospital stay in the LRC group [MD = -0.85; 95% CI: -1.07 to -0.63; P < 0.00001]. Robotic surgery was also associated with a significantly lower complication rate [OR = 0.73; 95% CI: 0.52 to 1.01; P = 0.05]. There were statistically significant differences between the groups in estimated blood loss [MD = -16.89; 95% CI: -24.80 to -8.98; P < 0.00001] and the rate of intraoperative conversion to open surgery [OR = 0.34, 95% CI: 0.15 to 0.75; P = 0.008)], but these differences were not clinically relevant. The recovery of bowel function in two groups is no significant differences [MD = -0.58, 95% CI: -0.96 to -0.20, P = 0.0008]. However, operation times [MD = 43.61, 95% CI: 39.11 to 48.10, P < 0.00001] were longer for RRC than for LRC. Compared to LRC, RRC was associated with reduced estimated blood loss, reduced postoperative complications, longer operation times. Recovery of bowel function and other perioperative outcomes were equivalent between the two surgeries.
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Affiliation(s)
- Shixun Ma
- Gansu Province Hospital, Lanzhou, China.
| | - Yan Chen
- The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | | | | | | | - Yufeng Lu
- Gansu Province Hospital, Lanzhou, China.
| | | | - Hui Cai
- Gansu Province Hospital, Lanzhou, China.
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23
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Mégevand JL, Amboldi M, Lillo E, Lenisa L, Ganio E, Ambrosi A, Rusconi A. Right colectomy: consecutive 100 patients treated with laparoscopic and robotic technique for malignancy. Cumulative experience in a single centre. Updates Surg 2018; 71:151-156. [PMID: 30448923 DOI: 10.1007/s13304-018-0599-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/08/2018] [Indexed: 12/11/2022]
Abstract
Robotic-assisted resections prove beneficial in overcoming potential limitation of laparoscopy, but clear evidences on patient's benefits are still lacking. We report our experience on 100 consecutive patients who underwent right colectomy with either robotic or laparoscopic approaches. Data were prospectively collected on a dedicated database (ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results). Median total operative time was 160 min in LS group (IQR = 140-180) and 204 min for RS group (IQR = 180-230). Median time to first flatus was 2.5 days for LS group (IQR = 2 - 3) and 2 days for RS group (IQR = 1-2). Length of stay (median) was 8 days in LS group (IQR = 6-10) and 5 days in RS group (IQR = 5-7). No statistically significant difference was found between the 2 groups when the number of harvested nodes, the anastomotic leakage and the postoperative bleeding were analyzed. The 30-day mortality was 0% in LS and RS groups. Conversion rate for LS group was 14% (7/50 pts) and for RS group was 0% (0/50). Minimally invasive surgery is a feasible and safe technique. The RS may overcome some technical limitations of laparoscopic surgery and it achieves the same oncological results compared to LS but with higher costs. The lower conversion rate allows to expect better clinical outcomes and lower complication rate.
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Affiliation(s)
- J L Mégevand
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy.
| | - M Amboldi
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy
| | - E Lillo
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy
| | - L Lenisa
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy
| | - E Ganio
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy
| | - A Ambrosi
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - A Rusconi
- Division of General Surgery, Department of Surgery, Humanitas S. Pio X Hospital, Via Nava 31, 20159, Milan, Italy
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Hamzaoglu I, Ozben V, Sapci I, Aytac E, Aghayeva A, Bilgin IA, Bayraktar IE, Baca B, Karahasanoglu T. "Top down no-touch" technique in robotic complete mesocolic excision for extended right hemicolectomy with intracorporeal anastomosis. Tech Coloproctol 2018; 22:607-611. [PMID: 30083781 DOI: 10.1007/s10151-018-1831-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a "top down technique" to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients. METHODS The top down technique consists of two steps. First, the omental bursa was entered to identify the right gastroepiploic vein. Tracing down this vein as a landmark, the gastrocolic trunk was exposed, branches of this trunk and the middle colic vessels were divided. Second, dissection was directed to the ileocolic region and proceeded in an inferior-to-superior direction along the superior mesenteric vein to divide the ileocolic and right colic vessels consecutively. The ileotranverse anastomosis was created intracorporeally. RESULTS There were 8 males and 4 females with a mean age of 64.8 ± 16.9 years and a mean body mass index of 25.6 ± 3.7 kg/m2. All the procedures were completed successfully. No conversions occurred. The mean operative time and blood loss were 312.1 ± 93.9 min and 110.0 ± 89.9 ml, respectively. The mean number of harvested lymph nodes was 45.2 ± 11.1. The mean length of hospital stay was 7.6 ± 4.7 days. Two patients had intraoperative complications and two had postoperative complications. There was no disease recurrence at a mean follow-up period of 10.4 ± 7.1 months. CONCLUSIONS The top down technique appears to be useful in robotic CME for an extended right hemicolectomy. Early identification of the gastrocolic trunk and middle colic vessels via this technique may prevent inadvertent vascular injury at the mesenteric root of the transverse colon.
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Affiliation(s)
- I Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
| | - V Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - I Sapci
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - E Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - A Aghayeva
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - I A Bilgin
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - I E Bayraktar
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - B Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - T Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
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Reitz ACW, Lin E, Rosen SA. A single surgeon's experience transitioning to robotic-assisted right colectomy with intracorporeal anastomosis. Surg Endosc 2018; 32:3525-3532. [PMID: 29380065 DOI: 10.1007/s00464-018-6074-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite substantial evidence demonstrating benefits of minimally invasive surgery, a large percentage of right colectomies are still performed via an open technique. Most laparoscopic right colectomies are completed as a hybrid procedure with extracorporeal anastomosis. As part of a pure minimally invasive procedure, intracorporeal anastomosis (ICA) may confer additional benefits for patients. The robotic platform may shorten the learning curve for minimally invasive right colectomy with ICA. METHODS From January 2014 to May 2016, 49 patients underwent robotic-assisted right colectomy by a board-certified colorectal surgeon (S.R). Extracorporeal anastomosis (ECA) was used in the first 20 procedures, whereas ICA was used in all subsequent procedures. Outcomes recorded in a database for retrospective review included operating time (OT), estimated blood loss (EBL), length of stay (LOS), conversion rate, complications, readmissions, and mortality rate. RESULTS Comparison of average OT, EBL, and LOS between extracorporeal and intracorporeal groups demonstrated no significant differences. For all patients, average OT was 141.6 ± 25.8 (range 86-192) min, average EBL was 59.5 ± 83.3 (range 0-500) mL, and average LOS was 3.4 ± 1.19 (range 1.5-8) days. Four patients required conversion, all of which occurred in the extracorporeal group. There were no conversions after the 18th procedure. The 60-day mortality rate was 0%. There were no anastomotic leaks, ostomies created, or readmissions. As the surgeon gained experience, a statistically significant increase in lymph node sampling was observed in oncologic cases (p = .02). CONCLUSIONS The robotic platform may help more surgeons safely and efficiently transition to a purely minimally invasive procedure, enabling more patients to reap the benefits of less invasive surgery. Transitioning from ECA to ICA during robotic right colectomy resulted in no significant change in OT or LOS. A lower rate of conversion to open surgery was noted with increased experience.
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Affiliation(s)
| | - Ed Lin
- Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth A Rosen
- Division of Colorectal Surgery, Emory University School of Medicine, 6335 Hospital Parkway, Suite 110, Johns Creek, GA, 30097, USA.
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Mangano A, Gheza F, Bustos R, Masrur M, Bianco F, Fernandes E, Valle V, Giulianotti PC. Robotic right colonic resection. Is the robotic third arm a game-changer? MINERVA CHIR 2018; 75:1-10. [PMID: 29860773 DOI: 10.23736/s0026-4733.18.07814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way. This is in part because traditional laparoscopy may have some hurdles and a long learning curve to reach mastery. The robotic technology may help in increasing the MIS penetrance in colorectal surgery. The use of the R3 can potentially increase the number of surgical options available. METHODS In this retrospective case series, after a long robotic colorectal experience connected to a robotic program started by Giulianotti et al. in October 2000, we present our results regarding a subset of colorectal patients who underwent robotic right colonic resections performed, all by a single surgeon (P.C.G.), using the R3 according to our standardized technique. RESULTS Out of all the robotic colorectal operations performed, this sub-sample sample included 33 patients: 21 males and 12 females. The age range was between 51 and 95 years old. The Body Mass Index (BMI) was between 21.6 to 43.1. The conversion rate to laparoscopy or to open surgery has been 0%. No intraoperative complications have been registered. The postoperative complications rates are reported in this manuscript. The perfusion check of the anastomosis by Near-infrared ICG (Indocyanine Green) enhanced fluorescence has been used. In 11.2% of the sample, the site of the anastomosis has been changed after ICG-Test. Moreover, when the ICG perfusion test has been performed no leakage occurred. CONCLUSIONS This subset of patients suggests the potential role of R3 and the benefits correlated to robotic surgery. In fact, the laparoscopic approach uses mostly a medial to lateral mobilization. Indeed, during laparoscopic surgery an early right colon mobilization may create problems in the surgical field visualization. In robotic surgery, R3 can lift upwards the cecum/ascending colon/hepatic flexure exposing, in doing so, the anatomical structures. Hence, we can use also the same approach of the open surgery (where the first step is usually the mobilization of the ascending colon mesentery). In other words, the R3 offers more operative options in terms of surgical pathways maintaining at the same time good perioperative outcomes. However, more studies are needed to confirm our findings.
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Affiliation(s)
- Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Francesco Bianco
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Valentina Valle
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Ozben V, Aytac E, Atasoy D, Erenler Bayraktar I, Bayraktar O, Sapci I, Baca B, Karahasanoglu T, Hamzaoglu I. Totally robotic complete mesocolic excision for right-sided colon cancer. J Robot Surg 2018; 13:107-114. [PMID: 29774501 DOI: 10.1007/s11701-018-0817-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022]
Abstract
Complexity and operative risks of complete mesocolic excision (CME) seem to be important drawbacks to generalize this procedure in the surgical treatment of right colon cancer. Robotic systems have been developed to improve quality and outcomes of minimal invasive surgery. The aim of this study was to evaluate the feasibility of robotic right-sided CME and present our initial experience. A retrospective review of 37 patients undergoing totally robotic right-sided CME between February 2015 and November 2017 was performed. All the operations were carried out using the key principles of both CME with intracorporeal anastomosis and no-touch technique. Data on perioperative clinical findings and short-term outcomes were analyzed. There were 20 men and 17 women with a mean age of 64.4 ± 13.5 years and a body mass index of 26.8 ± 5.7 kg/m2. The mean operative time and estimated blood loss were 289.8 ± 85.3 min and 77.4 ± 70.5 ml, respectively. Conversion to laparoscopy occurred in one patient (2.7%). All the surgical margins were clear and the mesocolic plane surgery was achieved in 27 (72.9%) of the cases. The mean number of harvested lymph nodes was 41.8 ± 11.9 (median, 40; range 22-65). The mean length of hospital stay was 6.6 ± 3.7 days. The intraoperative and postoperative complication rates were 5.4 and 21.6%, respectively. We believe that use of robot for right-sided CME is feasible and appears to provide remarkably a high number of harvested lymph nodes with good specimen quality.
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Affiliation(s)
- Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Deniz Atasoy
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ilknur Erenler Bayraktar
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Onur Bayraktar
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ipek Sapci
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
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Gaitanidis A, Simopoulos C, Pitiakoudis M. What to consider when designing a laparoscopic colorectal training curriculum: a review of the literature. Tech Coloproctol 2018; 22:151-160. [PMID: 29512045 DOI: 10.1007/s10151-018-1760-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/03/2017] [Indexed: 12/27/2022]
Abstract
Multiple studies have demonstrated the benefits of laparoscopic colorectal surgery (LCS), but in several countries it has still not been widely adopted. LCS training is associated with several challenges, such as patient safety concerns and a steep learning curve. Current evidence may facilitate designing of efficient training curricula to overcome these challenges. Basic training with virtual reality simulators has witnessed meteoric advances and may be essential during the early parts of the learning curve. Cadaveric and animal model training still constitutes an indispensable training tool, due to a higher degree of difficulty and greater resemblance to real operative conditions. In addition, recent evidence favors the use of novel training paradigms, such as proficiency-based training, case selection and modular training. This review summarizes the recent advances in LCS training and provides the evidence for designing an efficient training curriculum to overcome the challenges of LCS training.
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Affiliation(s)
- A Gaitanidis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece.
| | - C Simopoulos
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece
| | - M Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece
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Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 2017; 32:1104-1110. [PMID: 29218671 DOI: 10.1007/s00464-017-5980-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures. METHODS A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms. RESULTS After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD - 0.99 95% CI - 1.4 to - 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1-2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18-1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9-1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16-1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD - 0.52; 95% CI - 0.52 to - 0.04, p = 0.035). CONCLUSIONS RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.
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