1
|
Mansour KP, Mohan HM, Jiang W, Waters PS, Larach JT, Apte SS, Kong JC, Heriot AG, Warrier SK. Robotic pelvic side-wall lymph node dissection for rectal cancer: a systematic review of videos and application of the IDEAL 2A framework. J Robot Surg 2023:10.1007/s11701-023-01526-w. [PMID: 36689077 DOI: 10.1007/s11701-023-01526-w] [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: 07/11/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
Lateral pelvic lymph node dissection (LPLND) in rectal cancer has gained increasing traction worldwide. Robotic LPLND is an emerging technique. Utilising the IDEAL (idea, development, exploration, assessment and long-term follow-up) framework for surgical innovation, robotic LPLND is currently at the IDEAL 2A stage (development) mainly limited to case reports, case series and videos. A systematic literature review was performed for videographic robotic LPLND. Pubmed, Ovid and Web of Science were searched with a predefined search strategy. The LapVEGAS score for peer review of video surgery was adapted for the robotic approach (RoVEGAS) and applied to measure video quality. Two reviewers independently reviewed videos and consensus reached on technical steps and learning points. Data are presented as a narrative synthesis of results. The IDEAL 2A framework was applied to videos to assess their content at the present stage of innovation. A total of 83 abstracts were identified. In accordance with the PRISMA statement, nine videos were analysed. Adherence to the complete IDEAL 2a framework was low. All videos demonstrated LPLND; however, reporting of clinical outcomes was heterogeneous and completed in six of nine videos. Histopathology was reported in six videos, with other outcomes variably reported. No videos presented patient-reported outcome measures. Two videos reported presence or absence of recurrence on follow-up. Video articles provide a valuable educational resource in dissemination and adoption of robotic techniques. Standardisation of reporting objectives are needed. Complete reporting of pathology and oncologic outcomes is required in videographic procedural-based publications to meet the IDEAL 2A framework criteria.
Collapse
Affiliation(s)
| | - Helen M Mohan
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - William Jiang
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Peader S Waters
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - José T Larach
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sameer S Apte
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Joseph C Kong
- Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | | | | |
Collapse
|
2
|
Kumar NA, Sasi SP, Shinde RS, Verma K, Sugoor P, Desouza A, Engineer R, Saklani A. Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer. JSLS 2021; 24:JSLS.2020.00026. [PMID: 32714002 PMCID: PMC7347395 DOI: 10.4293/jsls.2020.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. Methods: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The short-term outcomes like perioperative details and histopathological characteristics were compared between the two groups. Results: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p = 0.00). The intraoperative blood loss (900 vs. 1550 ml, p = 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p = 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p = 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p = 0.634). The rate of R0 resection (87% vs. 89%, p = 0.668) was comparable between the two groups. Conclusion: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.
Collapse
Affiliation(s)
- Naveena An Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education
| | - Sajith P Sasi
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajesh S Shinde
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kamlesh Verma
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pavan Sugoor
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwin Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Reena Engineer
- Department Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
3
|
Evolution of Robotic Surgery in a Colorectal Cancer Unit in India. Indian J Surg Oncol 2020; 11:633-641. [PMID: 33281404 DOI: 10.1007/s13193-020-01105-7] [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: 11/18/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023] Open
Abstract
Only a handful of institutions in the country have an established robotic surgery program. Evolution of robotic surgery in the colorectal division, from inception to recent times, is presented here. All the patients undergoing robotic colorectal surgery from the inception of the program (September 2014) to August 2019 were identified. The patient and treatment details and short-term outcomes were collected retrospectively from the prospectively maintained database. The cohort was divided into four chronological groups (group 1 being the oldest) to assess the surgical trends. There were 202 patients. Seventy-one percent were male. Mean BMI was 23.25. Low rectal tumours were most common (47%). A total of 74.3% patients received neo-adjuvant treatment. Multivisceral resection was done in 22 patients, including 4 synchronous liver resections. Average operating time for standard rectal surgery was 280 min with average blood loss of 235 ml. The mean nodal yield was 14. Circumferential resection margin positivity was 6.4%. The mean hospital stay for pelvic exenteration was significantly higher than the rest of the surgeries (except for posterior exenteration and total proctocolectomy) (p = 0.00). Clavin-Dindo grade 3 and 4 complications were seen in 10% patients. As the experience of the team increased, more complex cases were performed. Blood loss, margin positivity, nodal yield, leak rates and complications were evaluated group wise (excluding those with additional procedures) to assess the impact of experience. We did not find any significant change in the parameters studied. With increasing experience, the complexity of surgical procedures performed on da Vinci Xi platform can be increased in a systematic manner. Our short-term outcomes, i.e. nodes harvested, margin positivity, hospital stay and morbidity, are on par with world standards. However, we did not find any significant improvement in these parameters with increasing experience.
Collapse
|
4
|
Kumar S, Rohila J, Sasi SP, Tantravahi U, K G D, Sharma V, Garach N, deSouza A, Saklani A. Robotic-assisted low anterior resection: beyond total mesorectal excision; a left vascular approach with presacral fascia excision - a video vignette. Colorectal Dis 2020; 22:595-596. [PMID: 31901001 DOI: 10.1111/codi.14947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S Kumar
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - S P Sasi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - U Tantravahi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Dharmakumar K G
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - V Sharma
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - N Garach
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| |
Collapse
|
5
|
Rohila J, Singh P, Sasi SP, Kumar S, deSouza A, Saklani A. Laparoscopic posterior supralevator exenteration for locally advanced rectal cancer with incisional hernia repair - a video vignette. Colorectal Dis 2020; 22:351. [PMID: 31654449 DOI: 10.1111/codi.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023]
Affiliation(s)
- J Rohila
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - P Singh
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - S P Sasi
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - S Kumar
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - A deSouza
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - A Saklani
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| |
Collapse
|
6
|
Nakanishi R, Yamaguchi T, Akiyoshi T, Nagasaki T, Nagayama S, Mukai T, Ueno M, Fukunaga Y, Konishi T. Laparoscopic and robotic lateral lymph node dissection for rectal cancer. Surg Today 2020; 50:209-216. [PMID: 31989237 PMCID: PMC7033048 DOI: 10.1007/s00595-020-01958-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
Abstract
In the era of neoadjuvant chemoradiotherapy/radiotherapy and total mesorectal excision, overall oncological outcomes after curative resection of rectal cancer are excellent, with local recurrence rates as low as 5–10%. However, lateral nodal disease is a major cause of local recurrence after neoadjuvant chemoradiotherapy/radiotherapy and total mesorectal excision. Patients with lateral nodal disease have a local recurrence rate of up to 30%. The oncological benefits of lateral pelvic lymph node dissection (LPLND) in reducing local recurrence, particularly in the lateral compartment, have been demonstrated. Although LPLND is not standard in Western countries, technical improvements in minimally invasive surgery have resulted in rapid technical standardization of this complicated procedure. The feasibility and short- and long-term outcomes of laparoscopic and robotic LPLND have been reported widely. A minimally invasive approach has the advantages of less bleeding and providing a better surgical view of the deep pelvic anatomy than an open approach. With precise autonomic nerve preservation, postoperative genitourinary dysfunction has been reported to be minimal. We review recent evidence on the management of lateral nodal disease in rectal cancer and technical improvements of LPLND, focusing on laparoscopic and robotic LPLND.
Collapse
Affiliation(s)
- Ryota Nakanishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| |
Collapse
|
7
|
Kammar P, Sasi S, Kumar N, Rohila J, deSouza A, Saklani A. Robotic posterior pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis 2019; 21:606. [PMID: 30856286 DOI: 10.1111/codi.14606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - S Sasi
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - N Kumar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| |
Collapse
|
8
|
Kammar P, Verma K, Sugoor P, Saklani A. Complete robotic lateral pelvic node dissection using the da Vinci Xi platform in rectal cancer - a video vignette. Colorectal Dis 2018; 20:1053-1054. [PMID: 30194908 DOI: 10.1111/codi.14412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - K Verma
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - P Sugoor
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| |
Collapse
|