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Vivas López A, Villar OG, Borda JG, Restrepo Nuñez R, Rubio E, Nevado C, Pelaez P, Labalde Martinez M, Alias D, Falcon K, Lorenzo S, Perea García J, Ferrero E. Low anterior resection with transanal transection and single-stapled anastomosis: technical aspects and initial results. Int J Colorectal Dis 2024; 39:85. [PMID: 38837095 DOI: 10.1007/s00384-024-04646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Rectal cancer (RC) is a surgical challenge due to its technical complexity. The double-stapled (DS) technique, a standard for colorectal anastomosis, has been associated with notable drawbacks, including a high incidence of anastomotic leak (AL). Low anterior resection with transanal transection and single-stapled (TTSS) anastomosis has emerged to mitigate those drawbacks. METHODS Observational study in which it described the technical aspects and results of the initial group of patients with medium-low RC undergoing elective laparoscopic total mesorectal excision (TME) and TTSS. RESULTS Twenty-two patients were included in the series. Favourable postoperative outcomes with a median length of stay of 5 days and an AL incidence of 9.1%. Importantly, all patients achieved complete mesorectal excision with tumour-free margins, and no mortalities were reported. CONCLUSION TTSS emerges as a promising alternative for patients with middle and lower rectal tumours, offering potential benefits in terms of morbidity reduction and oncological integrity compared with other techniques.
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Affiliation(s)
- Alfredo Vivas López
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain
| | | | | | - Rafael Restrepo Nuñez
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain
| | - Eduardo Rubio
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Cristina Nevado
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Pablo Pelaez
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - David Alias
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Kleber Falcon
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Sofia Lorenzo
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - José Perea García
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain.
- Molecular Medicine Unit, Department of Medicine, Institute of Biomedical Research of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), Campus Miguel de Unamuno s/n, University of Salamanca-SACYL-CSIC, 37007, Salamanca, Spain.
| | - Eduardo Ferrero
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
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Kotze PG, Avellaneda N, Moretti RDAM, Carvello M, Tomada EP, Campos FG, Spinelli A. Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques. Dis Colon Rectum 2024; 67:S26-S35. [PMID: 38710588 DOI: 10.1097/dcr.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques. OBJECTIVE To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy. DATA SOURCE Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. STUDY SELECTION Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis. INTERVENTION IPAA technique. MAIN OUTCOME MEASURES Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function). RESULTS Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques. LIMITATIONS A low number of studies with handsewn IPAA technique and a large number of studies added at authors' discretion were the limitations of this strudy. CONCLUSIONS Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.
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Affiliation(s)
- Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Nicolas Avellaneda
- General and Colorectal Surgery Department, CEMIC University Hospital, Buenos Aires, Argentina
| | | | - Michele Carvello
- Division of Colon and Rectal Surgery, IRCCS-Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elisa Paoluzzi Tomada
- Division of Colon and Rectal Surgery, IRCCS-Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Antonino Spinelli
- Division of Colon and Rectal Surgery, IRCCS-Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Rutgers ML, Burghgraef TA, Hol JC, Crolla RM, van Geloven NA, Leijtens JW, Polat F, Pronk A, Smits AB, Tuyman JB, Verdaasdonk EG, Sietses C, Consten EC, Hompes R. Total mesorectal excision in MRI-defined low rectal cancer: multicentre study comparing oncological outcomes of robotic, laparoscopic and transanal total mesorectal excision in high-volume centres. BJS Open 2024; 8:zrae029. [PMID: 38788679 PMCID: PMC11126316 DOI: 10.1093/bjsopen/zrae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The routine use of MRI in rectal cancer treatment allows the use of a strict definition for low rectal cancer. This study aimed to compare minimally invasive total mesorectal excision in MRI-defined low rectal cancer in expert laparoscopic, transanal and robotic high-volume centres. METHODS All MRI-defined low rectal cancer operated on between 2015 and 2017 in 11 Dutch centres were included. Primary outcomes were: R1 rate, total mesorectal excision quality and 3-year local recurrence and survivals (overall and disease free). Secondary outcomes included conversion rate, complications and whether there was a perioperative change in the preoperative treatment plan. RESULTS Of 1071 eligible rectal cancers, 633 patients with low rectal cancer were identified. Quality of the total mesorectal excision specimen (P = 0.337), R1 rate (P = 0.107), conversion (P = 0.344), anastomotic leakage rate (P = 0.942), local recurrence (P = 0.809), overall survival (P = 0.436) and disease-free survival (P = 0.347) were comparable among the centres. The laparoscopic centre group had the highest rate of perioperative change in the preoperative treatment plan (10.4%), compared with robotic expert centres (5.2%) and transanal centres (2.1%), P = 0.004. The main reason for this change was stapling difficulty (43%), followed by low tumour location (29%). Multivariable analysis showed that laparoscopic surgery was the only independent risk factor for a change in the preoperative planned procedure, P = 0.024. CONCLUSION Centres with expertise in all three minimally invasive total mesorectal excision techniques can achieve good oncological resection in the treatment of MRI-defined low rectal cancer. However, compared with robotic expert centres and transanal centres, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations.
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Affiliation(s)
- Marieke L Rutgers
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Thijs A Burghgraef
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Jeroen C Hol
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Rogier M Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Jeroen W Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriaan B Tuyman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Colin Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Esther C Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Mata R, Sahnan K, Pellino G, Spinelli A, Espín-Basany E. Robotic Total Mesorectal Excision With Transanal Transection and Single-Stapled Anastomosis: A Step-By-Step Video Demonstration. Dis Colon Rectum 2024; 67:e289-e290. [PMID: 38294827 DOI: 10.1097/dcr.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Rodrigo Mata
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Kapil Sahnan
- Department of Colorectal Surgery, St. Mark's Hospital and Academic Institute, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London, United Kingdom
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital -, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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5
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Alsourani A, Colombari RC, Sánchez-Rodríguez M, Sánchez EV, Zorita BD, Gómez LMJ, Dujovne Lindenbaum P, Tejedor P. Robotic surgery in stage IV rectal cancer: Ultra-low anterior resection with TTSS anastomosis and hepatectomy - A video vignette. Colorectal Dis 2024. [PMID: 38659091 DOI: 10.1111/codi.17000] [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: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Adnan Alsourani
- Colorectal Surgery Unit, University Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Enrique Velasco Sánchez
- Hepatobiliary and Pancreatic Surgery and Transplant Unit, University Hospital Gregorio Marañón, Madrid, Spain
| | - Benjamin Díaz Zorita
- Hepatobiliary and Pancreatic Surgery and Transplant Unit, University Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Patricia Tejedor
- Colorectal Surgery Unit, University Hospital Gregorio Marañón, Madrid, Spain
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Francesco C, Serafino V. Colorectal eversion technique combined with modified single-stapled double-purse-string low colorectal anastomosis. Colorectal Dis 2024; 26:772-775. [PMID: 38372032 DOI: 10.1111/codi.16907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 02/20/2024]
Abstract
AIM Total mesorectal excision with adequate free margins is the gold standard for rectal surgery. Applying a linear stapler in a narrow pelvis can be challenging and the proper distal margin difficult to assess. In selected cases the colorectal eversion technique combined with single-stapled double-purse-string anastomosis (SSDP) can be a practical solution. METHOD Eleven patients, six men and five women, mean body mass index 27 ± 1.3 kg/m2, underwent total mesorectal excision with the colorectal eversion technique combined with modified SSDP between September 2022 and January 2023. RESULTS The mean operative time was 190 min. The mean hospital stay was 4 days. There were no postoperative complications. The final histology showed complete mesorectal resection, circumferential resection margin negative, free distal resection margin, anastomotic doughnuts negative. At 7 ± 3 months follow-up there was no evidence of local recurrence or distant metastasis. CONCLUSION The colorectal eversion technique combined with modified SSDP is a reproducible and safe technique in selected patients. Prospective randomized trials with large patient series are needed to confirm our preliminary results.
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Affiliation(s)
- Crafa Francesco
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Vanella Serafino
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
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Stevanato Filho PR, Bezerra TS, Marques TMDM, Nahime RH, Takahashi RM, Nakagawa WT, Lopes A, Aguiar S. A precise approach to robotic intracorporeal rectal transection and hand-sewn purse-string anastomosis for low anterior resection. J Surg Oncol 2024; 129:939-944. [PMID: 38221657 DOI: 10.1002/jso.27583] [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: 10/08/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
This study presents a new technique for robotic-assisted intracorporeal rectal transection and hand-sewn anastomosis for low anterior resection that overcomes some limitations of conventional techniques. By integrating the advantages of the robotic platform, ensuring standardized exposure during rectal transection, and emphasizing the importance of avoiding complications associated with staple crossings, this innovation has the potential to significantly improve outcomes and reduce costs for patients with lower rectal tumors.
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Affiliation(s)
| | - Tiago S Bezerra
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Tomas M D M Marques
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Rebeca H Nahime
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renata M Takahashi
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Wilson T Nakagawa
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Ademar Lopes
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Samuel Aguiar
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
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8
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Maestro de Castro JL, Choolani Bhojwani E, Labarga Rodríguez F, Bueno Cañones AD, Veleda Belanche S, Simó Fernández V. Robotic minimally invasive abdominal surgery and transanal transection and single-stapled anastomosis for low rectal cancer-A video vignette. Colorectal Dis 2024; 26:826-827. [PMID: 38424701 DOI: 10.1111/codi.16921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/30/2023] [Indexed: 03/02/2024]
Affiliation(s)
| | - Ekta Choolani Bhojwani
- Section of Colorectal Surgery, Department of Surgery, University Hospital Río Hortega, Valladolid, Spain
| | - Fernando Labarga Rodríguez
- Section of Colorectal Surgery, Department of Surgery, University Hospital Río Hortega, Valladolid, Spain
| | | | - Sandra Veleda Belanche
- Section of Colorectal Surgery, Department of Surgery, University Hospital Río Hortega, Valladolid, Spain
| | - Vicente Simó Fernández
- Section of Colorectal Surgery, Department of Surgery, University Hospital Río Hortega, Valladolid, Spain
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9
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Stevanato Filho PR, Marques TMDDM, Bezerra TS, Nahime RH, Lopes A, Aguiar S. Treatment of colorectal anastomotic stricture using robotic intracorporeal rectal transection and hand-sewn purse-string anastomosis - a video vignette. Colorectal Dis 2024; 26:827-829. [PMID: 38385903 DOI: 10.1111/codi.16922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 02/23/2024]
Affiliation(s)
| | | | - Tiago Santoro Bezerra
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo City, São Paulo, Brazil
| | - Rebeca Hara Nahime
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo City, São Paulo, Brazil
| | - Ademar Lopes
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo City, São Paulo, Brazil
| | - Samuel Aguiar
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo City, São Paulo, Brazil
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D'Ancona G, Merlot B, Denost Q, Angioni S, Dennis T, Roman H. Combined Robotic Transanal Transection Single-Stapled Technique in Ultralow Rectal Endometriosis Involvement Associated With Parametrial and Vaginal Infiltration. J Minim Invasive Gynecol 2024; 31:267-268. [PMID: 38160748 DOI: 10.1016/j.jmig.2023.12.012] [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: 09/28/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe a combined robotic and transanal technique used to treat ultralow rectal endometriosis in a 36-year-old patient with multiple pelvic compartments, which was responsible for infertility, dyspareunia, left sciatic pain, and severe dyschezia. DESIGN Surgical video article. SETTING The achievement of a perfect bowel anastomosis in patients with low rectal endometriosis could be challenging owing to technical and anatomic limitations [1]. By allowing a right angle rectotomy with a single-stapled anastomosis, the transanal transection single-stapled technique overcomes these technical difficulties ensuring a good-quality anastomosis with an easier correction of postoperative anastomotic leakage when it occurs [2,3]. INTERVENTIONS The surgery starts by splitting the nodule in 3 components according to different anatomic structures involved (parametrium, vagina, and rectum). Parametrial and vaginal fragments are excised as previously described (Supplemental Videos 1) [4]. The rectal involvement is approached following several steps: isolation and cut of inferior mesenteric vessels (inferior mesenteric artery and inferior mesenteric vein) and left colic artery to obtain a proper colon mobilization; transanal rectotomy immediately below the lower limit of the nodule; extraction of the specimen through the anus (Supplemental Videos 2); proximal bowel segment transection 1 cm above the upper limit of the nodule; introduction of circular stapler anvil into the sigmoid colon; placement of 2 purse string to secure the anvil and at distal rectal cuff, respectively; connection of the anvil to the shoulder of circular stapler; stapler closing and firing with coloanal anastomosis formation; stapled line reinforcement by stitching; and integrity anastomosis test (Supplemental Videos 3). No preventive diverting stoma was performed in accordance with our policy [5]. CONCLUSIONS Although no data are yet available in patients with endometriosis, the use of transanal transection single-stapled technique may be an interesting approach in patients with very low rectal endometriosis involvement.
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Affiliation(s)
- Gianmarco D'Ancona
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo) (Drs. D'Ancona, Merlot, Dennis, and Roman), Clinique Tivoli-Ducos, Bordeaux, France; Division of Obstetrics and Gynecology, Department of surgical sciences, University of Cagliari, Cagliari, Italy (Drs. D'Ancona and Angioni).
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo) (Drs. D'Ancona, Merlot, Dennis, and Roman), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institut-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot and Roman)
| | - Quentin Denost
- Bordeaux Colorectal Institute (Dr. Denost), Clinique Tivoli-Ducos, Bordeaux, France
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, Department of surgical sciences, University of Cagliari, Cagliari, Italy (Drs. D'Ancona and Angioni)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo) (Drs. D'Ancona, Merlot, Dennis, and Roman), Clinique Tivoli-Ducos, Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo) (Drs. D'Ancona, Merlot, Dennis, and Roman), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institut-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot and Roman)
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11
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Filho PRS, Bezerra TS, Marques TMDM, Nahime RH, Takahashi RM, Nakagawa WT, Lopes A, Aguiar S. An alternative robotic approach to precise colorectal transection and single-staple anastomosis in high anterior resection: Video correspondence. J Surg Oncol 2024; 129:802-803. [PMID: 38093694 DOI: 10.1002/jso.27563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/11/2023] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Paulo R Stevanato Filho
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Tiago S Bezerra
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Tomas M D M Marques
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Rebeca H Nahime
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Renata M Takahashi
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Wilson T Nakagawa
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Ademar Lopes
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Samuel Aguiar
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
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12
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Harji D, Fernandez B, Boissieras L, Celerier B, Rullier E, Denost Q. IDEAL Stage 2a/b prospective cohort study of transanal transection and single-stapled anastomosis for rectal cancer. Colorectal Dis 2023; 25:2346-2353. [PMID: 37919463 DOI: 10.1111/codi.16789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 11/04/2023]
Abstract
AIM There are several anastomotic techniques available to facilitate restorative rectal cancer surgery after total mesorectal excision (TME), including double-stapled anastomosis (DST) and handsewn coloanal anastomosis (CAA). However, to date no one technique is superior with regard to anastomotic leakage (AL) or functional outcomes. Transanal transection single-stapled anastomosis (TTSS) aims to overcome some of the technical challenges and offer comparable clinical and functional outcomes to traditional anastomotic techniques. The aim of this study was to explore the role of TTSS in modern rectal cancer surgery and to provide comparative clinical and functional outcome data with DST and CAA. METHOD A prospective cohort study was undertaken to assess the safety and clinical and patient-reported outcomes associated with the TTSS procedure. All patients undergoing sphincter-preserving surgery for rectal cancer with an anastomosis performed within 6 cm of the anal verge between January 2016 and April 2021 were prospectively enrolled into this study. Clinical and patient-reported outcome data, including low anterior resection syndrome (LARS) assessment, were collected. The primary endpoint was anastomotic leakage within 30 days. RESULTS A total of 275 patients participated in this study, with 70 (25%) patients undergoing a TTSS, 110 (40%) undergoing a DST and 95 (35%) undergoing a CAA. Patients undergoing a CAA had more distal tumours than those having a TTSS or DST, with a median tumour height of 5, 7 and 9 cm (p < 0.001), respectively. We observed a statistically significant reduction in AL in the TTSS group compared with the DST group, with rates of 8.6% versus 20.9% (p = 0.028). There was no difference in LARS scores between patients undergoing TTSS and DST (p = 0.228), while patients with a CAA had worse LARS scores than TTSS patients (p = 0.002). CONCLUSION TTSS is a technically safe and feasible anastomotic technique in rectal cancer surgery as an alternative to DST and CAA. Its advantages over DST are a reduced AL rate and, over CAA, improved function. It should therefore be considered as an alternative technique to improve clinical and patient-reported outcomes in restorative rectal cancer surgery.
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Affiliation(s)
- Deena Harji
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - Benjamin Fernandez
- Centre Hospitalier Universitaire de Bordeaux Centre Medico-Chirurgical Magellan Service d Hepato-Gastroenterologie et d Oncologie Digestive Ringgold standard institution, Pessac, France
| | - Lara Boissieras
- Centre Hospitalier Universitaire de Bordeaux Centre Medico-Chirurgical Magellan Service d Hepato-Gastroenterologie et d Oncologie Digestive Ringgold standard institution, Pessac, France
| | - Bertrand Celerier
- Centre Hospitalier Universitaire de Bordeaux Centre Medico-Chirurgical Magellan Service d Hepato-Gastroenterologie et d Oncologie Digestive Ringgold standard institution, Pessac, France
| | - Eric Rullier
- Centre Hospitalier Universitaire de Bordeaux Centre Medico-Chirurgical Magellan Service d Hepato-Gastroenterologie et d Oncologie Digestive Ringgold standard institution, Pessac, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
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13
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Francesco C, Serafino V, Mario B, Antonio L. Colorectal eversion technique combined with modified DST (CET-M-DST) for low colorectal anastomosis after laparoscopic TME for colorectal cancer - Video correspondence. Colorectal Dis 2023; 25:2473-2474. [PMID: 37932880 DOI: 10.1111/codi.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Crafa Francesco
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Vanella Serafino
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Baiamonte Mario
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Longo Antonio
- European Center of Coloproctology and Pelvic Diseases, Multimedica Hospital, Milan, Italy
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14
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Piozzi GN, Khobragade K, Aliyev V, Asoglu O, Bianchi PP, Butiurca VO, Chen WTL, Cheong JY, Choi GS, Coratti A, Denost Q, Fukunaga Y, Gorgun E, Guerra F, Ito M, Khan JS, Kim HJ, Kim JC, Kinugasa Y, Konishi T, Kuo LJ, Kuzu MA, Lefevre JH, Liang JT, Marks J, Molnar C, Panis Y, Rouanet P, Rullier E, Saklani A, Spinelli A, Tsarkov P, Tsukamoto S, Weiser M, Kim SH. International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome. Colorectal Dis 2023; 25:1896-1909. [PMID: 37563772 DOI: 10.1111/codi.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Abstract
AIM Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. METHOD A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. RESULTS Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. CONCLUSION This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.
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Affiliation(s)
| | | | - Vusal Aliyev
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
| | | | - Vlad-Olimpiu Butiurca
- University of Medicine, Pharmacy Science, and Technology 'G.E. Palade', Târgu-Mureș, Romania
| | | | | | - Gyu-Seog Choi
- Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Andrea Coratti
- Azienda USL Toscana Sud Est-Misericordia Hospital, Grosseto, Italy
| | | | - Yosuke Fukunaga
- Cancer Institution Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan
| | | | - Francesco Guerra
- Azienda USL Toscana Sud Est-Misericordia Hospital, Grosseto, Italy
| | - Masaaki Ito
- National Cancer Center Hospital East, Chiba, Japan
| | - Jim S Khan
- University of Portsmouth, Portsmouth, UK
| | - Hye Jin Kim
- Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin Cheon Kim
- University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | | | - Tsuyoshi Konishi
- M.D. Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Li-Jen Kuo
- Taipei Medical University Hospital, Taipei City, Taiwan
| | | | - Jeremie H Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Jin-Tung Liang
- National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan
| | | | - Călin Molnar
- University of Medicine, Pharmacy Science, and Technology 'G.E. Palade', Târgu-Mureș, Romania
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, Seine, France
| | | | - Eric Rullier
- Bordeaux University Hospital, Haut-Leveque Hospital, Pessac, France
| | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Petr Tsarkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Martin Weiser
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Seon Hahn Kim
- Korea University Anam Hospital, Seoul, Korea
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Larach JT, Flynn J, Tew M, Fernando D, Apte S, Mohan H, Kong J, McCormick JJ, Warrier SK, Heriot AG. Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes. Int J Colorectal Dis 2023; 38:161. [PMID: 37284889 PMCID: PMC10247549 DOI: 10.1007/s00384-023-04446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform. METHODS Consecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs. RESULTS During the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 ± 83.4 versus 243 ± 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 ± 8235 versus A$15,525 ± 6382; P < 0.001) and overall costs (A$34,350 ± 14,770 versus A$26,083 ± 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA ≥ 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1). CONCLUSION Robotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Michelle Tew
- Health Economics, Department of Health Services Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Diharah Fernando
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Sameer Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.
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16
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Brunner M, Weber K, Denz A, Langheinrich M, Kersting S, Weber GF, Grützmann R, Krautz C. Omega suture technique for minimally invasive rectal anastomosis - a video vignette. Colorectal Dis 2023. [PMID: 37158135 DOI: 10.1111/codi.16598] [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: 02/13/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Klaus Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Axel Denz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Melanie Langheinrich
- Department of General, Visceral, Thoracic and Vascular Surgery, Greifswald University, Greifswald, Germany
| | - Stephan Kersting
- Department of General, Visceral, Thoracic and Vascular Surgery, Greifswald University, Greifswald, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
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17
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Deputy M, Pitman F, Sahnan K, Miskovic D, Faiz O. An early experience in robotic ileoanal pouch surgery with robotic intracorporeal single-stapled anastomosis (RiSSA) at a tertiary referral centre. Colorectal Dis 2023. [PMID: 36806873 DOI: 10.1111/codi.16528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
AIM A robotic approach to ileal pouch-anal anastomosis (IPAA) surgery offers advantages over other approaches in terms of precision, improved access to the pelvis and less muscular fatigue for the surgeon. The integrity of the anastomosis is also fundamental to successful IPAA surgery. The robotic platform can permit intracorporeal suturing deep within the pelvis to create a single-stapled, double purse-string anastomosis, which may reduce the risk of anastomotic complications. This study describes the safety and early outcomes of robotic intracorporeal single-stapled anastomosis (RiSSA) amongst patients operated consecutively at a tertiary centre immediately before and following the pandemic. METHOD A retrospective study of prospectively collected data analysing the outcome of patients undergoing robotic IPAA between 2019 and 2022 was conducted. All procedures were performed with the da Vinci Xi Surgical System (with a hand-assisted suprapubic incision to fashion the pouch). All pouch-anal anastomoses were performed using a double purse-string, single-stapled (RiSSA) method. Demographic, clinical and outcome data were collected. RESULTS Twenty consecutive patients (nine with ulcerative colitis and 11 with familial adenomatous polyposis) were included with a median age of 25 years (range 16-52); 18 had American Society of Anesthesiologists classification II, and mean body mass index was 24 kg/m2 (range 18.1-34.3). Nine patients (eight ulcerative colitis and one familial adenomatous polyposis) had undergone prior subtotal colectomy and therefore underwent restorative proctectomy with IPAA. Eleven patients underwent restorative proctocolectomy. All procedures were completed robotically. The median length of stay was 9 days (5-49). There were no unplanned admissions to intensive care and no deaths. Three patients were readmitted following hospital discharge for (i) an ileus managed conservatively, (ii) small bowel obstruction managed conservatively and (iii) small bowel obstruction due to constriction at the stoma site necessitating surgery. There were two additional reoperations both for drain complications, one for drain removal and one for drain erosion. On mobilization of the pouch in the latter case, an anastomotic defect was observed. In total, 19/20 patients underwent RiSSA without postoperative anastomotic problems. DISCUSSION RiSSA offers a safe and feasible alternative technique to other minimally invasive approaches with low rates of anastomosis-related complications.
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Affiliation(s)
- Mohammed Deputy
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - Francesca Pitman
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Harrow, UK.,Leicester University Medical School, George Davies Centre, Leicester, UK
| | - Kapil Sahnan
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - Danilo Miskovic
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - Omar Faiz
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
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18
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Luberto A, Crippa J, Foppa C, Maroli A, Sacchi M, De Lucia F, Carvello M, Spinelli A. Routine placement of abdominal drainage in pouch surgery does not impact on surgical outcomes. Updates Surg 2022; 75:619-626. [PMID: 36479676 PMCID: PMC9734453 DOI: 10.1007/s13304-022-01411-5] [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: 06/02/2022] [Accepted: 10/22/2022] [Indexed: 12/12/2022]
Abstract
The evidence does not support the routine use of abdominal drainage (AD) in colorectal surgery. However, there is no data on the usefulness of AD, specifically, after ileal pouch-anal anastomosis (IPAA). The aim of this study is to assess post-operative outcomes of patients undergoing IPAA with or without AD at a high volume referral center. A retrospective analysis of prospectively collected data of consecutive patients undergoing IPAA with AD (AD group) or without AD (NAD group) was performed. Baseline characteristics, operative, and postoperative data were analyzed and compared between the two groups. A total of 97 patients were included in the analysis, 46 were in AD group and 51 in NAD group. AD group had a higher BMI (23.9 ± 3.9 kg/m2 vs 21.9 ± 3.0 kg/m2; p = 0.007) and more commonly underwent two-stage proctocolectomy with IPAA compared to the NAD group (50.0% vs 3.9%; p < 0.001). There was no difference in anastomotic leak rate (6.5% AD vs 5.9% NAD group; p = 1.000), major post-operative complication (8.6% vs 7.9%; p = 0.893); median length of stay [IQR] (5 [5-7] days vs 5 [4-7] days; p = 0.305) and readmission < 90 days (8.7% vs 3.9%; p = 0.418). The use of AD does not impact on surgical outcome after IPAA and question the actual benefit of its routine placement.
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Affiliation(s)
- Antonio Luberto
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Jacopo Crippa
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan Italy ,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Annalisa Maroli
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Matteo Sacchi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Francesca De Lucia
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan Italy ,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan Italy ,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan Italy
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19
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Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis. Cancers (Basel) 2022; 14:cancers14205089. [PMID: 36291872 PMCID: PMC9600114 DOI: 10.3390/cancers14205089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Rectal cancer surgery remains a challenge and information about the learning curve in adopting new techniques is lacking. This paper analyzes our experience in taTME (since 2015) and robotic surgery (since 2018) at a fully accredited referral center for the treatment of rectal cancer in Spain. In this retrospective study, we aim to analyze the learning curves for taTME and robot-assisted rectal procedures in the incorporation of these platforms into our practice. We sought to describe our team’s experience in incorporating these techniques and to analyze the difficulties that we have had. Hoping that sharing our experience can help other groups improve their results during the difficult initial phase of incorporating new techniques. Abstract New techniques are being developed to improve the results of laparoscopic surgery for rectal cancer. This paper analyzes the learning curves for transanal total mesorectal excision (taTME) and robot-assisted surgery in our colorectal surgery department. We analyzed retrospectively data from patients undergoing curative and elective surgery for rectal cancer ≤12 cm from the anal verge. We excluded extended surgeries. We used cumulative sum (CUSUM) curve analysis to identify inflection points. Between 2015 and 2021, 588 patients underwent surgery for rectal cancer at our center: 67 taTME and 79 robot-assisted surgeries. To overcome the operative time learning curve, 14 cases were needed for taTME and 53 for robot-assisted surgery. The morbidity rate started to decrease after the 17th case in taTME and after the 49th case in robot-assisted surgery, but it is much less abrupt in robot-assisted group. During the initial learning phase, the rate of anastomotic leakage was higher in taTME (35.7% vs. 5.7%). Two Urological lesions occurred in taTME but not in robot-assisted surgery. The conversion rate was higher in robot-assisted surgery (1.5% vs. 10.1%). Incorporating new techniques is complex and entails a transition period. In our experience, taTME involved a higher rate of serious complications than robot-assisted surgery during initial learning period but required a shorter learning curve.
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20
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Banchini F, Luzietti E, Conti L, Palmieri G, Capelli P. Redo surgery after low anterior resection for chronic pelvic sinus and anastomotic disruption. Could pull-through procedure with delayed anastomosis be a feasible alternative? Case reports and narrative review. Int J Surg Case Rep 2022; 93:106967. [PMID: 35367950 PMCID: PMC8976098 DOI: 10.1016/j.ijscr.2022.106967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Case presentation Discussion Conclusion Complications after colorectal anastomosis, such as septic leakage or anastomotic disruption, remain a problem to deal with for colorectal surgeons. Conversion to terminal colostomy is the most frequent option chosen, but the most of time restoration of bowel continuity is not performed. Delayed coloanal anastomosis with pull-through procedure described by Turnbull-Cutait might be an option to consider in difficult situations, to maintain or to restore intestinal continuity and could be also chosen as a first option for coloanal anastomosis.
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21
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Spinelli A, Foppa C, Carrano FM, Sacchi M, Carvello M. Transanal transection and single-stapled anastomosis for ileo-anal pouch surgery - a video vignette. Colorectal Dis 2021; 23:2483-2484. [PMID: 34051036 DOI: 10.1111/codi.15762] [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: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | | | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
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22
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Tejedor P, Pastor C, Granero L, Esteban S, Sanchez-Justicia C, Baixauli J. Robotic ultralow anterior resection combined with transanal transection and coloanal anastomosis - A video vignette. Colorectal Dis 2021; 23:1588-1589. [PMID: 33665908 DOI: 10.1111/codi.15615] [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: 01/17/2021] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Carlos Pastor
- Department of Colorectal Surgery, University Clinic of Navarre, Pamplona, Spain
| | - Lucia Granero
- Department of Colorectal Surgery, University Clinic of Navarre, Pamplona, Spain
| | - Sara Esteban
- Department of Colorectal Surgery, University Clinic of Navarre, Pamplona, Spain
| | | | - Jorge Baixauli
- Department of Colorectal Surgery, University Clinic of Navarre, Pamplona, Spain
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23
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Larach JT, Rajkomar AKS, Smart PJ, McCormick JJ, Heriot AG, Warrier SK. Beyond transanal total mesorectal excision: short-term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision. Colorectal Dis 2021; 23:823-833. [PMID: 33217140 DOI: 10.1111/codi.15446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane. METHOD We performed a retrospective review of the outcomes of a case series of patients undergoing taTME for rectal cancer with mesorectal fascia or adjacent organ involvement. RESULTS Eleven patients (six men) underwent taTME for LARC requiring resection beyond total mesorectal excision (TME). All had a restorative procedure. The transabdominal approach was open in five and minimally invasive in six cases. All patients required the resection of at least one adjacent structure, including presacral fascia, internal iliac vessels, nerve roots, uterus, vagina or seminal vesicles. Four patients required a pelvic side-wall lymph node dissection and four had intraoperative radiotherapy. In all cases, the transanal approach was useful to disconnect the rectum distally, resect adjacent organs or control the R1 risk-point. Three patients had a complication of Clavien-Dindo grade III or above (one mechanical bowel obstruction, one pelvic collection and one urine sepsis). There were no anastomotic complications. Ten patients had an R0 resection. During a median follow-up of 11 (8.6-16) months there were no local recurrences, but two patients had distant metastases. During the study period, eight patients underwent closure of their stoma whilst the remaining three have had normal anastomotic assessments and will be closed in the future. CONCLUSION This early series shows that implementation of taTME for resections beyond TME may be feasible and safe in a highly selected setting.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amrish K S Rajkomar
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Philip J Smart
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
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24
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Spinelli A. The rationale for expanding transanal transection and single-stapled anastomosis from transanal total mesorectal excision to open, laparoscopic and robotic resections. Colorectal Dis 2019; 21:991. [PMID: 31476266 DOI: 10.1111/codi.14752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Antonino Spinelli
- Colon and Rectal Surgery Unit, Department of General Surgery, Humanitas Research Hospital, Milan, Italy
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