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Pathak A, Wanjari M. Minimally Invasive Colorectal Surgery Techniques. Cureus 2023; 15:e47203. [PMID: 38021760 PMCID: PMC10652800 DOI: 10.7759/cureus.47203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Colorectal surgery has witnessed a transformative shift with the advent of minimally invasive techniques, offering patients reduced postoperative discomfort, shorter hospital stays, and accelerated recovery compared to conventional open surgery. This comprehensive review aims to assess the current state of minimally invasive approaches in colorectal surgery, encompassing various techniques such as single-incision laparoscopic surgery, robot-assisted surgery, and conventional laparoscopic surgery. The article meticulously explores the benefits and drawbacks of each technique, delves into the established criteria for their application, delineates cautious circumstances, and analyzes the outcomes of minimally invasive colorectal surgery. Additionally, the integration of virtual reality and augmented reality for surgical planning and training is discussed, shedding light on the future trajectory of this field. Surgeons and researchers striving to enhance patient care and surgical outcomes in colorectal surgery will find this review article an invaluable resource, presenting crucial components of minimally invasive colorectal surgery and paving the way for continued advancements in the field.
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Affiliation(s)
- Akash Pathak
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Vanella S, Bottazzi EC, Farese G, Murano R, Noviello A, Palma T, Godas M, Crafa F. Minimally invasive colorectal surgery learning curve. World J Gastrointest Endosc 2022; 14:731-736. [PMID: 36438877 PMCID: PMC9693684 DOI: 10.4253/wjge.v14.i11.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 11/14/2022] Open
Abstract
The learning curve in minimally invasive colorectal surgery is a constant subject of discussion in the literature. Discordant data likely reflects the varying degrees of each surgeon’s experience in colorectal, laparoscopic or robotic surgery. Several factors are necessary for a successful minimally invasive colorectal surgery training program, including: Compliance with oncological outcomes; dissection along the embryological planes; constant presence of an expert tutor; periodic discussion of the morbidity and mortality rate; and creation of a dedicated, expert team.
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Affiliation(s)
- Serafino Vanella
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Enrico Coppola Bottazzi
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Giancarlo Farese
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Rosa Murano
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Adele Noviello
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Tommaso Palma
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Maria Godas
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Francesco Crafa
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
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Manigrasso M, Vertaldi S, Anoldo P, D’Amore A, Marello A, Sorrentino C, Chini A, Aprea S, D’Angelo S, D’Alesio N, Musella M, Vitiello A, De Palma GD, Milone M. Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience. J Pers Med 2021; 11:jpm11070621. [PMID: 34208988 PMCID: PMC8307843 DOI: 10.3390/jpm11070621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Abstract
The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.
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Affiliation(s)
- Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (M.M.); (A.V.)
- Correspondence:
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Salvatore Aprea
- “Federico II” University Hospital, Via Pansini 5, 80131 Naples, Italy; (S.A.); (S.D.); (N.D.)
| | - Salvatore D’Angelo
- “Federico II” University Hospital, Via Pansini 5, 80131 Naples, Italy; (S.A.); (S.D.); (N.D.)
| | - Nicola D’Alesio
- “Federico II” University Hospital, Via Pansini 5, 80131 Naples, Italy; (S.A.); (S.D.); (N.D.)
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (M.M.); (A.V.)
| | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (M.M.); (A.V.)
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (S.V.); (P.A.); (A.D.); (A.M.); (C.S.); (A.C.); (G.D.D.P.); (M.M.)
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Gkionis IG, Flamourakis ME, Tsagkataki ES, Kaloeidi EI, Spiridakis KG, Kostakis GE, Alegkakis AK, Christodoulakis MS. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience. BMC Surg 2020; 20:308. [PMID: 33267802 PMCID: PMC7709341 DOI: 10.1186/s12893-020-00975-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure.
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Affiliation(s)
- Ioannis G Gkionis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece.
| | - Mathaios E Flamourakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Eleni S Tsagkataki
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Eleni I Kaloeidi
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Konstantinos G Spiridakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Georgios E Kostakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | | | - Manousos S Christodoulakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
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Pitiakoudis M, Zezos P, Kouklakis G, Tsalikidis C, Romanidis K, Vradelis S, Tsaroucha AK, Kakolyris S, Simopoulos C. Endoscopically Assisted Transumbilical Single-Incision Laparoscopic Gastric Resection for GIST Treatment. J INVEST SURG 2015; 29:98-105. [PMID: 26631974 DOI: 10.3109/08941939.2015.1081309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Complete surgical resection with negative margins without lymphadenectomy is the treatment of choice for nonmetastatic Gastrointestinal Stromal Tumors (GISTs). Laparoscopic resection of gastric GISTs <5 cm is an acceptable and oncologically feasible, safe, and effective treatment. We present our experience of an endoscopically assisted minimally invasive transumbilical single-incision laparoscopic (SILS) technique for gastric GISTs resection. METHODS Four patients with small gastric GISTs ≤5 cm located on the greater curvature or the anterior wall were resected with SILS by using a lesion-lifting technique under the guidance of flexible gastroscopy. RESULTS The technique was feasible and safe and offered significant advantages in locating the tumor and controlling the resection margins. There were no major intraoperative or postoperative complications, conversions, or tumor ruptures. Pathology showed low-risk GISTs resected with disease-free margins without tumor rupture. No recurrences have been observed. CONCLUSION The endoscopically assisted SILS wedge gastrectomy is a feasible, safe, and advantageous technique for the treatment of the greater curvature or anterior wall gastric GISTs.
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Affiliation(s)
- Michail Pitiakoudis
- a 2nd Department of Surgery , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Petros Zezos
- b Gastrointestinal Endoscopy Unit , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Georgios Kouklakis
- b Gastrointestinal Endoscopy Unit , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Christos Tsalikidis
- a 2nd Department of Surgery , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Konstantinos Romanidis
- a 2nd Department of Surgery , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Stergios Vradelis
- b Gastrointestinal Endoscopy Unit , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Alexandra K Tsaroucha
- a 2nd Department of Surgery , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Stylianos Kakolyris
- c Department of Oncology , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
| | - Constantinos Simopoulos
- a 2nd Department of Surgery , Democritus University of Thrace, University General Hospital , Dragana , Alexandroupolis , Greece
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Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ. National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 2015; 30:1060-7. [PMID: 26092020 DOI: 10.1007/s00464-015-4296-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/01/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Social and racial disparities have been identified as factors contributing to differences in access to care and oncologic outcomes in patients with colorectal cancer. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS), both laparoscopic and robotic, across different racial, socioeconomic and geographic populations of patients with rectal cancer. METHODS We utilized the American College of Surgeons National Cancer Database to identify patients with rectal cancer from 2004 to 2011 who had undergone definitive surgical procedures through either an open, laparoscopic or robotic approach. Inclusion criteria included only one malignancy and no adjuvant therapy. Multivariate analysis was performed to investigate differences in age, gender, race, income, education, insurance coverage, geographic setting and hospital type in relation to the surgical approach. RESULTS A total of 8633 patients were identified. The initial surgical approach included 46.5% open (4016), 50.9% laparoscopic (4393) and 2.6% robotic (224). In evaluating type of insurance coverage, patients with private insurance were most likely to undergo laparoscopic surgery [OR (odds ratio) 1.637, 95% CI 1.178-2.275], although there was a less statistically significant association with robotic surgery (OR 2.167, 95% CI 0.663-7.087). Patients who had incomes greater than $46,000 and received treatment at an academic center were more likely to undergo MIS (either laparoscopic or robotic). Race, education and geographic setting were not statistically significant characteristics for surgical approach in patients with rectal cancer. CONCLUSIONS Minimally invasive approaches for rectal cancer comprise approximately 53% of surgical procedures in patients not treated with adjuvant therapy. Robotics is associated with patients who have higher incomes and private insurance and undergo surgery in academic centers.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA.
| | - Pragatheeshwar Thirunavukarasu
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Eisar Al-Sukhni
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
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Alnasser M, Schneider EB, Gearhart SL, Wick EC, Fang SH, Haider AH, Efron JE. National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 2013; 28:49-57. [PMID: 24002916 DOI: 10.1007/s00464-013-3160-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 07/25/2013] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Racial disparity in the treatment of colorectal cancer (CRC) has been cited as a potential cause for differences in mortality. This study compares the rates of laparoscopy according to race, insurance status, geographic location, and hospital size. METHODS The 2009 Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with the diagnosis of CRC by the International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariate logistic regression was performed to look at age, gender, insurance coverage, academic versus nonacademic affiliated institutions, rural versus urban settings, location, and proportional differences in laparoscopic procedures according to race. RESULTS A total of 14,502 patients were identified; 4,691 (32.35 %) underwent laparoscopic colorectal procedures and 9,811 (67.65 %) underwent open procedures. The proportion of laparoscopic procedures did not differ significantly by race: Caucasian 32.4 %, African-American 30.04 %, Hispanic 33.99 %, and Asian-Pacific Islander 35.12 (P = 0.08). Among Caucasian and African-American patients, those covered by private insurers were more likely to undergo laparoscopic procedures compared to other insurance types (P ≤ 0.001). The odds of receiving laparoscopic procedure at teaching hospitals was 1.39 times greater than in nonteaching hospitals (95 % confidence interval [CI] 1.29-1.48) and did not differ across race groups. Patients in urban hospitals demonstrated higher odds of laparoscopic surgery (2.24, 95 % CI 1.96-2.56) than in rural hospitals; this relationship was consistent within races. The odds of undergoing laparoscopic surgeries was lowest in the Midwest region (0.89, 95 % CI 0.81-0.97) but higher in the Southern region (1.14, 95 % CI 1.06-1.22) compared with the other regions. CONCLUSIONS Nearly one-third of all CRC surgeries are laparoscopic. Race does not appear to play a significant role in the selection of a laparoscopic CRC operation. However, there are significant differences in the selection of laparoscopy for CRC patients based on insurance status, geographic location, and hospital type.
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Affiliation(s)
- Monirah Alnasser
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA,
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