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Cleary RK, Silviera M, Reidy TJ, McCormick J, Johnson CS, Sylla P, Cannon J, Lujan H, Kassir A, Landmann R, Gaertner W, Lee E, Bastawrous A, Bardakcioglu O, Pandey S, Attaluri V, Bernstein M, Obias V, Franklin ME, Pigazzi A. Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial. Surg Endosc 2022; 36:4349-4358. [PMID: 34724580 PMCID: PMC9085698 DOI: 10.1007/s00464-021-08780-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/02/2021] [Accepted: 10/13/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. METHODS Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. RESULTS There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. CONCLUSION In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy.
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Affiliation(s)
- Robert K. Cleary
- Department of Surgery, Saint Joseph’s Mercy Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI 48106 USA
| | - Matthew Silviera
- Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Tobi J. Reidy
- Department of Surgery, Franciscan Health, Indianapolis, IN USA
| | - James McCormick
- Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA USA
| | - Craig S. Johnson
- Department of Surgery, Oklahoma Surgical Hospital, Tulsa, OK USA
| | - Patricia Sylla
- Division of Colorectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY USA
| | - Jamie Cannon
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL USA
| | - Henry Lujan
- Colon and Rectal Surgery, Jackson Health System, Miami, FL USA
| | - Andrew Kassir
- Colon and Rectal Clinical, Honor Health, Scottsdale, AZ USA
| | - Ron Landmann
- Department of Colon Rectal Surgery, Baptist MD Andersen Cancer Center, Jacksonville, FL USA
| | - Wolfgang Gaertner
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN USA
| | - Edward Lee
- Department of Surgery, Albany Medical College, Albany, NY USA
| | - Amir Bastawrous
- Colon and Rectal Clinic, Swedish Medical Center, Seattle, WA USA
| | - Ovunc Bardakcioglu
- Department of Colorectal, Las Vegas School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV USA
| | - Sushil Pandey
- West Valley Colon and Rectal Surgery Center, Sun City, AZ USA
| | - Vikram Attaluri
- Colon and Rectal Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA USA
| | - Mitchell Bernstein
- Division of Colon and Rectal Surgery, NYU Langone Medical Center, New York, NY USA
| | - Vincent Obias
- Division of Colon and Rectal Surgery, The George Washington University Hospital, Washington, DC USA
| | | | - Alessio Pigazzi
- Division of Colon and Rectal Surgery, Weill Medical College Cornell University, New York, NY USA
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Panteleimonitis S, Miskovic D, Bissett-Amess R, Figueiredo N, Turina M, Spinoglio G, Heald RJ, Parvaiz A. Short-term clinical outcomes of a European training programme for robotic colorectal surgery. Surg Endosc 2020; 35:6796-6806. [PMID: 33289055 PMCID: PMC8599412 DOI: 10.1007/s00464-020-08184-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/28/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery-EARCS). METHODS Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. RESULTS Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. CONCLUSIONS Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.
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Affiliation(s)
- Sofoklis Panteleimonitis
- School of Health and Care Professions, University of Portsmouth, St Andrews Court, St Michael's Road, Portsmouth, PO1 2PR, UK
| | | | | | - Nuno Figueiredo
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Matthias Turina
- Division of Colorectal Surgery and Proctology, University of Zurich Hospital, Moussonstrasse 2, 8044, Zurich, Switzerland
| | | | - Richard J Heald
- Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal.,Pelican Cancer Foundation, Dinwoodie Dr, Basingstoke, RG24 9NN, UK
| | - Amjad Parvaiz
- School of Health and Care Professions, University of Portsmouth, St Andrews Court, St Michael's Road, Portsmouth, PO1 2PR, UK. .,Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal. .,Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK.
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Keller DS, Senagore AJ, Fitch K, Bochner A, Haas EM. A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits. Surg Endosc 2016; 31:2846-2853. [PMID: 27815745 DOI: 10.1007/s00464-016-5295-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/14/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery. METHODS A Truven MarketScan® claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs). Care episodes were compared for average allowed costs, complication, and readmission rates after adjusting costs for demographics, comorbidities, and geographic region. RESULTS A total of 4615 colectomies were included-2054 (44.5 %) open and 2561 (55.5 %) MIS. Total allowed episode costs were significantly lower MIS than open ($37,540 vs. $45,284, p < 0.001). During the inpatient stay, open cases had significantly greater ICU utilization (3.9 % open vs. 2.0 % MIS, p < 0.001), higher overall complications (52.8 % open vs. 32.3 % MIS, p < 0.001), higher colorectal-specific complications (32.5 % open vs. 17.9 % MIS, p < 0.001), longer LOS (6.39 open vs. 4.44 days MIS, p < 0.001), and higher index admission costs ($39,585 open vs. $33,183 MIS, p < 0.001). Post-discharge, open cases had significantly higher readmission rates/100 cases (11.54 vs. 8.28; p = 0.0013), higher average readmission costs ($3055 vs. $2,514; p = 0.1858), and greater 30-day healthcare costs than MIS ($5699 vs. $4357; p = 0.0033). The net episode cost of care was $7744/patient greater for an open colectomy, even with similar DRG distribution. CONCLUSIONS In a commercially insured population, the risk-adjusted allowed costs for MIS colectomy episodes were significantly lower than open. The overall cost difference between MIS and open was almost $8000 per patient. This highlights an opportunity for health plans and employers to realize financial benefits by shifting from open to MIS for colectomy. With increasing bundled payment arrangements and accountable care sharing programs, the cost impact of shifting from open to MIS introduces an opportunity for cost savings.
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Affiliation(s)
- Deborah S Keller
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Street, R-1013, Dallas, TX, 75246, USA.
| | - Anthony J Senagore
- Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | | | | | - Eric M Haas
- Minimally Invasive Colon and Rectal Surgery, University of Texas Medical Center at Houston, Houston, TX, USA
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Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP. Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 2016; 68:63-9. [PMID: 26992927 DOI: 10.1007/s13304-016-0353-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/20/2016] [Indexed: 12/22/2022]
Abstract
Minimally invasive surgery has gained worldwide acceptance in the treatment of colonic cancer in the last decades, thanks to its well-known advantages in short-term outcomes. Nevertheless, the penetrance of minimally invasive colorectal surgery still remains low. Few studies and metanalysis, to date, have analyzed the results of robotic versus laparoscopic colorectal surgery, often with conflicting conclusions. The robotic platform, thanks to its technological features, may potentially overcome the limitation of standard laparoscopy, especially when performing a complete mesocolic excision resection and an intracorporeal anastomosis. Robotic surgery could also shorten the learning curve of young novice surgeons, provided that strict protocols of structured training are applied. This paper is an update on the current available outcomes of robotic vs laparoscopic surgery in right colectomy.
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Affiliation(s)
- Giampaolo Formisano
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy.
| | - Pasquale Misitano
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Giuseppe Giuliani
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Giulia Calamati
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Lucia Salvischiani
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paolo Pietro Bianchi
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
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Keller DS, Flores-Gonzalez JR, Ibarra S, Haas EM. Review of 500 single incision laparoscopic colorectal surgery cases - Lessons learned. World J Gastroenterol 2016; 22:659-667. [PMID: 26811615 PMCID: PMC4716067 DOI: 10.3748/wjg.v22.i2.659] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/09/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Single incision laparoscopic surgery (SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.
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Martin TD, Lorenz T, Ferraro J, Chagin K, Lampman RM, Emery KL, Zurkan JE, Boyd JL, Montgomery K, Lang RE, Vandewarker JF, Cleary RK. Newly implemented enhanced recovery pathway positively impacts hospital length of stay. Surg Endosc 2015; 30:4019-28. [PMID: 26694181 DOI: 10.1007/s00464-015-4714-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/01/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Enhanced recovery pathways (ERPs) are thought to improve surgical outcomes by standardizing perioperative patient care established in evidence-based literature. The objective of this study was to determine the impact of a colorectal surgery ERP on hospital length of stay (LOS) and other patient outcomes. METHODS This is a comparative effectiveness study of patients undergoing elective colorectal surgery 2 years prior (pre-ERP group) and 2 years after (ERP group) implementation of an ERP program. The primary outcome was hospital LOS. Secondary outcomes included postoperative complications, 30-day readmissions, and 30-day reoperations. Multivariable regression analyses were utilized to control for patient factors, general health factors, diagnosis, surgeon, colon versus rectal operations, and open versus minimally invasive operations-laparoscopic and robotic. An ERP checklist was developed to track adherence to components of the pathway. RESULTS The study population included 1036 patients: 523 in the pre-ERP group and 513 in the ERP group. Unadjusted LOS was significantly shorter in the ERP group than the control pre-ERP group [3 (IQR 3.5) vs 5 days (IQR 4.6); p < 0.0001]. Multivariable regression analysis confirmed the reduction in LOS, controlling for age, colon/rectum procedure, open/laparoscopic/robotic approach, primary diagnosis, and alvimopan use. Postoperative outcomes were not significantly different between groups except for 30-day readmissions, which were unexpectedly higher in the ERP group (14.6 vs 8.7 %, p = 0.04). CONCLUSIONS A newly implemented ERP on a dedicated colorectal surgery service in an academic non-university hospital setting resulted in shorter hospital LOS, but increased readmissions, for patients undergoing elective open and minimally invasive colon and rectal surgery. Future multi-institutional studies are needed to understand the impact of ERP on postoperative complications and readmissions.
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Affiliation(s)
- Thomas D Martin
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Talya Lorenz
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Jane Ferraro
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Kevin Chagin
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard M Lampman
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Karen L Emery
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Joan E Zurkan
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Jami L Boyd
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Karin Montgomery
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Rachel E Lang
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - James F Vandewarker
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Robert K Cleary
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA.
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Madhoun N, Keller DS, Haas EM. Review of single incision laparoscopic surgery in colorectal surgery. World J Gastroenterol 2015; 21:10824-9. [PMID: 26478673 PMCID: PMC4600583 DOI: 10.3748/wjg.v21.i38.10824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/08/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.
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Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK. A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 2015; 30:1576-84. [PMID: 26169638 DOI: 10.1007/s00464-015-4381-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Until randomized trials mature, large database analyses assist in determining the role of robotics in colorectal surgery. ACS NSQIP database coding now allows differentiation between laparoscopic (LC) and robotic (RC) colorectal procedures. The purpose of this study was to compare LC and RC outcomes by analyzing the ACS NSQIP database. METHODS The ACS NSQIP database was queried to identify patients who had undergone RC and LC during 2013. Demographic characteristics, intraoperative data, and postoperative outcomes were identified. Using propensity score matching, abdominal and pelvic colorectal operative and postoperative outcomes were analyzed. RESULTS A total of 11,477 cases were identified. In the abdomen, 7790 LC and 299 RC cases were identified, and 2057 LC and 331 RC cases were identified in the pelvis. There were significant differences in operative time, conversion to an open procedure in the pelvis, and hospital length of stay. RC operative times were significantly longer in both abdominal and pelvic cases. Conversion rates in the pelvis were less for RC when compared to LC--10.0 and 13.7%, respectively (p = 0.01). Hospital length of stay was significantly shorter for RC abdominal cases than for LC abdominal cases (4.3 vs. 5.3 days, p < 0.001) and for RC pelvic cases when compared to LC pelvic cases (4.5 vs. 5.3 days, p < 0.001). There were no significant differences in surgical site infection (SSI), organ/space SSI, wound complications, anastomotic leak, sepsis/shock, or need for reoperation within 30 days. CONCLUSION As the robotic platform continues to grow in colorectal surgery and as technical upgrades continue to advance, comparison of outcomes requires continuous reevaluation. This study demonstrated that robotic operations have longer operative times, decreased hospital length of stay, and decreased rates of conversion to open in the pelvis. These findings warrant continued evaluation of the role of minimally invasive technical upgrades in colorectal surgery.
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Affiliation(s)
- Anuradha R Bhama
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA.
| | - Vincent Obias
- Division Colon and Rectal Surgery, Department of Surgery, George Washington University, Washington, DC, 20037, USA
| | - Kathleen B Welch
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - James F Vandewarker
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
| | - Robert K Cleary
- Division of Colon and Rectal Surgery, Department of Surgery, St. Joseph Mercy Health System - Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI, 48106, USA
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Xu JM, Wei Y, Wang XY, Fan H, Chang WJ, Ren L, Jiang W, Fan J, Qin XY. Robot-assisted one-stage resection of rectal cancer with liver and lung metastases. World J Gastroenterol 2015; 21:2848-2853. [PMID: 25759560 PMCID: PMC4351242 DOI: 10.3748/wjg.v21.i9.2848] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/18/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
The Da Vinci Surgical System may help to overcome some of the difficulties of laparoscopy for complicated abdominal surgery. The authors of this article present a case of robot-assisted, one-stage radical resection of three tumors, including robotic anterior resection for rectal cancer, segmental hepatectomy for liver metastasis, and wedge-shaped excision for lung metastasis. A 59-year-old man with primary rectal cancer and liver and lung metastases was operated upon with a one-stage radical resection approach using the Da Vinci Surgical System. Resection and anastomosis of rectal cancer were performed extracorporeally after undocking the robot. The procedure was successfully completed in 500 min. No surgical complications occurred during the intervention and postoperative period, and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of simultaneous resection for rectal cancer with liver and lung metastases using the Da Vinci Surgery System to be reported. The procedure is feasible and safe and its main advantages for patient are avoiding repeated operation, reducing surgical trauma, shortening recovery time, and early implementation of postoperative adjuvant therapy.
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