Robotic-assisted colorectal surgery in obese patients: a case-matched series

Harr, Jeffrey N.; Luka, Samuel; Kankaria, Aman; Juo, Yen-Yi; Agarwal, Savita; Obias, Vincent

doi:10.1007/s00464-016-5291-1

Cited by 40 publications

(48 citation statements)

References 29 publications

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“…The reasons might be associated with that, the robotic system was more complicated and needed more time to install the procedures in general. [35] Furthermore, due to lack of haptic feedback and remote operation, surgeons had to take more time to complete regular tasks during robotic procedure. The experience of surgeons might be a significant factor contributing to the difference of operative time for RTME.…”

Section: Discussionmentioning

confidence: 99%

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Wang²,

Liang³

et al. 2017

Medicine

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Background:The aim of this study was to assess the safety and effectiveness of robotic-assisted versus laparoscopic total mesorectal excision (TME) in patients with rectal cancer.Methods:We systematically searched PubMed, EMBASE, Cochrane library, Web of science, and Chinese Biomedical Literature Database up to July 2016 to identify case-controlled studies that compared robotic TME (RTME) with laparoscopic TME (LTME) for rectal cancer. GRADE was used to interpret the primary outcomes of this meta-analysis.Results:We included 17 case–control studies (3601 participants: 1726 underwent RTME and 1875 LTME for rectal cancer) that compared RTME with LTME for rectal cancer. We found no statistically significant differences between techniques for local recurrence [odds ratio (OR) = 0.68, P = .216] and overall survival at 3 years (OR = 0.71, P = 1.140), complications (OR = 1.02, P = .883), positive circumferential resection margin (PCRM) (OR = 0.80, P = .256), the first passing flatus [weighted mean difference (WMD) = −0.11, P = .130], reoperation (OR = 0.66, P = .080), estimated blood loss (EBL) (WMD = −12.45, P = .500), and length of stay in hospital (LOS) (WMD = −0.69, P = .089). Compared with LTME, RTME was associated with lower rate of conversion (OR = 0.35, P < .001), urinary retention (OR = 0.41, P = .025), and longer operative time (WMD = 57.43, P < .001). The overall quality of evidence was poor in all outcomes.Conclusion:RTME in patients with rectal cancer was associated with a lower rate of conversion and less incidence of urinary retention. Generally, operative time in RTME was significantly longer than in LTME. The long-term oncological and function outcomes of RTME seem to be equivalent with LTME. Therefore, analysis of current studies to date did not indicate a major benefit of RTME over LTME.

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Section: Discussionmentioning

confidence: 99%

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Wang²,

Liang³

et al. 2017

Medicine

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“…However, this is still a subject of debate, with numerous studies demonstrating no difference in short-term outcomes between laparoscopic obese and non-obese colorectal surgery patients [30, 31]. Nevertheless, the role of robotic colorectal surgery in obese patients has only been investigated in a handful of studies [9, 18, 19, 32, 33], with only two comparing the outcomes of obese robotic vs laparoscopic rectal surgery patients [18, 19]. The remaining three studies compared the outcomes of obese versus non-obese patients receiving robotic rectal surgery, with all three studies demonstrating no difference in short-term outcomes between obese and non-obese patients [9, 32, 33].…”

Section: Discussionmentioning

confidence: 99%

“…There is consensus amongst surgeons that obesity increases the technical difficulty of colorectal surgery [7, 8]. Obese patients tend to have a thickened and excessive omentum and mesentery which restricts the space for instrumental manoeuvre, limits access and vision, distorts the surgical planes and can lead to problematic bleeding [9]. With obesity becoming increasingly a major hazard to public health worldwide, colorectal surgeons are likely to encounter and operate on this group of patients in increasing numbers [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Panteleimonitis

Pickering

Abbas

et al. 2018

Int J Colorectal Dis

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PurposeLaparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients.MethodsAll consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined.ResultsA total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033).ConclusionsIn this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.

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“…While robotic colorectal surgery has been proven to be generally safe in individuals with obesity, studies have shown that patients with obesity have a significantly higher prevalence of wound complications 10. Additionally, Haas et al showed that patients with morbid obesity undergoing minimally invasive colorectal surgery (conventional laparoscopic and robotic) have significantly longer operative times and increased blood loss during procedures 11.…”

Section: Discussionmentioning

confidence: 99%

Port site hernias following robotic colorectal surgery in people with obesity

Chang

Morin

Liu³

et al. 2018

BMJ Case Reports

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Port site hernias are a rare complication following robotic surgery that can result in disastrous outcomes. We describe incarcerated port site hernias in two patients with obesity. Both patients required laparoscopic reduction. Following laparoscopic reduction, one patient's postoperative course was complicated by pneumatosis intestinalis, requiring exploratory laparotomy and subsequent small bowel resection. It is standard practice to not close the fascia of port sites less than 12 mm in robotic surgery. However, this allows for the rare possibility of small bowel herniation through the port site. We suggest that our patients' history of obesity and metabolic dysfunction contributed to difficult port retention during the case, and longer operating times which caused an increased amount of torque at the port site. Additionally, compared with laparoscopic surgery, robotic surgery is associated with increased torque at port sites. The combination of these risk factors extended the fascial defect, ultimately leading to the incarceration of small bowel in the port site.

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Robotic-assisted colorectal surgery in obese patients: a case-matched series

Cited by 40 publications

References 29 publications

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Port site hernias following robotic colorectal surgery in people with obesity

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