Single-Stage Totally Robotic Dissection for Rectal Cancer Surgery: Technique and Short-Term Outcome in 50 Consecutive Patients

Choi, Duck Joo; Kim, Seon Hahn; Lee, Peter J. M.; Kim, Jin; Woo, Si Uk

doi:10.1007/dcr.0b013e3181b13536

Cited by 130 publications

(109 citation statements)

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“…[10][11][12][13][14][15][16][17][18][19] Prior studies have demonstrated that robotic surgery is feasible and safe 7,[11][12][13][14][15][16][17][18]20,21 but may be associated with higher cost and longer operative duration, particularly for rectal resections. 10,25 Given the single-centre reporting bias present in much of the literature, there is a need for research using multi-institutional data.…”

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confidence: 99%

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Feinberg

Elnahas

Bashir

et al. 2016

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Background: Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes. Methods:The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes.Results: There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion. Conclusion:Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients.Contexte : La chirurgie robotique est de plus en plus utilisée comme option de rechange peu effractive à la laparoscopie classique. La robotique permet de remédier à bon nombre des restrictions techniques et ergonomiques de la chirurgie laparoscopique, mais peu d'articles font état des résultats cliniques en chirurgie colorectale. Nous avons donc cherché à comparer les 2 techniques de résection colorectale en ce qui concerne les résultats peropératoires dans les 30 jours suivant l'intervention.Méthodes : À l'aide de base de données du National Surgical Quality Improvement Program de l'American College of Surgeons, nous avons recensé tous les patients ayant subi une résection colorectale par chirurgie laparoscopique ou robotique en 2013. Nous avons ensuite mené une analyse de régression logistique pour comparer des variables peropératoires et les résultats après 30 jours.Résultats : En tout, 8392 patients avaient subi une chirurgie colorectale par laparoscopie pendant la période visée, et 472 avaient subi une intervention par chirurgie robotique. Le second groupe avait une incidence plus faible de conversion peropéra-toire imprévue (9,5 % par rapport à 13,7 %; p = 0,008). On n'a relevé aucune différence significative entre les 2 types d'intervention quant aux autres résultats peropératoires et postopératoires, soit la durée de l'intervention, la durée du séjour à l'hôpital et la survenue d'un iléus, d'une fui...

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confidence: 99%

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Feinberg

Elnahas

Bashir

et al. 2016

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“…nos 52 pacientes submetidos à cirurgia com preservação esfincteriana, apenas um (1,7%) desenvolveu deiscência anastomótica. apesar dos diversos critérios adotados por diferentes autores, nossa taxa de deiscência anastomótica é inferior àquela encontrada na literatura, que varia de 3 até 17% para pacientes submetidos à ETM com preservação esfincteriana por técnica aberta, laparoscópica ou robótica 2,[20][21][22][23][24][25] . De acordo com a recomendação da aJcc, é necessária uma amostra linfonodal de no mínimo 10 a 14 linfonodos para um adequado estudo histopatoló-gico.…”

Section: Discussionunclassified

“…aceita-se um número ainda menor em pacientes submetidos à quimiorradioterapia pré-operatória 26 . em nossa série, apesar de 80% dos pacientes terem sidos submetidos a tratamento neoadjuvante, o núme-ro médio de linfonodos ressecados foi de 18,7. nosso resultado, em termos de amostragem linfonodal, é superior quando comparados aqueles reportados em outras séries de eTM por técnica aberta, laparoscópica ou robótica 2,3,[20][21][22][23][24]27,28 . Diversos estudos não randomizados demonstraram que a eTM com margem radial livre de invasão tumoral reduz a taxa de recidiva local 26 .…”

Section: Discussionunclassified

Excisão total do mesorreto por técnica robótica: resultados cirúrgicos e oncológicos iniciais

Ghezzi

Luca

Valvo

et al. 2011

Rev bras. colo-proctol.

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A média da margem cirúrgica distal foi de 2,9 ± 1,7 cm, enquanto a margem radial foi negativa em todos os pacientes. O tempo de seguimento pós-operatório foi de 14,3 meses. Apenas uma recidiva pélvica foi observada. As taxas de sobrevida geral e sobrevida câncer-específica foram respectivamente de 97,6% e 98,3%. Conclusões: ETM robótica é uma cirurgia exequível e segura. Apresenta resultados iguais ou mesmo melhores que as técnicas aberta e laparoscópica em termos de morbimortalidade, taxa de preservação esfincteriana e desfechos oncológicos iniciais.Palavras-chave: robótica; cirurgia colorretal; procedimentos cirúrgicos minimamente invasivos; neoplasias retais. Excisão total do mesorreto por técnica robótica:resultados cirúrgicos e oncológicos iniciais Robotic total mesorectal excision: early surgical and oncological outcomes . Desde a sua introdução, proposta por heald, em 1982, as taxas de sobrevida e de recidiva pélvica em pacientes submetidos à cirurgia do câncer de reto melhoraram substancialmente 2,3 . em razão disso, a eTM é considerada atualmente o tratamento cirúrgico gold standard de pacientes com tumores localizados nos terços inferior e médio do reto 4 . Mais recentemente, a quimiorradioterapia neoadjuvante tem sido empregada não apenas para diminuir a taxa de recidiva local, mas também para tornar possível a cirurgia de preservação esfincteriana a um maior número de pacientes 5,6 . Diversos estudos demonstraram que a cirurgia laparoscópica do câncer de cólon apresenta resultados imediatos superiores e resultados oncológicos equivalentes à cirurgia aberta 7,8,9 . apesar dos poucos ensaios clínicos randomizados, a cirurgia laparoscópica do câncer de reto apresenta resultados pós-operatórios e oncológicos similares à cirurgia aberta [9][10][11][12][13][14][15][16][17] . apesar de suas vantagens, a complexidade técnica da excisão total do mesorreto, a longa curva de aprendizado e a possibilidade de que ambos os fatores possam comprometer os resultados oncológicos são os principais fatores que limitam a ampla aplicação da cirurgia

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“…For this laparoscopic procedure, there are alternatives such as hand-assisted ultra-low resection [98] one handsize incision surgery [99] and robot-assisted rectum laparoscopic resection [100][101][102].…”

Section: 7% [Consensus]; Gor A: 857% [Consensus])mentioning

confidence: 99%

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

et al. 2011

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Background The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. Methods An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. Results Laparoscopic surgery for extraperitoneal (midand low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not

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Single-Stage Totally Robotic Dissection for Rectal Cancer Surgery: Technique and Short-Term Outcome in 50 Consecutive Patients

Abstract: Single-stage robotic dissection for rectal cancer surgery is feasible, and its short-term outcome is acceptable. Our technique can be a suitable procedure to maximize the advantages of the da Vinci system.

Cited by 130 publications

References 18 publications

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Excisão total do mesorreto por técnica robótica: resultados cirúrgicos e oncológicos iniciais

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

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