The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis

Al-Mazrou, Ahmed M.; Chiuzan, Codruța; Kiran, Ravi P.

doi:10.1007/s00384-017-2845-1

Cited by 41 publications

(25 citation statements)

References 34 publications

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“…While most previous studies have shown no difference in postoperative ileus between RS and LS groups, there are exceptions that demonstrate significantly less ileus in the RS group. 19,22–24 The robotic-assisted approach offers technological advantages for more complex tasks often required during sigmoidectomies for diverticular disease, such as splenic flexure takedown and dissection of a complicated phlegmon adherent to the pelvic side-wall and retroperitoneum. It is possible that performing complicated segments of the procedure with a less traumatic “minimal-touch” technique may result in decreased ileus rates, but the inconsistencies in these findings warrants further study.…”

Section: Discussionmentioning

confidence: 99%

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Raskin

Keller

Gorrepati

et al. 2019

JSLS

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Background and Objectives:The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States.Methods:This is a retrospective propensity score–matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons.Results:There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications—ileus, wound complications, and acute renal failure—and more patients discharged directly to home.Conclusions:The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.

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Section: Discussionmentioning

confidence: 99%

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Raskin

Keller

Gorrepati

et al. 2019

JSLS

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“…10,11,15 Furthermore, laparoscopic and robotic platforms have been shown to accelerate recovery comparing to traditional open approach. 23,24 We noted the period after 2012 to increase the odds of early discharge (LOS < 5). Although colorectal surgery is a known risk factor for UTI, 29 we found a continuous reduction in the complication over the included years (Fig.…”

Section: Discussionmentioning

confidence: 94%

“…From the dataset, complications which may require reoperation such as wound infection, anastomotic leak and bleeding requiring transfusion were illustrated to be minimized for hand-assisted laparoscopic when compared to open colectomy. 24 Using the same data, robotic approach reduced postoperative systemic infection compared to laparoscopic surgery in another analysis. 23 We found minimally invasive surgery to accordingly be performed more in the most recent years (42.6% vs. 56.1%, before and after 2012 respectively).…”

Section: Discussionmentioning

confidence: 97%

Sustained positive impact of ACS-NSQIP program on outcomes after colorectal surgery over the last decade

Al-Mazrou

Zhang

et al. 2020

The American Journal of Surgery

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“…For robotic surgery, there is an ongoing discussion on investment in equipment and costs per procedure, plus time needed for setup and docking. 64,65 The future launch of different robotic systems might lower the price to make the platform more competitive to costs of conventional laparoscopic surgery. As in all advanced surgical procedures a whole learning curriculum is required with proctoring during first cases and still with a high initial conversion rate.…”

Section: Beyond Tmementioning

confidence: 99%

Total Mesorectal Excision Technique—Past, Present, and Future

Knol

Keller

2020

Clinics in Colon and Rectal Surgery

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While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic assessment, the development and timing of multimodal therapies, and surgical technique. The most significant contribution in advancing rectal cancer care may be the standardization and widespread implementation of total mesorectal excision (TME). The TME, popularized by Professor Heald in the early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all associated lymph nodes through the avascular embryologic plane, has shown universal reproducible reductions in local recurrence and improvement in disease-free and overall survival. Widespread education and training of surgeons worldwide in the TME have significantly impact outcomes for rectal cancer surgery, and the procedure has become the gold standard for curative resection of rectal cancer. In this article, we discuss the evolution of the standard abdominal approach to the TME, with emphasis on the history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical evolution.

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The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis

Cited by 41 publications

References 34 publications

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Sustained positive impact of ACS-NSQIP program on outcomes after colorectal surgery over the last decade

Total Mesorectal Excision Technique—Past, Present, and Future

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