Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes

Lee, Yongjin F; Albright, Jeremy J.; Akram, Warqaa; Wu, Juan; Ferraro, Jane; Cleary, Robert K.

doi:10.1007/s11605-018-3706-0

Cited by 22 publications

(11 citation statements)

References 28 publications

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“…A previous study stated that POI is an important factor to prolong the length of hospital stay even in the context of ERAS-guidelines compliant laparoscopic colorectal surgery. [44] We did not find any difference among the 3 groups with respect to POI. The reason for this inconsistency may be due to the relatively small intraoperative temperature change in our trial.…”

Section: Discussionmentioning

confidence: 61%

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

et al. 2019

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Background:Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery.Methods:One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded.Results:Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05).Conclusion:Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.

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Section: Discussionmentioning

confidence: 61%

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

et al. 2019

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“…It is well known that conversion from minimally invasive to open surgery is associated with worse outcomes, namely increased rates of infection, cardiac complications, ileus, reoperation, longer length of stay, and higher overall costs. [35][36][37][38] Robotic colectomies are associated with a lower risk of conversion to open surgery as compared to laparoscopic colectomies, which provides another benefit of simultaneous resection performed robotically. [39][40][41][42][43] The strength of this review is the fact that there are currently few published reviews of the literature on simultaneous robotic resections for colorectal cancer with liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Robot Assisted Colon and Liver Resection for Metastatic Colon Cancer

McGuirk

Gachabayov

Rojas

et al. 2021

JSLS

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Introduction: Simultaneous robot assisted colon and liver resections are being performed more frequently at present due to the expanded adoption of the robotic platform for surgical management of metastatic colon cancer. However, this approach has not been studied in detail with only case series available in the literature. The aim of this systematic review was to evaluate the current body of evidence on the feasibility of performing simultaneous robotic colon and liver resections.Methods: A systematic review was performed through PubMed to identify relevant articles describing simultaneous colon and liver resections for metastatic colon cancer.Results: A total of 28 patients underwent simultaneous resections robotically with an average operative time of 420.3 minutes and average blood loss of 275.6 ml. Postoperative stay was 8.6 days on average with all cases achieving negative surgical margins.Conclusions: Robotic simultaneous resection of colorectal cancer with liver metastases is technically feasible and seems oncologically equivalent to open or laparoscopic surgery. Further studies are urgently needed to assess benefits of robotic surgery in the patient population.

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“…Conversion has been used as a marker of proficiency since the advent of minimally invasive techniques. Conversion to open surgery may have a negative impact on both short‐ and long‐term outcomes. Decreasing conversion rate is therefore important to improve surgical and oncological quality.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

Crippa

Grass

Achilli

et al. 2020

British Journal of Surgery

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Background The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. Methods A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m2 or more) was performed. Results A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non‐obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71). Conclusion Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non‐obese patients.

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Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes

Cited by 22 publications

References 28 publications

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

Simultaneous Robot Assisted Colon and Liver Resection for Metastatic Colon Cancer

Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

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