Control Comparison of the New EndoWrist and Traditional Laparoscopic Staplers for Anterior Rectal Resection with the Da Vinci Xi: A Case Study

Guadagni, Simone; Franco, Gregorio Di; Gianardi, Desirée; Palmeri, Matteo; Ceccarelli, Cristina; Bianchini, Matteo; Furbetta, Niccolò; Caprili, G; D’Isidoro, C; Moglia, Andrea; Melfi, Franca; Buccianti, P; Mosca, Franco; Morelli, Luca

doi:10.1089/lap.2018.0218

Cited by 13 publications

(21 citation statements)

References 27 publications

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“…The publication of the ROLARR[ 42 ] trials has answered several questions about the feasibility, safety and comparative equivalence of RTME and non-inferiority of LTME too. In addition, RTME seems to be relatively expensive[ 29 , 42 , 58 , 59 ] and less cost-effective procedure and therefore routine use of this approach may not be justified for TME.…”

Section: Discussionmentioning

confidence: 99%

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Jones

Qassem

Sains

et al. 2018

WJGO

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AIMTo compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).METHODSStandard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).RESULTSOne RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.CONCLUSIONRTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

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Section: Discussionmentioning

confidence: 99%

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Jones

Qassem

Sains

et al. 2018

WJGO

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“…Although there were a small number of patients included in the study, these preliminary results showed a trend towards improving results using the RS, with no leaks in this group (compared with 10.5% in the LS group). Three years later, Guadagni et al 17 showed a trend towards less firings and better postoperative outcomes in the RS group. Results were nonsignificant probably because of a small sample size.…”

Section: Fluorescencementioning

confidence: 94%

“…10,13,15 Stapler Only 4 studies were included in this section of the review, with a total of 391 patients (laparoscopic stapler [LS] group = 251, RS group = 140). 2,[16][17][18] The results of the 4 studies included in this review are summarised in Table 2. The first study showing the experience with the RS was published by Koh et al 16 in 2014.…”

Section: Fluorescencementioning

confidence: 99%

The Use of Enhanced Technologies in Robotic Surgery and Its Impact on Outcomes in Rectal Cancer: A Systematic Review

2020

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The main advantage of the robotic approach is the surgical precision that the technology offers. It is particularly useful in rectal cancer as this is a technically challenging procedure. The technological advantage of the robot leads to better postoperative outcomes. Apart from the 3D vision and endowrist instrumentation in comparison to laparoscopy, the options of using fluorescence imaging, endowrist stapler, and table motion have revolutionised the way of performing an anterior resection. Thus, the true benefit of these advances will be the quality of the surgery, which leads to better postoperative outcomes. This article focuses on the current status of applications of new modalities and technology development in robotic rectal surgery. A systematic literature search was performed using PubMed, MEDLINE, and cochrane database. The studies included were considered based on the following (1) articles written in English, (2) full text is available, (3) whether the topic is related to the use of novel technologies during robotic rectal surgery, and (4) sample: adult patients and malignant rectal disease. The primary end point was to analyse the current use of technological advances in robotic rectal surgery. Only a few studies are currently available on the use of these different technologies in robotic colorectal surgery. Many of these reports describe promising results, although with short-term outcomes. The use of technologies in robotic colorectal surgery is safe and feasible and can be used together to improve short-term outcomes. Intraoperative fluorescence angiography has demonstrated to reduce the rate of anastomotic leak, whereas the robotic stapler and the table motion simplify anatomic resection.

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“…[6][7][8][9][10][11] Finally, 4 studies were included in our metaanalysis, with a total of 391 patients (LS group = 251, RS group = 140). [12][13][14][15] The flow chart of the selection process is represented in Figure 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis

et al. 2020

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Minimally invasive surgery for total mesorectal excision (TME) remains technically challenging due to poor manoeuvrability within the pelvis, which makes extremely difficult to introduce a laparoscopic stapler (LS) for the rectal transection. We aim to perform a systematic review and meta-analysis on robotic TME after the use of robotic stapler (RS) or LS after robotic TME. MethodA systematic literature search was performed using PubMed, MEDLINE and Cochrane Database. Participants who underwent robotic anterior resection were considered following these criteria: 1) studies comparing RS and LS; 2) studies reporting the rate of anastomotic leakage (AL). The primary outcome was the risk of AL. Secondary outcomes

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Control Comparison of the New EndoWrist and Traditional Laparoscopic Staplers for Anterior Rectal Resection with the Da Vinci Xi: A Case Study

Abstract: Our experience suggests that the new robotic staplers simplify transection, which could reduce the average number of stapler firings used during rectal resection and could decrease the incidence of anastomotic leakage. These findings require confirmation in larger studies.

Cited by 13 publications

References 27 publications

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

The Use of Enhanced Technologies in Robotic Surgery and Its Impact on Outcomes in Rectal Cancer: A Systematic Review

The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis

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