Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

Schootman, Mario; Hendren, Samantha; Loux, Travis; Ratnapradipa, Kendra L.; Eberth, Jan M.; Davidson, Nick O.

doi:10.1007/s11605-017-3460-8

Cited by 21 publications

(39 citation statements)

References 29 publications

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“…This poses the question: why doesnʼt robotic surgery benefit colon surgery? We should also emphasize that Schootman et al 1) presented data from multiple institutes and that profiles of the surgeons involved were not available. In contrast, the latter studies were conducted at single institutes where the surgeons have extensive experience.…”

Section: Robotic Surgerymentioning

confidence: 98%

“…Schootman et al recently compared the short-term results of robotic surgery and conventional laparoscopic surgery for treating colon diseases 1) . Data for a total of 2233 robotic and 10 844 conventional laparoscopic surgeries performed between 2013 and 2015 were obtained from the National Surgical Quality Improvement Program (NSQIP).…”

Section: Dear Editormentioning

confidence: 99%

“…Difficult cases are more likely to be treated by experts, and more short communication challenging cases are apt to be referred to centralized hospitals. We are deeply concerned that the statistical analysis conducted by Schootman et al 1) on 13 077 patients did not take into consideration surgical expertise or other indicators of surgical quality. Therefore, the results might have hidden the real benefits of robotic surgery.…”

Section: Robotic Surgerymentioning

confidence: 99%

“…Even if robotic surgery really causes only one additional complication in 32 surgically treated patients 1) , this is enough to impel strict guidelines for utilizing this procedure. If robotic surgery can be performed with a safety profile that is equivalent and/or superior to conventional laparoscopic surgery, then the surgical approach chosen should be based on the preferences of both surgeon and patient.…”

Section: Korst and Lessmentioning

confidence: 99%

“…Hence, the use of robotic surgery to treat colorectal cancer in our institute seems feasible so far. However, furtherance of robotic surgery requires solid evidence of this technique's real benefits.Schootman et al recently compared the short-term results of robotic surgery and conventional laparoscopic surgery for treating colon diseases 1) . Data for a total of 2233 robotic and 10 844 conventional laparoscopic surgeries performed between 2013 and 2015 were obtained from the National Surgical Quality Improvement Program (NSQIP).…”

mentioning

confidence: 99%

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Adaptation of robotic surgery for colorectal cancer in a regional university

Maeda

Kobayashi

2017

Ann. Cancer Res. Therap.

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Dear Editor,Robotic surgery to treat colorectal cancer was first used in our regional university at the end of 2014. Staff undertook a comprehensive training program to acquire new techniques required for using this innovative device, composed of online training, onsite training at our institute with the actual robot, off-site training using animal subjects, visiting institutes with the relevant expertise, and pre-operative simulation. By the end of 2016, seven cases had been treated using robotic surgery at our institute. Although the mean operation time (range: 179-464 minutes) is longer than that for laparoscopic surgery in our institute, there have been no cases of open conversion or postoperative complications following robotic surgery. Hence, the use of robotic surgery to treat colorectal cancer in our institute seems feasible so far. However, furtherance of robotic surgery requires solid evidence of this technique's real benefits.Schootman et al recently compared the short-term results of robotic surgery and conventional laparoscopic surgery for treating colon diseases 1) . Data for a total of 2233 robotic and 10 844 conventional laparoscopic surgeries performed between 2013 and 2015 were obtained from the National Surgical Quality Improvement Program (NSQIP). Not surprisingly, the propensity score-matched outcomes revealed that robotic surgery was associated with longer operation times and a lower chance of open conversion. It is likely that the setup for robotic surgery (including docking and undocking) to enable console operation contributed to the extended operation times. In addition, the consequent dexterous surgery theoretically reduced open conversion rates. However, in contrast to general expectations, analysis of postoperative complications revealed that some complications were 3.1% more frequent following robotic surgery. Increases in critical events such as readmission within 30 days of surgery, prolonged ileus, reoperations, and anastomotic leakage are concerning. Many reviews have also discussed the safety and efficacy of robotic surgery in patients with rectal/colorectal cancers 2,3) . Robotic surgery was consistently associated with decreased open conversion rates and longer operation times; however, most of the studies analyzed were retrospective studies. Although it appears that robotic surgery and conventional laparoscopic surgery have similar safety profiles, this alone is not enough to justify the preferential use of robotic surgery, especially considering the higher costs associated with this technique. Some reports indicate that robotic surgery is a superior technique for patients with rectal cancer. A recent study found that patients had better urogenital function due to preservation of the pelvic nerves following robotic surgery 4) . Postoperative complications in patients with obesity or lower rectal cancer treated at a single institute were also consistently reduced following robotic surgery 5) .Overall, the literature suggests that robotic surgery adversely affects the outcomes...

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Section: Robotic Surgerymentioning

confidence: 98%

Section: Dear Editormentioning

confidence: 99%

Section: Robotic Surgerymentioning

confidence: 99%

Section: Korst and Lessmentioning

confidence: 99%

mentioning

confidence: 99%

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Adaptation of robotic surgery for colorectal cancer in a regional university

Maeda

Kobayashi

2017

Ann. Cancer Res. Therap.

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Robotic‐assisted colectomy for right‐sided colon cancer: Short‐term surgical outcomes of a multi‐institutional prospective cohort study in Japan

Yamauchi

Shiomi

Matsuda

et al. 2023

Annals of Gastroent Surgery

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BackgroundIn Japan, there are no substantial reports on robotic‐assisted colectomy because few institutions performed the procedure, as it was not covered by national insurance until March 2022.AimThis study aimed to evaluate the safety and feasibility of robotic‐assisted colectomy for patients with curatively resectable colon cancer in Japan.MethodsThis multi‐institutional, prospective, single‐arm, observational study enrolled patients diagnosed with curatively resectable clinical stage I–IIIC colon adenocarcinoma with D2 or D3 lymph node dissection and treated with robotic‐assisted colectomy. The primary endpoint was the conversion rate to laparotomy. The non‐inferiority of outcomes for robotic‐assisted colectomy versus laparoscopic colectomy, which was determined from historical data, was verified.ResultsOne hundred patients were registered between July 2019 and March 2022 and underwent robotic‐assisted colectomy performed by seven expert surgeons at six institutions. Thirteen patients were excluded because their surgeons had insufficient experience performing robotic‐assisted colectomy; therefore, 87 patients were eligible for the primary endpoint analysis. There was no conversion in these 87 patients, and robotic‐assisted colectomy was non‐inferior to laparoscopic colectomy in terms of conversion rate (90% confidence interval 0–3.38, p = 0.0006). No intraoperative adverse events occurred, and no mortality was observed in a total of 100 patients. The rate of patients with Clavien–Dindo complications grade III or higher was 4%.ConclusionThis study showed the non‐inferiority of the conversion rates between robotic‐assisted colectomy and laparoscopic colectomy. Favorable perioperative outcomes also suggest the safety and feasibility of robotic‐assisted colectomy.

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Obese patients and robotic colorectal surgery: systematic review and meta-analysis

et al. 2020

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Background: Obesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta-analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non-obese patients. Methods: MEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta-analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m 2 or above) undergoing robotic colorectal cancer resections were compared with non-obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery). Results: A total of 131 full-text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non-obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non-obese patients (weighted mean difference −21⋅99 (95 per cent c.i. −31⋅52 to −12⋅46) min; P < 0⋅001). Obese patients had a higher rate of conversion to laparotomy than non-obese patients (odds ratio 1⋅99, 95 per cent c.i. 1⋅54 to 2⋅56; P < 0⋅001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non-obese patients. Conclusion: Robotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non-obese patients. Further studies should focus on better stratification of the obese population with colorectal disease as candidates for robotic procedures.

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Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

Cited by 21 publications

References 29 publications

Adaptation of robotic surgery for colorectal cancer in a regional university

Adaptation of robotic surgery for colorectal cancer in a regional university

Robotic‐assisted colectomy for right‐sided colon cancer: Short‐term surgical outcomes of a multi‐institutional prospective cohort study in Japan

Obese patients and robotic colorectal surgery: systematic review and meta-analysis

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