Robotic colorectal surgery: previous laparoscopic colorectal experience is not essential

Abstract

A background in minimally invasive colorectal surgery (MICS) has been thought to be essential prior to robotic-assisted colorectal surgery (RACS). Our aim was to determine whether MICS is essential prior to starting RACS training based on results from our initial experience with RACS. Two surgeons from our centre received robotic training through the European Academy of Robotic Colorectal Surgery (EARCS). One surgeon had no prior formal MICS training. We reviewed the first 30 consecutive robotic colorectal procedures from a prospectively maintained database between November 2014 and January 2016 at our institution. Fourteen patients were male. Median age was 64.5 years (range 36-82) and BMI was 27.5 (range 20-32.5). Twelve procedures (40%) were performed by the non-MICS-trained surgeon: ten high anterior resections (one conversion), one low anterior resection and one abdomino-perineal resection of rectum (APER). The MICS-trained surgeon performed nine high and four low anterior resections, one APER and in addition three right hemicolectomies and one abdominal suture rectopexy. There were no intra-operative complications and two patients required re-operation. Median post-operative stay was five days (range 1-26). There were two 30-day re-admissions. All oncological resections had clear margins and median node harvest was 18 (range 9-39). Our case series demonstrates that a background in MICS is not essential prior to starting RACS training. Not having prior MICS training should not discourage surgeons from considering applying for a robotic training programme. Safe and successful robotic colorectal services can be established after completing a formal structured robotic training programme.

Surgical Complexity and Outcome During the Implementation Phase of a Robotic Colorectal Surgery Program—A Retrospective Cohort Study

“…male patients with low rectal cancer) ( 14 ). Several authors have demonstrated that robotic surgery has a short learning curve, which seems to be independent from previous laparoscopic experience ( 15 – 20 ). Moreover, with structured training programs such as the curriculum of the EARCS available ( 12 , 21 , 22 ), case series with virtually no complications during the implementation phase of robotic surgery have been published ( 22 , 23 ).…”

No beneficial effect on survival but a decrease in postoperative complications in patients with rectal cancer undergoing robotic surgery: a retrospective cohort study

“…Robotic surgery requires that a surgeon take a long time to learn to adapt to new surgical techniques, such as controlling consoles, manipulating new instruments, and cooperation with the surgical team [ 20 – 22 ]. Our team has adequate experience in robotic surgery, with nearly 200 cases of robotic surgery on rectal cancer per year, which is why our study demonstrated that the operation time and intraoperative bleeding were both significantly less than those of laparoscopy.…”

No beneficial effect on survival but with a decreased postoperative adverse events for robotic surgery in patients with rectal cancer: A retrospective cohort study

“…Robotic surgery requires a surgeon to take a long time to learn to adapt to new surgical techniques, such as controlling consoles, manipulating new instruments, and cooperation with the surgical team [20,21,22]. Our team has adequate experience in robotic surgery, with nearly 200 cases of robotic surgery on rectal cancer per year, and that is why our study demonstrated the operation time and intraoperative bleeding were both signi cantly less than that of laparoscopy.…”