Robotic rectal surgery

Rencüzoğulları, Ahmet; Görgün, Emre

doi:10.1002/jso.23956

Cited by 17 publications

(12 citation statements)

References 34 publications

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“…Operative time is considered to be long in robotic colorectal surgery because of additional set-up time, additional docking time, and the steep learning curve associated with this technique [ 29 ]. This meta-analysis showed no significant difference in operative time between the two surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis

Sun

et al. 2016

World J Surg Onc

109

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BackgroundThe objective of this meta-analysis was to compare the clinical and oncologic outcomes of robotic low anterior resection (R-LAR) with conventional laparoscopic low anterior resection (L-LAR).MethodsA search in the MEDLINE, Embase, and Ovid databases was performed for studies published before July 2014 that compared the clinical and oncologic outcomes of R-LAR and L-LAR. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, a fixed or random effects model was used for the meta-analysis. The clinical and oncologic outcomes evaluated included operative time, estimated blood loss, length of hospital stay, rate of conversion to open surgery, post-operative complications, circumferential margin status, and number of lymph nodes collected.ResultsEight studies, including 324 R-LAR cases and 268 conventional L-LAR cases, were analyzed. The meta-analysis showed that R-LAR was associated with a shorter hospital stay (mean difference (MD) = −1.03; 95 % confidence interval (CI) = −1.78, −0.28; P = 0.007), lower conversion rate (odds ratio (OR) = 0.08; 95 % CI = 0.02, 0.31; P = 0.0002), lower rate of circumferential margin involvement (OR = 0.5; 95 % CI = 0.25, 1.01; P = 0.05), and lower overall complication rate (MD = 0.65; 95 % CI = 0.43, 0.99; P = 0.04) compared with L-LAR. There was no difference in operative time (MD = 28.4; 95 % CI = −3.48, 60.27; P = 0.08), the number of lymph nodes removed (MD = −0.63; 95 % CI = −0.78, 2.05; P = 0.38), and days to return of bowel function (MD = −0.15; 95 % CI = −0.37, 0.06; P = 0.17).ConclusionsR-LAR was shown to be associated with a shorter hospital stay, lower conversion rate, lower rate of circumferential margin involvement, and lower overall complication rate compared with L-LAR. There were no differences in operative time, the number of lymph nodes removed, and days to return of bowel function.

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Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis

Sun

et al. 2016

World J Surg Onc

109

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“…When abdominoperineal excision (APR) was required, after the colon was transected, the specimen was extracted through the perineal incision. Details of the open, laparoscopic and robotic techniques for rectal excision have been described previously by our group .…”

Section: Methodsmentioning

confidence: 99%

“…Details of the open, laparoscopic and robotic techniques for rectal excision have been described previously by our group [16][17][18][19].…”

Section: Preoperative Evaluation Surgical Technique and Postoperativmentioning

confidence: 99%

The relationship between mesorectal grading and oncological outcome in rectal adenocarcinoma

et al. 2019

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Aim The prognostic association between mesorectal grading and oncological outcome in patients undergoing resection for rectal adenocarcinoma is controversial. The aim of this retrospective chart review was to determine the individual impact of mesorectal grading on rectal cancer outcomes. Method We compared oncological outcomes in patients with complete, near‐complete and incomplete mesorectum who underwent rectal excision with curative intent from 2009 to 2014 for Stage cI–III rectal adenocarcinoma. We also assessed the independent association of mesorectal grading and oncological outcome using multivariate models including other relevant variables. Results Out of 505 patients (339 men, median age of 60 years), 347 (69%) underwent a restorative procedure. There were 452 (89.5%), 33 (6.5%) and 20 (4%) patients with a complete, near‐complete and incomplete mesorectum, respectively. Local recurrence was seen in 2.4% (n = 12) patients after a mean follow‐up of 3.1 ± 1.7 years. Unadjusted 3‐year Kaplan–Meier analysis by mesorectal grade showed decreased rates of overall, disease‐free and cancer‐specific survival and increased rates of overall and distant recurrence with a near‐complete mesorectum, while local recurrence was increased in cases of an incomplete mesorectum (all P < 0.05). On multivariate analyses, a near‐complete mesorectum was independently associated with decreased cancer‐specific survival (hazard ratio 0.26, 95% CI 0.1–0.7; P = 0.007). There were no associations between mesorectal grading and overall survival, disease‐free survival, overall recurrence or distant recurrence (all P > 0.05). Conclusion Mesorectal grading is independently associated with oncological outcome. It provides unique information for optimizing surgical quality in rectal cancer.

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“…In addition, the constraint of 2-dimensional visualization significantly reduces depth perception and hand-eye coordination. 6 The introduction of the da Vinci ® robotic system (Intuitive Surgical, Sunnyvale CA) for proctectomy results in a 3-dimensional view with fixed retraction provided by the assisting robotic arm along with flexible instrumentation which enhances maneuverability. In some surgical environments, the philosophy has been to introduce the robot in order to overcome some of the pitfalls of laparoscopy, thereby providing an alternative to the conventional transition in training and surgical apprenticeship where the trainee would normally graduate from open through to laparoscopic and then to robotic surgery.…”

Section: Introductionmentioning

confidence: 99%

Robotic rectal resection: preliminary Russian experience

Khatkov

Pozdnyakov

Атрощенко

et al. 2018

Journal of Coloproctology

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Purpose To outline the preliminary experience of the da Vinci® robotic system used in a Moscow tertiary colorectal referral center for an unselected range of benign and malignant rectal conditions. Methods Prospective non-randomized single-center study which analyzed results of 26 robotic rectal resections performed between january 2014 and december 2016. Results The cohort included 10 females and 16 males (mean total age 61.6 years). Three patients underwent surgery for benign rectal villous adenomas. The median overall ASA score was 4 (ranged from 2 to 5). Of the surgeries, there were 19 total mesorectal excisions with 6 patients undergoing a multivisceral resection. The mean operating time was 358 minutes with a mean blood loss of 203 mL. All total mesorectal excision specimens were adjudged according Philip Quirke classification as mesorectal plane – Grade 3 with a mean of 18.5 lymph nodes identified (from 12 to 35). Of these there were 10 patients (38.5%) with lymph node metastases. After surgery the average pain score was 2.1 out of 10 on the “Visual-Analogue Pain Intensity Scale” and 1.5 score out of 10 on the “Brief Pain Inventory with Quality of Life”. Anal continency after rectal resection with total mesorectal excisions estimated according Wexner Scale: 10 days after surgery average score was −3.1 and a 6 month after surgery −1.6 score. The median length of hospital stay was 11 days (from 10 to 15). Conclusion Our initial experience with a totally robotic rectal resection has shown the technique to be safe and feasible, particularly in patients where conventional laparoscopic rectal resection would be anticipated to be challenging.

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Robotic rectal surgery

Cited by 17 publications

References 34 publications

Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis

Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis

The relationship between mesorectal grading and oncological outcome in rectal adenocarcinoma

Robotic rectal resection: preliminary Russian experience

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