Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves

Melich, George; Hong, Young Ki; Kim, Jieun; Hur, Hyuk; Baik, Seung Hyuk; Kim, Nam Kyu; Liberman, Alexander; Min, Byung Soh

doi:10.1007/s00464-014-3698-0

Cited by 102 publications

(82 citation statements)

References 27 publications

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“…Sixteen studies[10,12,14,16,17,22,23,25,27,28,37,38,40-42,48] (1257 patients) reported a totally robotic procedure which was carried out with either a single[10,16,17,22,23,25,27,28,37,38,40-42,48] or a double docking[12,28] technique. In 22 studies[8,13,15,18,20,21,25,26,30-34,36,39,43-47,49,50] (1384 patients) an hybrid robotic technique was performed: The inferior mesenteric vessels ligation and splenic flexure mobilization were performed laparoscopically whereas pelvic dissection and total mesorectal excision were performed robotically.…”

Section: Studies Overviewmentioning

confidence: 99%

“…The mean value ranged from 17 mL[36] to 280 mL[14] with the robotic approach and from 59.2[18] to 271.4[15] in the laparoscopic group. Among 16 comparative studies[8-10,12-15,17,19-21,23,24,29,31,33] that evaluated the EBL only Kang et al[23] and Erguner et al[21] reported a significantly lower EBL with the robotic approach when compared to the laparoscopic one.…”

Section: Studies Overviewmentioning

confidence: 99%

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Robotic rectal surgery: State of the art

Staderini¹,

Foppa²,

Minuzzo³

et al. 2016

WJGO

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Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

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Section: Studies Overviewmentioning

confidence: 99%

Section: Studies Overviewmentioning

confidence: 99%

Robotic rectal surgery: State of the art

Staderini¹,

Foppa²,

Minuzzo³

et al. 2016

WJGO

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“…The purported advantages of using a robot during surgery include improved depth perception, improved dexterity and control, and improved surgeon ergonomics [2]. The use of the technology allowing robot-assisted surgery was approved by the United States Food and Drug Administration (FDA) in 2000 [3].…”

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confidence: 99%

An appraisal of the learning curve in robotic general surgery

et al. 2017

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Although robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.

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“…28 The intro of a learner in the MIS can be easier for the RRC than LRC in a specific center with rigorous protocols, which can be explained once more due to some of the structural advantages of the RS like the three-dimensional view, for instance. 29 But, acceptable outcomes can be fulfilled with simultaneously practical exercise.…”

Section: Discussionmentioning

confidence: 99%