scholarly journals Effective implementation and adaptation of structured robotic colorectal programme in a busy tertiary unit

2020 ◽  
Author(s):  
A. Thomas ◽  
K. Altaf ◽  
D. Sochorova ◽  
U. Gur ◽  
A. Parvaiz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Blood Loss ◽  
Resection Margin ◽  
Training Programme ◽  
Short Term ◽  
Oncological Outcomes ◽  
Robotic Colorectal Surgery ◽  
Tertiary Center

Abstract Background Safety and feasibility of robotic colorectal surgery has been reported as increasing over the last decade. However safe implementation and adaptation of such a programme with comparable morbidities and acceptable oncological outcomes remains a challenge in a busy tertiary unit. We present our experience of implementation and adaptation of a structured robotic colorectal programme in a high-volume center in the United Kingdom. Methods Two colorectal surgeons underwent a structured robotic colorectal training programme consisting of time on simulation console, dry and wet laboratory courses, case observation, and initial mentoring. Data were collected on consecutive robotic colorectal cancer resections over a period of 12 months and compared with colorectal cancer resections data of the same surgeons’ record prior to the adaptation of the new technique. Patient demographics including age, gender, American Society of Anesthesiologist score (ASA), Clavien–Dindo grading, previous abdominal surgeries, and BMI were included. Short-term outcomes including conversion to open, length of stay, return to theatre, 30- and 90-days mortality, blood loss, and post-operative analgesia were recorded. Tumour site, TNM staging, diverting stoma, neo-adjuvant therapy, total mesorectal excision (TME) grading and positive resection margins (R1) were compared. p values less than or equal to 0.05 were considered statistically significant. Results Ninety colorectal cancer resections were performed with curative intent from June 2018 to June 2020. Thirty robotic colorectal cancer resections (RCcR) were performed after adaption of programme and were compared with 60 non-robotic colorectal cancer resections (N-RCcR) prior to implementation of technique. There was no conversion in the RCcR group; however, in N-RCcR group, five had open resection from start and the rest had laparoscopic surgery. In laparoscopic group, there were six (10.9%) conversions to open (two adhesions, three multi-visceral involvements, one intra-operative bleed). Male-to-female ratio was 20:09 in RCcR group and 33:20 in N-RCcR groups. No significant differences in gender (p = 0.5), median age (p = 0.47), BMI (p = 0.64) and ASA scores (p = 0.72) were present in either groups. Patient characteristics between the two groups were comparable aside from an increased proportion of rectal and sigmoid cancers in RCcR group. Mean operating time, and returns to theaters were comparable in both groups. Complications were fewer in RCcR group as compared to N-RCcR (16.6% vs 25%). RCcR group patients have reduced length of stay (5 days vs 7 days) but this is not statistically significant. Estimated blood loss and conversion to open surgery was significantly lesser in the robotic group (p < 0.01). The oncological outcomes from surgery including TNM, resection margin status, lymph node yield and circumferential resection margin (for rectal cancers) were all comparable. There was no 30-day mortality in either group. Conclusion Implementation and integration of robotic colorectal surgery is safe and effective in a busy tertiary center through a structured training programme with comparable short-term survival and oncological outcomes during learning curve.

scholarly journals Short-term clinical outcomes of a European training programme for robotic colorectal surgery

2020 ◽  
Author(s):  
Sofoklis Panteleimonitis ◽  
◽  
Danilo Miskovic ◽  
Rachelle Bissett-Amess ◽  
Nuno Figueiredo ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Training Programme ◽  
Short Term ◽  
R1 Resection ◽  
Robotic Colorectal Surgery ◽  
Baseline Characteristics

Abstract Background Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery—EARCS). Methods Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. Results Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. Conclusions Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.

scholarly journals Comparison of Short-Term Outcomes Between Robotic-Assisted and Laparoscopic Surgery in Colorectal Cancer

2018 ◽  
Vol 26 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Xiao-Long Zhu ◽  
Pei-Jing Yan ◽  
Liang Yao ◽  
Rong Liu ◽  
De-Wang Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Bowel Function ◽  
Postoperative Recovery ◽  
Postoperative Hospital Stay ◽  
Robot Assisted ◽  
Short Term ◽  
Robotic Colorectal Surgery

Aim. The robotic technique has been established as an alternative approach to laparoscopy in colorectal surgery. The aim of this study was to compare short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods. The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and October 2017. We evaluated patient demographics, perioperative characteristics, and pathologic examination. A multivariable linear regression model was used to assess short-term outcomes between robot-assisted and laparoscopic surgery. Short-term outcomes included time to passage of flatus and postoperative hospital stay. Results. A total of 284 patients were included in the study. There were 104 patients in the robotic colorectal surgery (RCS) group and 180 in the laparoscopic colorectal surgery (LCS) group. The mean age was 60.5 ± 10.8 years, and 62.0% of the patients were male. We controlled for confounding factors, and then the multiple linear model regression indicated that the time to passage of flatus in the RCS group was 3.45 days shorter than the LCS group (coefficient = −3.45, 95% confidence interval [CI] = −5.19 to −1.71; P < .001). Additionally, the drainage of tube duration (coefficient = 0.59, 95% CI = 0.3 to 0.87; P < .001) and transfers to the intensive care unit (coefficient = 7.34, 95% CI = 3.17 to 11.5; P = .001) influenced the postoperative hospital stay. The total costs increased by 15501.48 CNY in the RCS group compared with the LCS group ( P = .008). Conclusions. The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of shorter postoperative recovery time of bowel function and shorter hospital stays.

scholarly journals Laparoscopic colorectal cancer surgery - a prospective study of short-term outcomes of consecutive cases over 3 years

2021 ◽  
Vol 14 (2) ◽  
pp. 25-31
Author(s):  
Nitin Patel ◽  
Vipul D. Yagnik
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Median Time ◽  
Laparoscopic Colorectal Surgery ◽  
Team Approach ◽  
Short Term ◽  
Early Recovery ◽  
Postoperative Stay

This study was carried out with the objectives to study the feasibility of laparoscopic colorectal cancer resection, to observe short term outcome such as recovery parameters, oncologic safety, morbidity and mortality, and to analyze the experience of laparoscopic colorectal surgery in a teaching hospital. Between January 2007 and July 2009, all consecutive adult cases admitted to our department for colorectal cancer were assessed for eligibility. The ethical committee approved the protocol at the Sterling Hospital. Out of 31 patients,17 were males and 14 females. The mean age was 59 years. The most common clinical presentation was weight loss and altered bowel habits. Rectum (51.61%) was the most commonly involved organ followed by cecum (22.58%). - median time to liquid diet was two days (range 1-22), and a solid diet was three days (range 3-30). The median time to first flatus was two days (range 1-5), and the first stool was five days (range 3-7). The postoperative stay was eight days (range 6-30) median time to mobilization was 2.5 days. The postoperative stay is cumulative and includes patients who underwent reoperation for the anastomotic leak. The median operating time was 240 mins (range 116 – 520). The median length of incision was 6 cm (range 4 – 10 cm). The median blood loss was 170 ml. Blood loss was higher in patients with hemorrhage and tumor adhesions, and both of them were converted to open. These patients incidentally had a more extended hospital stay. The laparoscopic technique for colorectal cancer is feasible and safe. Laparoscopic colorectal surgery (LCS) is associated with short term benefits like the earlier return of gastrointestinal function and shorter length of hospital stay. From the oncologic point of view, tumor resections are adequate, taking into context numbers of lymph nodes retrieved and resectional margins in context to oncologic safety. The decreased postoperative wound infections and early recovery facilitate appropriate adjuvant therapy. Advanced laparoscopic surgery requires a team approach with proper case selection. Transvaginal delivery of specimens can give scar-less surgery and the option for assisted natural orifice surgery.

THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

2016 ◽  
pp. 26-29
Author(s):  
D. . Zitta ◽  
V. . Subbotin ◽  
Y. . Busirev
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Elderly Patients ◽  
Fast Track ◽  
Randomized Study ◽  
Conventional Group ◽  
Intraoperative Blood Loss ◽  
Elective Colorectal Surgery ◽  
Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

Short-Term Outcomes for Robotic Colorectal Surgery by Provider Volume

2013 ◽  
Vol 217 (6) ◽  
pp. 1063-1069.e1 ◽  
Author(s):  
Deborah S. Keller ◽  
Lobat Hashemi ◽  
Minyi Lu ◽  
Conor P. Delaney
Keyword(s):  
Colorectal Surgery ◽  
Short Term ◽  
Robotic Colorectal Surgery ◽  
Provider Volume

scholarly journals Short-term outcomes of total knee arthroplasty performed with and without a tourniquet

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 15
Author(s):  
Mihai Grigoras ◽  
Oliver Boughton ◽  
May Cleary ◽  
Paul McKenna ◽  
Fiachra E. Rowan
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Postoperative Pain ◽  
Length Of Stay ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Thromboembolic Event ◽  
Short Term ◽  
Thromboembolic Risk ◽  
Total Knee

Introduction: Not using a tourniquet could improve early postoperative pain, range of motion (ROM), length of stay (LOS), and thromboembolic risk in patients undergoing total knee arthroplasty (TKA). Our aim was to compare these factors, intraoperative blood loss, and gender-related outcomes in patients undergoing primary TKA with or without a tourniquet. Methods: We performed a retrospective cohort study of 97 patients undergoing TKA with or without tourniquet from 2018 to 2020. Revisions and bilateral TKAs were excluded. Blood loss was estimated using a validated formula. Postoperative pain was tested using the visual analogue scale (VAS). ROM and quadriceps lag were assessed by a physiotherapist on a postoperative day 2 and discharge. The index of suspicion for a thromboembolic event was defined as the number of embolic-related investigations ordered in the first 6 months post-surgery. The Shapiro–Wilk test was used to assess the distribution of the data, Mann–Whitney for the continuous variables, and Fischer’s test for the categorical ones. Results and Discussion: There was a significant difference in blood loss. The non-tourniquet group lost on average 32% more blood (1291 mL vs. 878 mL, p<0.001 two-tailed). We found no difference in pain, ROM, LOS, and quadriceps lag on day 2 and at discharge. There was one thromboembolic event in the tourniquet group, but the thromboembolic index of suspicion did not differ (p=0.53). With tourniquet use, women had a significantly lower day 2 maximum flexion than men (71.56° vs. 84.67°, p=0.02). In this retrospective cohort study, the results suggest that tourniquet use is associated with lower blood loss and similar postoperative pain, range of motion, quadriceps lag, length of stay, and thromboembolic risk. There might be some differences between how men and women tolerate a tourniquet, with women having worse short-term outcomes compared to men.

scholarly journals Short term oncological outcomes of completely intracorporeal anastomosis after left sided robotic resections for colorectal cancer

2020 ◽  
Vol 107 (11) ◽  
pp. e498-e499
Author(s):  
Kevin T. Behm ◽  
Fabian Grass ◽  
Mohamed A. Abd El Aziz ◽  
Scott R. Kelley
Keyword(s):  
Colorectal Cancer ◽  
Intracorporeal Anastomosis ◽  
Short Term ◽  
Oncological Outcomes

scholarly journals Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

2015 ◽  
Vol 9 (1-2) ◽  
pp. 48 ◽  
Author(s):  
Aziz M. Khambati ◽  
Elias Wehbi ◽  
Walid A. Farhat
Keyword(s):  
Length Of Stay ◽  
Surgical Outcomes ◽  
Laparoscopic Approach ◽  
Hospital Length ◽  
Single Site ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Tertiary Center ◽  
Single Site Surgery

Introduction: Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada.Methods: We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/ devices were used to perform the procedures. Access was achieved through a transumbilical incision.Results: A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed.Conclusions: There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery

2015 ◽  
Vol 12 (4) ◽  
pp. 680-685 ◽  
Author(s):  
Jorge Lagares-Garcia ◽  
Abigail O'Connell ◽  
Anthony Firilas ◽  
Christopher Chad Robinson ◽  
Bonnie P. Dumas ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Colorectal Surgery ◽  
Body Mass ◽  
Short Term ◽  
Robotic Colorectal Surgery
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