The art of robotic colonic resection: a review of progress in the past 5 years

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

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Operative Outcomes of Minimally Invasive Esophagectomy versus Open Esophagectomy for Resectable Esophageal Cancer

South Asian Journal of Cancer ◽

10.1055/s-0041-1730085 ◽

2021 ◽

Vol 10 (04) ◽

pp. 230-235

Author(s):

Ramachandra Chowdappa ◽

Anvesh Dharanikota ◽

Ravi Arjunan ◽

Syed Althaf ◽

Chennagiri S. Premalata ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Hospital Stay ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Operative Duration

Abstract Background There is a recent rise in the incidence of esophageal carcinoma in India. Surgical resection with or without neoadjuvant chemoradiation is the current treatment modality of choice. Postoperative complications, especially pulmonary complications, affect many patients who undergo open esophagectomy for esophageal cancer. Minimally invasive esophagectomy (MIE) could reduce the pulmonary complications and reduce the postoperative stay. Methodology We performed a retrospective analysis of prospectively collected data of 114 patients with esophageal cancer in the department of surgical oncology at a tertiary cancer center in South India between January 2019 and March 2020. We included patients with resectable cancer of middle or lower third of the esophagus, and gastroesophageal junction tumors (Siewert I). MIE was performed in 27 patients and 78 patients underwent open esophagectomy (OE). The primary outcome measured was postoperative complications of Clavien–Dindo grade II or higher within 30 days. Other outcomes measured include overall mortality within 30 days, intraoperative complications, operative duration and the length of hospital stay. Results A postoperative complication rate of 18.5% was noted in the MIE group, compared with 41% in the OE group (p = 0.034). Pulmonary complications were noted in 7.4% in the MIE group compared to 25.6% in the OE group (p = 0.044). Postoperative mortality rates, intraoperative complications, and other nonpulmonary postoperative complications were almost similar with MIE as with open esophagectomy. Although the median operative time was more in the MIE group (260 minutes vs. 180 minutes; p < 0.0001), the median length of hospital stay was shorter in patients undergoing MIE (9 days vs. 12 days; p = 0.0001). Conclusions We found that MIE resulted in lower incidence of postoperative complications, especially pulmonary complications. Although, MIE was associated with prolonged operative duration, it resulted in shorter hospital stay.

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Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x13137608455299 ◽

2011 ◽

Vol 93 (8) ◽

pp. 603-607 ◽

Cited By ~ 11

Author(s):

JS Khan ◽

AK Hemandas ◽

KG Flashman ◽

A Senapati ◽

D O'Leary ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Laparoscopic Group ◽

Right Hemicolectomy ◽

Curative Intent ◽

Term Outcome ◽

Mortality And Morbidity ◽

Conversion To Open Surgery ◽

Widespread Acceptance ◽

Grade Tumour

INTRODUCTION Laparoscopic colorectal surgery has gained widespread acceptance. While many studies have compared laparoscopic and open left-sided resections, there is limited literature on right colonic resections. We aimed to analyse the short-term outcome of laparoscopic (LRH) and open right hemicolectomy (ORH) in our unit. METHODS Consecutive patients undergoing elective right hemicolectomies over a period of 28 months were included in the study. No selection criteria were used to allocate the surgical approach. Study parameters included surgical technique, demographic details, ASA grade, body mass index (BMI), length of hospital stay (LOS), post-operative mortality and morbidity, readmission rate and histopathological data. RESULTS A total of 164 patients underwent right hemicolectomies during the study period (LRH: 89, ORH: 75). Both groups were comparable in age, sex, BMI, ASA grade, tumour stage and lymph node harvest. Four patients (4.5%) in the laparoscopic group required conversion to open surgery. In resections with curative intent, microscopic margins were positive in two patients (3%) in the ORH group compared to one (1%) in the LRH group. Seven ORH patients had an adverse post-operative outcome (three anastomotic leaks, four deaths); there were no deaths/immediate complications in the LRH group (p<0.05). The median LOS for LRH patients (4 days, range: 2–21 days) was significantly shorter than for ORH patients (8 days, range: 3–38 days) (p<0.0001, Mann–Whitney U test). By day 5, 77% of LRH patients were discharged compared with only 21% of patients in the ORH group. There were two readmissions (2.7%) in the ORH group and nine (10.1%) in the LRH group. CONCLUSIONS Our findings demonstrate advantages in favour of LRH in terms of a shorter hospital stay and reduced post-operative major complications. LRH is safe and should therefore be available to all patients requiring colonic resection.

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Magyarországon végzett infrarenalis aortaaneurysma-műtétek eredményei az Érsebészeti Regiszter adatai alapján (2010–2014)

Orvosi Hetilap ◽

10.1556/650.2015.30309 ◽

2015 ◽

Vol 156 (49) ◽

pp. 1991-2002 ◽

Cited By ~ 2

Author(s):

László Hidi ◽

Gábor Menyhei ◽

Tamás Kováts ◽

Adrienn Dobai ◽

Zoltán Szeberin

Keyword(s):

Aortic Aneurysm ◽

Hospital Stay ◽

Endovascular Repair ◽

High Capacity ◽

Length Of Hospital Stay ◽

Perioperative Mortality ◽

Exact Test ◽

Infrarenal Aortic Aneurysm ◽

The Past ◽

Calculation Results

Introduction: The Hungarian Society for Vascular Surgery decided to analyse and publish regularly the data of the Hungarian Vascular Registry. Aim: The aim of the authors was to present the outcome of infrarenal aortic aneurysm surgeries performed during the past five years. Method: Prospectively collected multicentric data obtained from the Hungarian Vascular Registry between January 1, 2010 and December 31, 2014 were analysed retrospectively. Statistical analysis was performed using Fisher’s exact test and odds ratio calculation. Results: It was found that 16.72% of the 1435 operations were performed for ruptured aneurysms. Five institutes having the highest capacity performed 78.4% of the operations. In the ruptured aortic aneurysm group the age of patients was 71.77±9.82 years (mean±SD), and perioperative mortality was 33.75%. In the intact aortic aneurysm group the age of patients was 69.50±8.46 years and the perioperative mortality was 3.51%. In both groups perioperative mortality (ruptured: p<0,05, OR = 0.11; intact: p<0.05, OR = 0.26) and the length of hospital stay (ruptured: p<0.05, OR = 4.55; intact: p<0.001, OR = 4.27) were significantly lower in patients who had endovascular repair compared to those with open repair. In both groups perioperative mortality (ruptured: p<0.0001, OR = 0.32; intact: p<0.0001, OR = 0.23) and length of hospital stay (ruptured: p<0.05, OR = 3.16; intact: p<0.001, OR = 3.84) were significantly lower in the five institutes having the highest capacity than in the remaining institutes. Conclusions: In patients having endovascular repair and in institutes with high capacity the perioperative mortality and length of hospital stay were significantly lower. Orv. Hetil., 2015, 156(49), 1991–2002.

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Laparoscopic nephrectomy: Moroccan experience of 68 cases

African Journal of Urology ◽

10.1186/s12301-021-00175-5 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Abdoulazizi Bilgo ◽

Amine Saouli ◽

Tarik Karmouni ◽

Khalid El Khader ◽

Abdellatif Koutani ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Intraoperative Complications ◽

Operating Time ◽

Length Of Hospital Stay ◽

Upper Urinary Tract ◽

Laparoscopic Nephrectomy ◽

Reliable Technique ◽

Average Hospital ◽

Estimated Blood Loss

Abstract Background The aim of this study was to analyze the feasibility and the safety of laparoscopic nephrectomy in the treatment of pathologies of the upper urinary tract through the experience of the Urology B department. Methods We have retrospectively and monocentrally selected patients who underwent laparoscopic nephrectomy from January 2017 to December 2019. The collection was carried out on archived files, based on demographic, clinical and perioperative data. The primary endpoint was the occurrence of complications and secondarily the length of the operation and the length of hospital stay. The statistical analysis was carried out using the SPSS software. Results A total of 68 patients were included in our series. The average age of our patients was 57.8 years. There was a slight female predominance: 39 female patients (57.4%) for 29 male patients (42.6%). Indications for nephrectomy were dominated by renal tumor (33.82%) followed by lithiasis (16.17%) and non-functioning kidney (16.17%) at the same rank. During the study period, 31 (45.6%) simple nephrectomy, 26 (38.2%) total nephrectomy, 1 (1.5%) partial nephrectomy and 10 (14.7%) nephroureterectomy were performed in our department. In our series, the average operating time was 180 min. Estimated blood loss averaged 321.8 ml with extremes of a few milliliter to 1100 ml. Intraoperative complications were reported in 10 (14.7%) patients; conversion was necessary in 6 cases (8.82%). The postoperative follow-up was straightforward in 53 (77.94%) patients with an average hospital stay of 3.6 days. The rate of postoperative complications according to Clavien–Dindo was 22.1%. Histological examination of the nephrectomies carried out in our department revealed mainly chronic non-specific pyelonephritis in 24 (35.3%) patients, followed by renal cell carcinoma in 23 (33.82%) patients and urothelial carcinoma in 9 (13.2%) patients. Conclusion Laparoscopic nephrectomy appears to be an efficient and reliable technique. This technique has led to a significant improvement in operative morbidity, mainly represented by the length of hospital stay, operating time and blood loss.

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Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

10.21203/rs.3.rs-94523/v1 ◽

2020 ◽

Author(s):

Murat Başer ◽

Mehmet Kağan Katar

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Open Surgery ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Operation Time ◽

Complication Rates ◽

Duration Of Symptoms ◽

Conversion To Open Surgery ◽

Group B

Abstract Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

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802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION

Diseases of the Esophagus ◽

10.1093/dote/doab052.802 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Deepika Razia ◽

Sumeet K Mittal

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Antireflux Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Short Term ◽

Perioperative Morbidity ◽

Conversion To Open Surgery ◽

Time Length

Abstract Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction. Methods After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up. Results During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1). Conclusion Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.

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ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS OF THE EFFECTIVENESS AND SAFETY OF THE PROCEDURE IN THE PATIENT WITH ROUX-EN-Y GASTRIC BYPASS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1432 ◽

2019 ◽

Vol 32 (2) ◽

Cited By ~ 1

Author(s):

Flávio Heuta IVANO ◽

Bruno Jeronimo PONTE ◽

Thais Caroline DUBIK ◽

Victor Kenzo IVANO ◽

Vitória Luiza Locatelli WINKELER ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Postoperative Complications ◽

Hospital Stay ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Endoscopic Procedure ◽

Endoscopic Retrograde ◽

Therapeutic Success

ABSTRACT Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

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Estimation of the Efficacy of Retroperitoneoscopic Renal Cysts Deroofing

Herald Urology ◽

10.21886/2308-6424-2019-7-4-5-12 ◽

2020 ◽

Vol 7 (4) ◽

pp. 5-12

Author(s):

Sh. T. Mukhtarov ◽

F. A. Akilov ◽

D. Kh. Mirkhamidov ◽

B. A. Ayubov

Keyword(s):

Hospital Stay ◽

Postoperative Period ◽

Conflicts Of Interest ◽

Intraoperative Complications ◽

Renal Cysts ◽

Safe Procedure ◽

Surgical Interventions ◽

Minimal Invasiveness ◽

Kidney Cysts ◽

The Mean

Introduction. The intensive introduction of modern endovideosurgical techniques creates the prerequisites for the further expansion of minimally invasive surgical interventions. Literature reviews` data on the results of retroperitoneoscopic operations suggest that endovideosurgery in urology has broad prospects for further development.Purpose of the study. To estimate of the efficacy and safety of the retroperitoneoscopic operations for renal cysts.Materials and methods. Retroperitoneoscopic operations (renal cysts deroofing) were performed for 152 symptomatic patients with Bosniak I kidney cysts (from 4.4 х 3.8 cm to 14.5 х 14.0 cm). Proposal of the operations were classified according to the technical difficulty as “Easy” in 147 (96.7%) cases (Е: sum of scores 3-5), in 5 (3.3%) cases – «Slightly difficult» (SD: score 7). Statistical analyses of the results performed by the program Microsoft Office Excel 2007, StatSoft Statistica 8.0 with using the Student-Fisher`s criteria.Results. The mean duration of the operations was 35.7 ± 6.1 min (30-90 min); there were not any intraoperative complications; the mean blood loss was 23.0 ± 4.1 ml (10-100 ml); there was no need for blood transfusion; incidence of postoperative complications were 2.4% - in 4 cases there were manifestation of urinary tract infection during the postoperative period (II category of the complications according to Clavien-Dindo classification); mean hospital stay was 2.2 ± 0.1 day (1-6 days); drainages were removed on second postoperative day; there were not any conversions to open operations and additional procedures in postoperative period.Conclusions. Retroperitoneoscopic renal cysts deroofing is effective and safe procedure for the treatment of simple kidney cysts. This method has the advantages of minimal invasiveness, minimal complications, short in hospital stay and fast recovery of the patients.The study did not have sponsorship. The authors have declared no conflicts of interest.

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1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience

British Journal of Surgery ◽

10.1093/bjs/znab259.796 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K France ◽

M Aradaib ◽

M Jha

Keyword(s):

Robotic Surgery ◽

Anterior Resection ◽

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Right Colectomy ◽

University Hospital ◽

R0 Resection ◽

Oncological Outcomes ◽

Robotic Colorectal Surgery ◽

Institutional Experience

Abstract Aim This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service. Method Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated. Results A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%. Conclusions Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.

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Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation

Canadian Urological Association Journal ◽

10.5489/cuaj.3725 ◽

2016 ◽

Vol 10 (7-8) ◽

pp. 253 ◽

Cited By ~ 8

Author(s):

Christie Rampersad ◽

Premal Patel ◽

Joshua Koulack ◽

Thomas McGregor

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Intraoperative Complications ◽

Graft Function ◽

Length Of Hospital Stay ◽

Donor Nephrectomy ◽

Open Approach ◽

Intraoperative Complication ◽

Estimated Blood Loss ◽

Mini Open

Introduction: Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes.Methods: From 2007‒2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011‒2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches.Results: We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission.Conclusions: Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.

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