scholarly journals A rare cause of lower gastrointestinal bleeding treated with robotic colorectal surgery

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Robin Osofsky ◽  
Cyril Kamya ◽  
Hamza Hanif ◽  
Victor Phuoc
Keyword(s):  
Colorectal Surgery ◽  
Gastrointestinal Bleeding ◽  
Metastatic Melanoma ◽  
Sigmoid Colon ◽  
Surgical Resection ◽  
Lower Gastrointestinal Bleeding ◽  
Sigmoid Colectomy ◽  
Robot Assisted ◽  
Robotic Assisted ◽  
Robotic Colorectal Surgery

Abstract Background Metastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma. Case presentation A 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB. Conclusion  This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.

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.

Young adult with varicosities and recurrent lower gastrointestinal bleeding

2019 ◽  
Vol 6 (8) ◽  
pp. 3012
Author(s):  
Vidhyachandra V. Gandhi ◽  
Pratik Gautam ◽  
Nitin V. Pai ◽  
Sujai Hegde
Keyword(s):  
Gastrointestinal Bleeding ◽  
Sigmoid Colon ◽  
Lower Limb ◽  
Low Anterior Resection ◽  
Lower Gastrointestinal Bleeding ◽  
Lateral Side ◽  
Left Lower Limb ◽  
Left Buttock ◽  
Klippel Trenaunay Syndrome ◽  
Mr Angiogram

A 30 years gentleman presented with anaemia since last ten years due to recurrent rectal bleeding. He has had multiple admissions with transfusions in the preceding 10 years without a clear clinical diagnosis. His physical examination revealed gross pallor, prominent veins on the lateral side of the left lower limb with minimal hypertrophy and a hemangiomatous patch over the left buttock. Colonoscopy revealed a few dilated tortuous submucosal vessels in the rectum and sigmoid colon. A MR angiogram showed absent left popliteal vein and angiomatous lesions in the rectum and sigmoid colon. He was diagnosed to have Klippel-Trenaunay syndrome with hemangiomata of the lower gastrointestinal tract causing bleeding. He underwent a low anterior resection with stapled anastomosis, which has effectively controlled his bleeding. Adults with gastrointestinal bleeding due to congenital venous malformations commonly have visible external stigmata, which are often pointers of rare syndromes.

scholarly journals Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery

2019 ◽  
Vol 8 (6) ◽  
pp. 879 ◽  
Author(s):  
Malgorzata Krzystek-Korpacka ◽  
Marek Zawadzki ◽  
Paulina Lewandowska ◽  
Krzysztof Szufnarowski ◽  
Iwona Bednarz-Misa ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Bowel Function ◽  
Early Postoperative Period ◽  
Robot Assisted ◽  
Angiogenic Potential ◽  
Robotic Colorectal Surgery ◽  
Colorectal Cancer Patients

Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response.

scholarly journals Robot-Assisted Excision of a Pararectal Gastrointestinal Stromal Tumor in a Patient with Previous Ileal Neobladder

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
A. Ploumidis ◽  
A. Mottrie ◽  
A. F. Spinoit ◽  
M. Gan ◽  
V. Ficarra ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Pelvic Surgery ◽  
Pathology Report ◽  
Robot Assisted ◽  
Mesenchymal Tumors ◽  
Ileal Neobladder ◽  
Robotic Assisted ◽  
Stromal Tumors ◽  
Adjacent Structures ◽  
Oncological Results

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract with surgical resection remaining the cornerstone of therapy. Pararectal lesions are considered to be technically difficult and pose in some cases a challenge. We report, to the best of our knowledge, the first robotic-assisted pararectal GIST excision. A 43-year-old man was referred to our center with pararectal GIST recurrence, despite treatment with targeted therapy. Eleven years ago, he underwent extensive abdominal surgery including cystoprostatectomy with ileal neobladder diversion due to GIST resection in the rectoprostatic space. Robot-assisted surgical resection was successfully performed without the need for temporary colostomy. The postoperative course of the patient was uneventful, and the pathology report confirmed a GIST recurrence with negative surgical margins and pelvic lymph nodes free of any tumor. Robotic-assisted pelvic surgery can be extended to incorporate excision of pararectal GISTs, as a safe, less invasive surgical alternative with promising oncological results and minimal injury to adjacent structures.

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