Robotic rectosigmoidectomy: pioneer case report in Brazil. Current scene in colorectal robotic surgery

Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci® surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery

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Robotic colorectal surgery: Where are we right now?

Proceedings of the Institution of Mechanical Engineers Part C Journal of Mechanical Engineering Science ◽

10.1243/09544062jmes2065 ◽

2010 ◽

Vol 224 (7) ◽

pp. 1415-1419 ◽

Cited By ~ 3

Author(s):

J Kang ◽

K Y Lee

Keyword(s):

Minimally Invasive Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Degrees Of Freedom ◽

Three Dimensional ◽

Colorectal Disease ◽

Widespread Application ◽

Robotic Colorectal Surgery

Minimally invasive surgery has become mainstream in surgical management of colorectal disease. Based on evidence of oncologic safety and benefit to patients, laparoscopic colorectal surgery is regarded as a successful alternative to open surgery. Since the introduction of the da Vinci® system as another tool for minimally invasive surgery, there have been several reports regarding the feasibility and safety of the system. The authors looked at their experience with 412 robotic colorectal surgeries and found that it was feasible and safe. Incidence of operation-related morbidity was around 11 per cent and system-related problems were 2.4 per cent. There was no operation-related or system-related mortality. From a technological perspective, robotic surgery has several advantages over laparoscopic surgery, including a magnifying view with a three-dimensional image, a stable camera platform, and instruments with Endowrist® technology that allow for seven degrees of freedom of movement. However, there is still room for improvement. The revolution of robotic technology can aid in the realization of a dream: a smaller, cheaper, and more sophisticated robotic system, which will further facilitate the widespread application of robotic surgery to colorectal disease.

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Technical essential aspects in robotic colorectal surgery: mastering the Da Vinci Si and Xi platforms

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20213007 ◽

2021 ◽

Vol 48 ◽

Author(s):

ANDRE LUIZ GIOIA MORRELL ◽

ALEXANDER CHARLES MORRELL-JUNIOR ◽

ALLAN GIOIA MORRELL ◽

ELIAS COUTO ALMEIDA-FILHO ◽

DUARTE MIGUEL FERREIRA RODRIGUES RIBEIRO ◽

...

Keyword(s):

Robotic Surgery ◽

Colorectal Surgery ◽

Da Vinci ◽

Port Placement ◽

Technical Aspects ◽

Essential Condition ◽

Practical Applications ◽

Technological Advances ◽

Robotic Colorectal Surgery ◽

Standard Laparoscopy

ABSTRACT Background: laparoscopy surgery has many proven clinical advantages over conventional surgery and more recently, robotic surgery has been the emerging platform in the minimally invasive era. In the colorectal field, although overcoming limitations of standard laparoscopy, robotic surgery still faces challenging situations even by the most experienced colorectal surgeons. This study reports essentials technical aspects and comparison between Da Vincis Si and Xi platforms aiming to master and maximize efficiency whenever performing robotic colorectal surgery. Methods: this study overviews the most structured concepts and practical applications in robotic colorectal surgery in both Si and Xi Da Vinci platforms. Possible pitfalls are emphasized and step-wise approach is described from port placement and docking process to surgical technique. We also present data collected from a prospectively maintained database. Results: our early experience includes forty-four patients following a standardized total robotic left-colon and rectal resection. Guided information and practical applications for a safe and efficient robotic colorectal surgery are described. We also present illustrations and describe technical aspects of a standardized procedure. Conclusion: performing robotic colorectal surgery is feasible and safe in experienced surgeons hands. Although the Da Vinci Xi platform demonstrates greater versatility in a more user-friendly design with technological advances, the correct mastery of technology by the surgical team is an essential condition for its fully robotic execution in a single docking approach.

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Incidence of Symptomatic Internal Hernia following Minimal Invasive colorectal surgery: A Single Center Experience

Nepal Medical College Journal ◽

10.3126/nmcj.v23i3.40377 ◽

2021 ◽

Vol 23 (3) ◽

pp. 204-209

Author(s):

Rajiv Nakarmi ◽

Tian Yu-Feng ◽

Khaa-Hoo Ong ◽

Muza Shrestha ◽

Sundar Maharjan ◽

...

Keyword(s):

Colorectal Surgery ◽

Internal Hernia ◽

Colorectal Resection ◽

Minimal Invasive ◽

Laparoscopic Colorectal Resection ◽

Single Center Experience ◽

Internal Hernias ◽

Initial Surgery ◽

Robotic Colorectal Surgery ◽

Laparoscopic Closure

Laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant diseases. Recent reviews suggest that the incidence of symptomatic internal hernias after laparoscopic colorectal resection is from 0.39 to 0.65%. Unlike in open surgery, laparoscopic closure of a mesenteric defect is inherently challenging as inadvertent injury to the marginal vessels may compromise blood supply to the anastomosis. For these reasons, many surgeons leave the defect open during laparoscopic surgery. But this may lead to development of post-operative internal hernia through the defect. This is a retrospective study where we included 149 patients who underwent laparoscopic/ robotic colorectal surgeries from March 2019 to March 2020. Data pertaining for following variables were collected which included age, sex, indication for surgery, location of the pathology, splenic flexure mobilization. The incidence of internal hernia among these patients were calculated and assessed using SPSS 20. Incidence of internal hernia was found to be 0.67% which was diagnosed and treated on the 18th post-operative day of initial surgery. Internal hernia is a rare but important complication of laparoscopic/robotic colorectal surgery with a high mortality rate if not diagnosed early. Defect closure is still controversial during the initial surgery and probably not indicated for all patients and depends on surgeon’s preference.

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Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study

Surgical Innovation ◽

10.1177/1553350618765540 ◽

2018 ◽

Vol 25 (3) ◽

pp. 251-257 ◽

Cited By ~ 4

Author(s):

Matteo Palmeri ◽

Desirée Gianardi ◽

Simone Guadagni ◽

Gregorio Di Franco ◽

Luca Bastiani ◽

...

Keyword(s):

Colorectal Surgery ◽

Colorectal Resection ◽

Da Vinci ◽

Da Vinci Xi ◽

Short Term ◽

Colorectal Cancer Surgery ◽

New Device ◽

Robotic Colorectal Surgery ◽

Number Of Patients ◽

Table Motion

Background. The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM. Methods. Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group). Results. Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024). Conclusions. In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.

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Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

Indian Journal of Surgery ◽

10.1007/s12262-021-02864-5 ◽

2021 ◽

Author(s):

Vivek Sharma ◽

Thusitha Hettiarachchi ◽

Dhiraj Sharma ◽

Irshad Shaikh

Keyword(s):

Laparoscopic Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Anterior Resection ◽

Cost Effective ◽

Robotic Assisted ◽

Novel Method ◽

Standard Laparoscopic Surgery ◽

The Cost ◽

Disposable Equipment

AbstractIn the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

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Robotic Surgery for Complicated Diverticular Disease

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0041-1729863 ◽

2021 ◽

Vol 34 (05) ◽

pp. 297-301

Author(s):

Fadwa Ali ◽

Elizabeth Raskin

Keyword(s):

Minimally Invasive Surgery ◽

Laparoscopic Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Minimally Invasive ◽

Diverticular Disease ◽

Invasive Surgery ◽

Economic Burden ◽

Complicated Diverticulitis ◽

Robotic Colorectal Surgery

AbstractDiverticular disease is common, and increasing in prevalence worldwide. The treatment for acute and chronic diverticular disease has a huge clinical and economic burden. Surgery is standard for complicated diverticulitis, and there are several benefits to using robotic surgery in these cases. Complicated diverticular disease can result in fistula, fibrosis, and deranged anatomy, which present technical challenges to the surgeon. Understanding and anticipating these anatomical challenges is key to successful surgery. While fears of conversion in complicated cases may stop surgeons from using traditional laparoscopic surgery, robotic surgery is especially promising for enhancing dexterity, visualization, and facilitating completely minimally invasive surgery in these complicated cases. In this chapter, we review end-to-end technical strategies of robotic colorectal surgery for complicated diverticular disease, including cases with colovesicular, colovaginal, and colocutaneous fistulae.

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Safety with Innovation in Colon and Rectal Robotic Surgery

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0041-1726352 ◽

2021 ◽

Vol 34 (05) ◽

pp. 273-279

Author(s):

Deborah S. Keller ◽

Christina N. Jenkins

Keyword(s):

Clinical Practice ◽

Laparoscopic Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Disruptive Technology ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Marketing Model ◽

Sales And Marketing ◽

Robotic Colorectal Surgery

AbstractRobotic colorectal surgery has been touted as a possible way to overcome the limitations of laparoscopic surgery and has shown promise in rectal resections, thus shifting traditional open surgeons to a minimally invasive approach. The safety, efficacy, and learning curve have been established for most colorectal applications. With this and a robust sales and marketing model, utilization of the robot for colorectal surgery continues to grow steadily. However, this disruptive technology still requires standards for training, privileging and credentialing, and safe implementation into clinical practice.

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Surgical Complexity and Outcome During the Implementation Phase of a Robotic Colorectal Surgery Program—A Retrospective Cohort Study

Frontiers in Oncology ◽

10.3389/fonc.2020.603216 ◽

2021 ◽

Vol 10 ◽

Author(s):

Catharina Müller ◽

Johannes Laengle ◽

Stefan Riss ◽

Michael Bergmann ◽

Thomas Bachleitner-Hofmann

Keyword(s):

Robotic Surgery ◽

Colorectal Surgery ◽

Case Complexity ◽

Major Complications ◽

Period 2 ◽

Robotic Colorectal Surgery ◽

Level I ◽

Colorectal Resections ◽

Over Time ◽

Complex Cases

BackgroundRobotic surgery holds particular promise for complex oncologic colorectal resections, as it can overcome many limitations of the laparoscopic approach. However, similar to the situation in laparoscopic surgery, appropriate case selection (simple vs. complex) with respect to the actual robotic expertise of the team may be a critical determinant of outcome. The present study aimed to analyze the clinical outcome after robotic colorectal surgery over time based on the complexity of the surgical procedure.MethodsAll robotic colorectal resections (n = 85) performed at the Department of Surgery, Medical University of Vienna, between the beginning of the program in April 2015 until December 2019 were retrospectively analyzed. To compare surgical outcome over time, the cohort was divided into 2 time periods based on case sequence (period 1: patients 1–43, period 2: patients 44–85). Cases were assigned a complexity level (I-IV) according to the type of resection, severity of disease, sex and body mass index (BMI). Postoperative complications were classified using the Clavien-Dindo classification.ResultsIn total, 47 rectal resections (55.3%), 22 partial colectomies (25.8%), 14 abdomino-perineal resections (16.5%) and 2 proctocolectomies (2.4%) were performed. Of these, 69.4% (n = 59) were oncologic cases. The overall rate of major complications (Clavien Dindo III-V) was 16.5%. Complex cases (complexity levels III and IV) were more often followed by major complications than cases with a low to medium complexity level (I and II; 25.0 vs. 5.4%, p = 0.016). Furthermore, the rate of major complications decreased over time from 25.6% (period 1) to 7.1% (period 2, p = 0.038). Of note, the drop in major complications was associated with a learning effect, which was particularly pronounced in complex cases as well as a reduction of case complexity from 67.5% to 45.2% in the second period (p = 0.039).ConclusionsThe risk of major complications after robotic colorectal surgery increases significantly with escalating case complexity (levels III and IV), particularly during the initial phase of a new colorectal robotic surgery program. Before robotic proficiency has been achieved, it is therefore advisable to limit robotic colorectal resection to cases with complexity levels I and II in order to keep major complication rates at a minimum.

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