scholarly journals Robotic Surgery Contributes To The Preservation of Bowel and Urinary Function After Total Mesorectal Excison: Comparisons With Transanal and Conventional Laparoscopic Surgery

2021 ◽  
Author(s):  
Takuya Miura ◽  
Yoshiyuki Sakamoto ◽  
Hajime Morohashi ◽  
Akiko Suto ◽  
Shunsuke Kubota ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Anal Verge ◽  
Lower Rectal Cancer ◽  
Urinary Function ◽  
Conventional Laparoscopic Surgery ◽  
Permanent Stoma ◽  
Conventional Laparoscopic ◽  
Significant Difference

Abstract Background Determine whether robotic surgery is more effective than transanal and conventional laparoscopic surgery in preserving bowel and urinary function after total mesorectal excision (TME). Methods Of 79 lower rectal cancer patients who underwent function-preserving TME between 2016 and 2020, 64 patients consented to a prospective questionnaire-based functional observation study (52 responded). At six months post-resection or ileostomy closure, Wexner, low anterior resection syndrome (LARS), modified fecal incontinence quality of life, and international prostate symptom scores were used to evaluate bowel and urinary function, comparing robotic surgery (RTME) with transanal (taTME) or conventional laparoscopic surgery (LTME). Results RTME was performed in 35 patients (54.7%), taTME in 15 (23.4%), and LTME in 14 (21.9%). While preoperative bowel/urinary functions were similar in all three procedures, and the distance from the anal verge to tumor was almost the same, more hand-sewn anastomoses were performed and the anastomotic height from the anal verge was shorter in taTME than RTME. At 2 years post-resection, 8 patients (12.5%) had a permanent stoma; RTME showed a significantly lower rate of permanent stoma than taTME (2.9% vs 40%, p < 0.01). Despite no significant difference, all bowel function assessments were better in RTME than in taTME or LTME. Major LARS was observed in all taTME and LTME cases, but only 78.8% of RTME. No clear difference arose between RTME and taTME in urinary function; urinary dysfunction was more severe in LTME than RTME (36.4% vs 6.1%, p = 0.02). Conclusions In function-preserving TME for lower rectal cancer, robotic surgery was suggested to be more effective than transanal and conventional laparoscopic surgery in terms of bowel and urinary functions.

scholarly journals Creatine kinase elevation after robotic surgery for rectal cancer due to a prolonged lithotomy position

2020 ◽  
Author(s):  
Yuki Tsuchiya ◽  
Shinya Munakata ◽  
Ryoichi Tsukamoto ◽  
Yu Okazawa ◽  
Kosuke Mizukoshi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Creatine Kinase ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Postoperative Complications ◽  
Operation Time ◽  
University Hospital ◽  
Lithotomy Position ◽  
Conventional Laparoscopic Surgery ◽  
And Gender

Abstract Background Robotic surgery for rectal cancer, which is now performed worldwide, can be associated with elevated creatine kina se levels postoperatively. In this study, we compared postoperative complications between patients undergoing robotic surgery and laparoscopic surgery. Methods We identified 66 consecutive patients who underwent curative resection for rectal cancer at Juntendo University Hospital between January 2016 and February 2019. Patients were divided into a conventional laparoscopic surgery (CLS) group (n = 38) and a robotic-assisted laparoscopic surgery (RALS) group (n = 28) before comparing various clinicodemographic factors between the groups. Results Patient age and gender, surgical approach (CLS/RALS), pathological T factor, pathological stage, duration of postoperative hospital stay, and postoperative complications were not significantly different between the RALS and CLS groups. However, the operation time was significantly longer in the RALS group (407 min) than in the CLS group ( 295 min; p < 0.001 ). Notably, the serum level of creatine kinase on postoperative day 1 was significantly higher in the CLS group (154 IU/L) than in the RALS group (525 IU/L; p < 0.001), despite there being no significant differences in the incidence of rhabdomyolysis. The multivariate analysis showed that RALS/CLS (HR 6.0 95% CI 1.3–27.5, p = 0.02) and operation time (HR 15.9 95% CI 3.79–67.4, p = 0.001) remained independent factors of CK elevation on postoperative day 1. Conclusions Clinically relevant positioning injuries and rhabdomyolysis may occur in patients who are subjected to a prolonged and extreme Trendelenburg position or who have extra force applied to the abdominal wall because of remote center displacement. The creatine kinase value should therefore be measured after RALS to monitor for the sequelae of these potential positioning injuries.

scholarly journals Comparison of Survival between Single-Access and Conventional Laparoscopic Surgery in Rectal Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Siripong Sirikurnpiboon
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Local Recurrence ◽  
Demographic Data ◽  
Transanal Total Mesorectal Excision ◽  
Recurrence Rates ◽  
Conventional Laparoscopic Surgery ◽  
Single Access ◽  
Conventional Laparoscopic ◽  
Conversion Rates

Introduction. Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME). Most reports of SALS for rectal cancer have shown pathologic outcomes comparable to those of conventional laparoscopic surgery (CLS); however, SALS is considered to be superior to CLS in terms of lower levels of discomfort and faster recovery rates. This study aimed to compare the survival outcomes of the two approaches. Methods. From 2011 to 2014, 84 cases of adenocarcinoma of the rectum and anal canal were enrolled. The operations were anterior, low anterior, intersphincteric, and abdominoperineal resections. Data collected included postoperative outcomes. The oncological outcomes recorded included 3-year and 5-year survival, local recurrence, and metastasis. Results. SALS was performed on 41 patients, and CLS was utilized in 43 cases. The demographic data of the two groups were similar. Intraoperative volumes of blood loss and conversion rates were similar, but operative time was longer in the SALS group. There were no significant differences in postoperative complications or pathological outcomes. The oncologic results were similar in terms of 3-year survival (100% and 97.7%; p  = 1.00), 5-year survival (78.0% and 86.0%; p  = 0.401), local recurrence rates (19.5% vs 11.6%, p  = 0.376), and metastasis rates (19.5% vs 11.6%; p  = 0.376) for SALS and CLS, respectively. Conclusion. SALS and CLS for rectal and anal cancer had comparable pathological and survival results, but SALS showed some superior benefits in the early postoperative period.

scholarly journals Robotic-assisted surgery for low rectal cancer: Initial experiences from 15 consecutive cases at Cho Ray Hospital

2019 ◽  
Vol 9 (4) ◽  
Author(s):  
Viet Trung Lam ◽  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Range Of Motion ◽  
Laparoscopic Resection ◽  
Low Rectal Cancer ◽  
Safe Procedure ◽  
Conventional Laparoscopic Surgery ◽  
Robotic Assisted ◽  
Conventional Laparoscopic ◽  
Robotic Assisted Surgery

Abstract Introduction: Conventional laparoscopic surgery for low rectal cancer has several challenges regarding the technique issues such as a limited range of motion instruments. With the advantages, Robotic-assisted surgery has resolved this problems compared with the conventional laparoscopic surgery because it’s dexterity could improve the range of motion instruments. To evaluate the short-term and early oncological outcomes of robotic-assisted surgery for low rectal cancer. Material and Methods: Prospective study to describe one consecutive series of robotic-assisted laparoscopic resection for low rectal cancer at Department of Digestive Surgery of Cho Ray hospital. Results: Between October 2017 and June 2018, robotic-assisted laparoscopic resection with total mesorectal excision has performed on 15 consecutive patients with rectal cancer at Cho Ray hospital. The mean age was 50. Male/ female ratio was 2.75/1. The types of procedures performed were: 13 low anterior resections (LAR), 1 intersphincteric resection with coloanal anastomosis, and 1 abdominoperineal resection (APR). The overall mean operation time was 240 minutes. None of the cases was converted to open procedure. Mean harvested lymph nodes were 12. There was no surgical morbidity or mortality. On the postoperative day 1 and 2, mean visual analog scale (VAS) scores were 3.5. Mean postoperative hospital stay was 7.5 days. Conclusion: Robotic-assisted laparoscopic resection for low rectal cancer is a feasible and safe procedure with acceptable oncological results.

scholarly journals No beneficial effect on survival but with a decreased postoperative adverse events for robotic surgery in patients with rectal cancer: A retrospective cohort study

2021 ◽  
Author(s):  
Xiong Lei ◽  
Lingling Yang ◽  
Zhixiang Huang ◽  
Haoran Shi ◽  
Zhen Zhou ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Adverse Events ◽  
Beneficial Effect ◽  
Disease Free Survival ◽  
Operation Time ◽  
Laparoscopy Group ◽  
Significant Difference ◽  
Robot Group

Abstract Aim To compare the oncologic outcomes in patients with rectal cancer receiving robotic vs. laparoscopic surgery. Methods The clinical data of patients with rectal cancer receiving robotic surgery (Robot group, n = 317) or laparoscopic surgery (Laparoscopy group, n = 224) were collected for outcomes assessment. The primary endpoints were the survival outcome. The secondary outcomes were postoperative adverse events and pathologic characteristics. Results Patients in the Robot group have significantly shorter operation time (163.6 ± 41.1vs.190.6 ± 52.5min), shorter time to 1st gas passing [2(1)vs.3(1)d] and shorter hospital day [7(2)vs.8(3)d], compared to those in Laparoscopy group (P < 0.001, respectively). The incidence of urinary retention short- and long term in Robot group is significant lower than in Laparoscopy group (1.9% vs. 10.7%; 0.6% vs. 4.0%, P < 0.05, respectively). TNM stage II and III was more frequently observed in the Robot group than that in the Laparoscopy group (94.3% vs. 83.5%), whereas stage I was more common in the Laparoscopy group than in the Robot group (5.7% vs. 16.5%). No significant difference in the overall survival (OS) and disease-free survival (DFS) were observed in Robot group and Laparoscopy group at 1-, 3- and 5-year. By a multivariable-adjusted analysis, the robotic surgery was not an independent prognostic factor for OS and DFS. Conclusions A beneficial effect on survival of the robotic surgery for rectal cancer could not be demonstrated. However, the robot is a feasible surgical procedure due to the decreased postoperative adverse event.

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