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

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.

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

2010 ◽  
Vol 47 (1) ◽  
pp. 116-118 ◽  
Author(s):  
Marcelo Averbach ◽  
Pedro Popoutchi ◽  
Oswaldo Wiliam Marques Jr ◽  
Ricardo Z Abdalla ◽  
Sérgio Podgaec ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Colorectal Surgery ◽  
Colorectal Resection ◽  
Deep Infiltrating Endometriosis ◽  
Brazil Current ◽  
Current Series ◽  
Robotic Colorectal Surgery ◽  
Rectal Involvement ◽  
Surgical Device ◽  
Standard Laparoscopic 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

Robotic colorectal surgery: Where are we right now?

2010 ◽  
Vol 224 (7) ◽  
pp. 1415-1419 ◽  
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.

Robotic Colorectal Surgery Learning Curve and Case Complexity

2018 ◽  
Vol 28 (10) ◽  
pp. 1163-1168 ◽  
Author(s):  
Darcy D. Shaw ◽  
Moriah Wright ◽  
Lindsay Taylor ◽  
Noelle L. Bertelson ◽  
Maniamparampil Shashidharan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Learning Curve ◽  
Case Complexity ◽  
Robotic Colorectal Surgery

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

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.

Robotic Surgery for Complicated Diverticular Disease

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.

Safety with Innovation in Colon and Rectal Robotic Surgery

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.

scholarly journals Robotic Colorectal Surgery using Senhance® Robotic Platform: Single Center Experience with First 13 Cases

2019 ◽  
Vol 18 (1) ◽  
pp. 13-17
Author(s):  
Narimantas Evaldas Samalavičius ◽  
Olegas Deduchovas
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Postoperative Bleeding ◽  
Stage Iv ◽  
Robotic System ◽  
University Hospital ◽  
Robotic Platform ◽  
Bleeding Vessel ◽  
Robotic Colorectal Surgery ◽  
Colorectal Resections

[full article, abstract in English; abstract in Lithuanian] Until recently, robotic surgery has been associated only with da Vinci robotic system. A novel Senhance® robotic system (TransEnterix Surgical Inc., Morrisville, NC, USA) has been introduced almost 5 years ago. Published reports on experience in colorectal surgery using this robotic platform is very limited. We present a prospective analysis of first 13 robotic colorectal surgeries in Klaipėda University Hospital, Klaipėda, Lithuania. 13 patients underwent various colorectal resections: 10 for colorectal cancer and 3 for colonic polyps. 7 were men and 6 women, age range 32–77 years, on an average 56 years. Among 10 patients with colorectal cancer, 3 had stage I, 3 stage II, 3 stage III and 1 stage IV colorectal cancer. 2 patients were operated for unremovable ascending colon adenomas and 1 underwent prophylactic subtotal colectomy with ileorectal anastomisis for familial adenomatous polyposis. Complication occurred in 1 case (7.7%). This patient underwent robotic abdominoperineal resection for low rectal cancer, developed postoperative bleeding from perineal wound on day 7 and had to be taken to operative room for oversuturing the bleeding vessel. Operative time was on an average 3 hours 50 minutes, ranging from 2 hours and 55 minutes to 6 hours and 10 minutes. In-hospital stay ranged from 5 to 16 days, on an average 7 days. Conclusion. Our experience with different types of robotic colorectal resections allows us to state that Senhance® robotic system is feasible and safe for colorectal surgery, and wider implementation of this system in our specialty worldwide is simply a question of time.

Robotic colorectal surgery in Australia: evolution over a decade

2021 ◽  
Author(s):  
José Tomás Larach ◽  
Julie Flynn ◽  
Joseph Kong ◽  
Peadar S. Waters ◽  
Jacob J. McCormick ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Robotic Colorectal Surgery

scholarly journals Robotic colorectal surgery: more than a fantastic toy?

2018 ◽  
Vol 3 (1) ◽  
pp. 65-68 ◽  
Author(s):  
James W.T. Toh ◽  
Kevin Phan ◽  
Seon-Hahn Kim
Keyword(s):  
Rectal Cancer ◽  
Colorectal Surgery ◽  
Da Vinci Surgical System ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Cancer Trial ◽  
Robotic Colorectal Surgery ◽  
Significant Difference ◽  
Meta Analyses ◽  
Laparoscopic Assisted

AbstractThere has been a rapid rise in the number of robotic colorectal procedures worldwide since the da Vinci Surgical System robotic technology was approved for surgical procedures in the year 2000. Several recent meta-analyses and systematic reviews have shown a significant difference in outcomes between robotic and laparoscopic rectal cancer surgery. However, these results from pooled data have not been supported by the initial results reported from the Robotic assisted versus laparoscopic assisted resection for rectal cancer trial. In this article, we examine the current evidence for robotic colorectal surgery, assess its features and functionality, evaluate its learning curve and provide our perspective on its future.

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