Robotic Surgery for Rectal Cancer: A Single Center Experience of 100 Consecutive Cases
Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome.
A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes.
Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%.
Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field.
Available from: Olivia Sgarbura
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Robotic surgery has opened a new era in several specialties but the diffusion of medical innovation is slower indigestive surgery than in urology due to considerations related to cost and cost-efficiency. Studies often discuss the launching of the robotic program as well as the technical or clinical data related to specific procedures but there are very few articles evaluating already existing robotic programs. The aims of the present study are to evaluate the results of a five-year robotic program and to assess the evolution of indications in a center with expertise in a wide range of thoracic and abdominal robotic surgery.
Material and methods:
All consecutive robotic surgery cases performed in our center since the beginning of the program and prior to the 31st of December 2012 were included in this study, summing up to 734 cases throughout five years of experience in the field. Demographic, clinical, surgical and postoperative variables were recorded and analyzed.Comparative parametric and non-parametric tests, univariate and multivariate analyses and CUSUM analysis were performed.
In this group, the average age was 50,31 years. There were 60,9% females and 39,1% males. 55,3% of all interventions were indicated for oncological disease. 36% of all cases of either benign or malignant etiology were pelvic conditions whilst 15,4% were esogastric conditions. Conversion was performed in 18 cases (2,45%). Mean operative time was 179,4Â+-86,06 min. Mean docking time was 11,16Â+-2,82 min.The mean hospital length of stay was 8,54 (Â+-5,1) days. There were 26,2% complications of all Clavien subtypes but important complications (Clavien III-V) only represented 6,2%.Male sex, age over 65 years old, oncological cases and robotic suturing were identified as risk factors for unfavorable outcomes.
The present data support the feasibility of different and complex procedures in a general surgery department as well as the ascending evolution of a well-designed and well-conducted robotic program. From the large variety of surgical interventions, we think that a robotic program could be focused on solving oncologic cases and different types of pelvic and gastroesophageal junction conditions, especially rectal, cervical and endometrial cancer, achalasia and complicated or redo hiatal hernia.
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ABSTRACT: Just like simulators are a standard in aviation and aerospacesciences, we expect for surgical simulators to soon become astandard in medical applications. These will correctly instructfuture doctors in surgical techniques without there being aneed for hands on patient instruction. Using virtual reality bydigitally transposing surgical procedures changes surgery in arevolutionary manner by offering possibilities for implementingnew, much more efficient, learning methods, by allowing thepractice of new surgical techniques and by improving surgeonabilities and skills. Perfecting haptic devices has opened thedoor to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purelytheoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculustechniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barriersand controversies still remain, regarding implementation andgeneralization of surgical virtual simulators. These obstaclesremain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of hapticdevices.
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ABSTRACT: Abdominoperineal approach for rectosigmoidian resection,first imagined and performed in 1948 by Orwar Swenson,was the surgical technique that opened the pathway in thetreatment of congenital megacolon (1). B. Duhamel (1956) and F. Soave (1964) intended to correct the postoperative complicationsappeared after the Duhamel technique andproposed surgical procedures that keep the aganglionicrectum in transit (2,3). In 1994 K. Bax reproduces theDuhamel procedure using laparoscopic approach (4). K.Georgeson, in 1995, reproduced the Swenson technique forrectosigmoidian resection using minimal invasive surgery (5).Today, this approach represents the most frequently usedprocedure for the radical treatment of congenital megacolon.
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