Solitary rectal ulcer syndrome is a rare condition that is associated with disordered defecation and is thought to be an ischemic injury from repeated mucosal trauma. Treatment is designed to ...alleviate the underlying defecatory problems and is only moderately successful. We report an interesting case of solitary rectal ulcer syndrome in a young woman, which was resistant to standard nonoperative management but completely resolved during two pregnancies only to recur when she was not pregnant, and we suggest a possible hormonal explanation for this unique occurrence.
Robotics in colorectal surgery has been in the market for 17 years now, and continuously gaining popularity; three-dimensional steady views, great range of motion, tremor filtration, augmented ...dexterity, and articulated instruments, help surgeons to overcome some of the difficulties of laparoscopy and enables them to reach very low into the pelvis. The objective of our study is to present our experience with robotic, total and partial mesorectal excision and evaluate the efficiency of robotic surgery in the group of patients with rectal tumours. This is a prospective, observational study. The procedures were undertaken in a Teaching hospital in United Kingdom, for 4 years period (11/2014–02/2019). The SI Davinci system was used. Technical and oncological outcomes were assessed. The analysis included 85 patients (49 male) who underwent rectal resections. 80 patients (94%) had cancer. Davinci total mesorectal excision (61) and partial mesorectal excision (24) with single side-docking technique. We reviewed the efficiency of the robotic platform in patients with rectal tumours. Median age was 65 (37–89) years and BMI was 27 kg/m
2
(19–37.7). 61 patients had tumours within 10 cm from anal verge. There were no deaths and no intraoperative complications. One patient was converted to open, due to system failure. Five patients returned to theatre and two had radiologic drain of a pelvic collection. Median length of hospital stay was 6 days and total operative time was 285 min; after 46 cases, the operative time reduced statistically significant. We removed 35 lymph nodes on average (6–119). R0 resection achieved in 83 patients (97.6%). 75 patients had their sphincters preserved (88.2%). The limitation is that it is a single-institution observational study. Robotic rectal cancer surgery is safe and effective with high rate of sphincter preservation. Our data for short-term outcomes are favourable against previously published data.
Aim
Surgery for rectal cancer is challenging for both technical and anatomical reasons. The European Academy of Robotic Colorectal Surgery (EARCS) provides a competency‐based training programme ...through a standardized approach. However, there is no consensus on technical standards for robotic surgery when used during surgery for rectal cancer. The aim of this consensus study was to establish operative standards for anterior resection incorporating total mesorectal excision (TME) using robotic techniques, based on recommendations of expert European colorectal surgeons.
Method
A Delphi questionnaire with a 72‐item statement was sent through an electronic survey tool to 24 EARCS faculty members from 10 different countries who were selected based on expertise in robotic colorectal surgery. The task was divided into theatre setup, colonic mobilization and rectal dissection, and each task area was further divided into several subtasks. The levels of agreement (A* > 95% agreement, A > 90%, B > 80% and C > 70%) were considered adequate while agreement of < 70% was considered inadequate. Once consensus was reached, a draft document was compiled and sent out for final approval.
Results
The average length of experience of robotic colorectal surgery for participants in this study was 6 years. Initial agreement was 87%; in nine items, it was < 70%. After suggested modifications, the average level of agreement for all items reached 94% in the second round (range 0.75–1).
Conclusion
This is the first European consensus on the standardization of robotic TME. It provides a baseline for technical standards and structured training in robotic rectal surgery.
Aim
The aim was to develop and operationally define ‘performance metrics’ that characterize a reference approach to robotic‐assisted low anterior resection (RA‐LAR) and to obtain face and content ...validity through a consensus meeting.
Method
Three senior colorectal surgeons with robotic experience and a senior behavioural scientist formed the Metrics Group. We used published guidelines, training materials, manufacturers’ instructions and unedited videos of RA‐LAR to deconstruct the operation into defined, measurable components – performance metrics (i.e. procedure phases, steps, errors and critical errors). The performance metrics were then subjected to detailed critique by 18 expert colorectal surgeons in a modified Delphi process.
Results
Performance metrics for RA‐LAR had 15 procedure phases, 128 steps, 89 errors and 117 critical errors in women, 88 errors and 118 critical errors in men. After the modified Delphi process the final performance metrics consisted of 14 procedure phases, 129 steps, 88 errors and 115 critical errors in women, 87 errors and 116 critical errors in men. After discussion by the Delphi panel, all procedure phases received unanimous consensus apart from phase I (patient positioning and preparation, 83%) and phase IV (docking, 94%).
Conclusion
A robotic rectal operation can be broken down into procedure phases, steps, with errors and critical errors, known as performance metrics. The face and content of these metrics have been validated by a large group of expert robotic colorectal surgeons from Europe. We consider the metrics essential for the development of a structured training curriculum and standardized procedural assessment for RA‐LAR.
Traditionally, loop ileostomy is reversed under general anaesthetic. In patients with severe cardiorespiratory disease, many surgeons opt for a one-stage, low Hartmann's procedure to avoid a second ...general anaesthetic to reverse a defunctioning stoma. Closure of loop ileostomy under spinal anaesthetic would allow high-risk patients to avoid a permanent stoma and a general anaesthetic.
Seven patients (6 of whom were men) had reversal of loop ileostomy under spinal anaesthetic. The median age was 63 years (range 43--70). Six patients had significant co-morbidity with a median American Society of Anesthesiologists (ASA) grade of 3. The ileostomy was reversed in a side-to-side fashion using a linear stapler. The small bowel wall was infiltrated with local anaesthetic prior to firing the stapler.
All patients tolerated the procedure without discomfort. Patients started feeding on the first postoperative day. Analgesia requirements postoperatively were minimal. No complications occurred due to the anaesthetic technique.
With careful patient selection, preparation and a gentle and meticulous surgical technique, reversal of loop ileostomy can be achieved under spinal anaesthesia, thereby, saving high-risk patients with low tumours (suitable for sphincter preservation) from having a one-stage resection with permanent stoma.
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