Key messages•Triage strategies to keep suspected and confirmed cases in isolation.•Virtual consultations and limiting all out patient activity.•Screening asymptomatic patients with nucleic acid test, ...antibody testing & CT chest.•Designated staff and operating areas for COVID 19 infected patients.•Careful use of laparoscopy with precautions.•Limited operating on cancer patients with consideration of alternatives treatment strategies.•Precautions and protocol for surgical management are needed after the epidemic.
Supervised training of laparoscopic colorectal cancer surgery to fellows and consultants (trainees) may raise doubts regarding safety and oncological adequacy. This study investigated these concerns ...by comparing the short- and long-term outcomes of matched supervised training cases to cases performed by the trainer himself.
A prospective database was analysed retrospectively. All elective laparoscopic colorectal cancer resections in curative intent of adult patients (≥ 18 years) which were performed (non-training cases) or supervised to trainees (training cases) by a single laparoscopic expert surgeon (trainer) were identified. All trainees were specialist surgeons in training for laparoscopic colorectal surgery. Supervised training was standardised. Training cases were 1:1 propensity-score matched to non-training cases using age, American Society of Anesthesiologists (ASA) grade, tumour site (rectum, left and right colon) and American Joint Committee on Cancer (AJCC) tumour stage. The resulting groups were analysed for both short- (operative, oncological, complications) and long-term (time to recurrence, overall and disease-free survival) outcomes.
From 10/2006 to 2/2016, a total of 675 resections met the inclusion criteria, of which 95 were training cases. These resections were matched to 95 non-training cases. None of the matched covariates exhibited an imbalance greater than 0.25 (│d│>0.25). There were no significant differences in short- (length of procedure, conversion rate, blood loss, postoperative complications, R0 resections, lymph node harvest) and long-term outcomes. When comparing training cases to non-training cases, 5-year overall and disease-free survival rates were 71.6% (62.4-82.2) versus 81.9% (74.2-90.4) and 70.0% (60.8-80.6) versus 73.6% (64.9-83.3), respectively (not significant). The corresponding hazard ratios (95% confidence intervals, p) were 0.57 (0.32-1.02, p = 0.057) and 0.87 (0.51-1.48, p = 0.61), respectively (univariate Cox proportional hazard model).
Standardised supervised training of laparoscopic colorectal cancer procedures to specialist surgeons may not adversely impact short- and long-term outcomes. This result may also apply to newer surgical techniques as long as standardised teaching methods are followed.
Complete mesocolic excision (CME) in right-sided colon cancers appears to confer oncological benefits compared to conventional colectomy. Identification of the superior mesenteric vein (SMV) remains ...challenging. We describe the novel use of intra-operative robotic ultrasound scan (rUSS) in obese patients (BMI ≥ 29). All consecutive patients having robotic CME for colon cancer between 2014 and 2017 were included in this retrospective cohort study. Data were recorded on an ethics approved prospective database and included patient demographics, clinical and oncological outcomes. Patients were divided into group 1 (BMI ≤ 28) and group 2 (BMI ≥ 29). SMV first approach was employed in all cases and SMV detection was aided using rUSS in group 2. Primary outcome was postoperative morbidity. Secondary outcomes included conversion rate, operative time and length of stay (LOS). 41 (group 1, median 66 years) were compared to 32 patients (group 2, median 63 years). There were no conversions to laparoscopy or laparotomy. Median operative times for group 2 were 30 min longer (186 vs. 216 min,
p
= 0.05). Overall morbidity was similar (20% vs. 19% in group 1 and 2,
p
= 0.26). There was no significant difference between the two groups with regard to LOS (median 7 vs. 6 days,
p
= 0.48), readmissions (2 vs. 5,
p
= 0.13), R0 resection rate (98% vs. 94%,
p
= 0.43) and lymph node harvest (median 31 vs. 30,
p
= 0.28).CME can be technically more challenging than conventional colectomy in obese patients and is associated with longer operative times. The use of rUSS in obese patients can help to identify SMV and allow safer dissection.
Lateral pelvic node dissection (LPND) poses significant technical challenges. Despite the advent of robotic surgery, determining the optimal minimally invasive approach remains a topic of debate. ...This study aimed to compare postoperative outcomes between robotic total mesorectal excision with LPND (R-LPND) and laparoscopic total mesorectal excision with LPND (L-LPND).
This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 and AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) guidelines. Utilizing the RevMan 5.3.5 statistical package from the Cochrane Collaboration, a random-effects model was employed.
Six eligible studies involving 652 patients (316 and 336 in the R-LPND and L-LPND groups, respectively) were retrieved. The robotic approach demonstrated favourable outcomes compared with the laparoscopic approach, manifesting in lower morbidity rates, reduced urinary complications, shorter hospital stays, and a higher number of harvested lateral pelvic lymph nodes. However, longer operative time was associated with the robotic approach. No significant differences were observed between the two groups regarding major complications, anastomotic leak, intra-abdominal infection, neurological complications, LPND time, overall recurrence, and local recurrence.
In summary, the robotic approach is a safe and feasible alternative for Total Mesorectal Excision (TME) with LPND in advanced rectal cancer. Notably, it is associated with lower morbidity, particularly a reduction in urinary complications, a shorter hospital stay and increased number of harvested lateral pelvic nodes. The trade-off for these benefits is a longer operative time.
The use of minimally invasive surgery (MIS) for paediatric surgery has been on the rise since the early 2000s and is complicated by factors unique to paediatric surgery. The rise of robotic surgery ...has presented an opportunity in MIS for children, and recent developments in the reductions in port sizes and single-port surgery offer promising prospects. This study aimed to present a systematic overview and analysis of the existing literature around the use of robotic platforms in the treatment of paediatric gastrointestinal diseases.
In accordance with the PRISMA Statement, a systematic review on paediatric robotic gastrointestinal surgery was conducted on Pubmed, Cochrane, and Scopus. A critical appraisal of the study was performed using the Newcastle Ottawa Scale.
Fifteen studies were included, of which seven were on Hirschsprung's disease and eight on other indications. Included studies were heterogeneous in their populations, age, and sex, but all reported low incidences of intraoperative complications and conversions in their robotic cohorts. Only one study reported on a comparator cohort, with a longer operative time in the robotic cohort (180 vs. 152 and 156 min,
< 0.001), but no significant differences in blood loss, length of stay, intraoperative complications, postoperative complications, or conversion.
Robotic surgery may play a role in the treatment of paediatric gastrointestinal diseases. There is limited data available on modern robotic platforms and almost no comparative data between any robotic platforms and conventional minimally invasive approaches. Further technological developments and research are needed to enhance our understanding of the potential that robotics may hold for the field of paediatric surgery.
Abstract
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary ...inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.
Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for ...malignant disease.
PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates.
Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = - 16.10, 95% CI - 36.57 to 4.36, p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI - 0.18 to 1.36, p = 0.13), and recurrence (OR = 0.97, 95% CI 0.30 to 3.15, p = 0.96).
HALS is an efficient alternative to OS in right colectomy which combines the advantages of OS with the mini-invasive surgery.
Purpose
To compare the outcomes of colonic splenic flexure tumours treated by extended right colectomy versus left colectomy.
Methods
Stage I–III splenic flexure tumours, treated either by extended ...right colectomy or left colectomy between 1996 and 2011, were identified in a prospective database, and the short- and long-term outcomes compared. The survival analyses were performed using the Kaplan–Meier method and adjusted using a Cox-proportional hazard model.
Results
A total of 30 (44 %) splenic flexure tumours were resected by left colectomy and 38 (56 %) by right colectomy. Emergency operations were more common (74 versus 20 %,
p
< 0.001) in the right colectomy group. In the univariate analysis, the 5-year overall survival (55 % for right colectomy versus 60 % for left colectomy,
p
= 0.197) and 5-year recurrence-free survival (41 versus 54 %,
p
= 0.180, respectively) showed a trend towards a non-significant survival benefit for left colectomy. However, when adjusted for age, gender, ASA classification, tumour stage, urgency and year of surgery, this trend disappeared.
Conclusion
Patients undergoing extended right or left colectomy for splenic flexure tumours seemed to have comparable short- and long-term outcomes.
The role of robotic lateral pelvic lymph node dissection (LPLND) for lateral pelvic nodal disease (LPND) in rectal cancer has yet to be investigated in the Western hemisphere. This study aims to ...investigate the safety and feasibility of robotic LPLND by utilising a well-established totally robotic TME protocol.
We conducted a retrospective study on 17 consecutive patients who underwent robotic LPLND for LPND ± TME for rectal cancer between 2015 and 2021. A single docking totally robotic approach from the left hip with full splenic mobilisation was performed using the X/Xi da Vinci platform. All patients underwent a tri-compartmental robotic en bloc excision of LPND with preservation of the obturator nerve and pelvic nerve plexus, leaving a well-skeletonised internal iliac vessel and its branches.
The median operative time was 280 min, which was 40 min longer than our standard robotic TME. The median BMI was 26, and there were no conversions. The median inpatient stay was 7 days with no Clavien-Dindo > 3 complications. One patient (6%) developed local recurrence and metastatic disease within 5 months. The proportion of histologically confirmed LPND was 41%, of which 94% were well to moderately differentiated adenocarcinoma. Median pre-operative lateral pelvic node size was significantly higher in positive nodes (14 mm vs. 8 mm (
= 0.01)). All patients had clear resection margins on histology.
Robotic LPLND is safe and feasible with good peri-operative and short-term outcomes, with the ergonomic advantages of a robotic TME docking protocol readily transferrable in LPLND.
PDF
