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Journal of Gastrointestinal Surgery

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01-03-2012 | Original Article

Robotic-Assisted Proctectomy for Inflammatory Bowel Disease: A Case-Matched Comparison of Laparoscopic and Robotic Technique

Authors: Aaron T. Miller, Julia R. Berian, Michele Rubin, Roger D. Hurst, Alessandro Fichera, Konstantin Umanskiy

Published in: Journal of Gastrointestinal Surgery | Issue 3/2012

Abstract

Background

The objective of this study was to compare short-term outcomes of robotic and laparoscopic proctectomy in patients with inflammatory bowel disease (IBD).

Methods

This is an IRB-approved case-matched review. Seventeen robotic proctectomies (RP), 10 with ileal pouch anal anastomosis (IPAA) and 7 completion (CP), were matched to laparoscopic proctectomies (LP). Short-term and functional outcomes were compared between LP and RP.

Results

In CP cohort, operative times were longer in the RP group (351 RP vs 238 LP min, p = 0.03), mean robotic time 90 min. Estimated blood loss (EBL) was similar between RP-CP and LP-CP groups (p = 0.18). Return of bowel function (RBF) was slower in RP-CP group (3.0 vs 1.7 days, p = 0.04), and length of stay (LOS) was longer (6.4 vs 4.1 days, p = 0.02). In the IPAA group, there were no differences between operative times (p = 0.14), robotic time 86 min; EBL (p = 0.15), and postoperative complications. Return of bowel function (3.6 vs 2.6 days, p = 0.3) and LOS (8.5 vs 6.1 days, p = 0.17) were similar between RP and LP. Bowel and sexual function were equivalent between LP and RP-IPAA groups.

Conclusions

Robotic proctectomy is a safe and effective technique for patients with IBD. It is comparable to LP with regard to perioperative outcomes, complications, and short-term functional results.

Fiorino G, Rovida S, Correale C, Malesci A, Danese S. Emerging biologics in the treatment of inflammatory bowel disease: what is around the corner? Curr Drug Targets. 2010 Feb;11(2):249–60.PubMedCrossRef

Grimpen F, Pavli P. Advances in the management of inflammatory bowel disease. Intern Med J. 2010 Apr;40(4):258–64.PubMedCrossRef

Pandey S, Luther G, Umanskiy K, Malhotra G, Rubin MA, Hurst RD, Fichera A. Minimally invasive pouch surgery for ulcerative colitis: is there a benefit in staging? Dis Colon Rectum. 2011 Mar;54(3):306–10.PubMedCrossRef

Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg. 2009 Mar;13(3):526–32.PubMedCrossRef

Holder-Murray J, Zoccali M, Hurst RD, Umanskiy K, Rubin M, Fichera A. Totally laparoscopic total proctocolectomy: A safe alternative to open surgery in inflammatory bowel disease. Inflamm Bowel Dis. 2011. doi: 10.1002/ibd.21808

Ahmed K, Khan MS, Vats A, Nagpal K, Priest O, Patel V, Vecht JA, Ashrafian H, Yang GZ, Athanasiou T, Darzi A. rrent status of robotic assisted pelvic surgery and future developments. Int J Surg. 2009 Oct;7(5):431–40.PubMedCrossRef

Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg. 2004 Jan;239(1):14–21.PubMedCrossRef

Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006 Oct;20(10):1521–5.PubMedCrossRef

De Souza AL, Prasad LM, Ricci J, Park JJ, Marecik SJ, Zimmern A, Blumetti J, Abcarian H. A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma. Dis Colon Rectum. 2011 Mar;54(3):275–82.

10.

Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011 Feb;54(2):151–6.PubMedCrossRef

11.

Pedraza R, Patel CB, Ramos-Valadez DI, Haas EM. Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis. Minim Invasive Ther Allied Technol. 2011 Jul;20(4):234–9

12.

Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum. 2000 May;43(5):604–8PubMedCrossRef

13.

Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J. Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg. 2006 May;243(5):667–70.PubMedCrossRef

14.

Rotholtz NA, Aued ML, Lencinas SM, Zanoni G, Laporte M, Bun M, Boerr L, Mezzadri NA. Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection. Surg Endosc. 2008 May;22(5):1303–8.PubMedCrossRef

15.

Rink AD, Radinski I, Vestweber KH. Does mesorectal preservation protect the ileoanal anastomosis after restorative proctocolectomy? J Gastrointest Surg. 2009 Jan;13(1):120–8.PubMedCrossRef

16.

Sartori CA, Sartori A, Vigna S, Occhipinti R, Baiocchi GL. Urinary and sexual disorders after laparoscopic TME for rectal cancer in males. J Gastrointest Surg. 2011 Apr;15(4):637–43.PubMedCrossRef

17.

Asoglu O, Matlim T, Karanlik H, Atar M, Muslumanoglu M, Kapran Y, Igci A, Ozmen V, Kecer M, Parlak M. Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc. 2009 Feb;23(2):296–303.PubMedCrossRef

18.

Breukink SO, van der Zaag-Loonen HJ, Bouma EM, Pierie JP, Hoff C, Wiggers T, Meijerink WJ. Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision. Dis Colon Rectum. 2007 Feb;50(2):147–55.PubMedCrossRef

19.

Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg. 2003 Sep;238(3):433–41.PubMed

20.

Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010 Nov;24(11):2888–94.PubMedCrossRef

21.

Park JS, Choi GS, Lim KH, Jang YS, Jun SH. Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol. 2010 Dec;17(12):3195–202.PubMedCrossRef

22.

Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 2010 Jun;17(6):1614–20.PubMedCrossRef

23.

Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L. Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS. 2009 Apr-Jun;13(2):176–83.PubMed

Title: Robotic-Assisted Proctectomy for Inflammatory Bowel Disease: A Case-Matched Comparison of Laparoscopic and Robotic Technique
Authors: Aaron T. Miller
Julia R. Berian
Michele Rubin
Roger D. Hurst
Alessandro Fichera
Konstantin Umanskiy
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1692-6

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Springer Medicine

Robotic-Assisted Proctectomy for Inflammatory Bowel Disease: A Case-Matched Comparison of Laparoscopic and Robotic Technique

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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