Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Robotic Surgery
Published in: Journal of Robotic Surgery 1/2021

01-02-2021 | Rectal Cancer | Original Article

Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital

Authors: Thalia Petropoulou, Shwan Amin

Published in: Journal of Robotic Surgery | Issue 1/2021

Login to get access

Abstract

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/m2 (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.
Literature
1.
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefPubMed
2.
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645CrossRefPubMed
3.
Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRefPubMed
4.
van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218CrossRefPubMed
5.
Park J, Choi G-S, Lim KH, Kang BM, Jun SH (2009) Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13(2):275–281CrossRefPubMed
6.
Baek JH, Pastor C, Pigazzi A (2010) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525CrossRefPubMed
7.
Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25:240–248CrossRefPubMed
8.
Miskovic D, Ahmed J, Bissett-Amess R, Gómez Ruiz M, Luca F, Jayne D, Figueiredo N, Heald RJ, Spinoglio G, Parvaiz A (2019) European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis 21(3):270–276CrossRefPubMed
9.
National Bowel Cancer Audit, Annual Report (2019) An audit of the care received by people with Bowel Cancer in England and Wales v2.0, 0 Healthcare Quality Improvement Partnership (HQIP)
10.
Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580CrossRefPubMedCentralPubMed
11.
Corrigan N, Marshall H, Croft J, Copeland J, Jayne D, Brown J (2018) Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 19(1):339CrossRefPubMedCentralPubMed
12.
Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, de Forges H, Colombo PE (2018) Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol 25(12):3572–3579CrossRefPubMed
13.
14.
Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY et al (2015) Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a case-matched retrospective study. Medicine 94:e522CrossRefPubMedCentralPubMed
15.
Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL (2017) Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 31(6):2387–2396CrossRefPubMed
16.
Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison—open, laparoscopic, and robotic surgery. Ann Surg 257(1):95-101CrossRefPubMed
17.
Zakaria A, Yang I, Kim SH, Toh JWT (2017) Totally robotic single docking low anterior resection for rectal cancer: pearls and pitfalls. Tech Coloproctol 21(11):893–895CrossRefPubMed
18.
Ortiz-Oshiro E, Sánchez-Egido I, Moreno-Sierra J, Pérez CF, Díaz JS, Fernández-Represa JÁ (2012) Robotic assistance may reduce conversion to open in rectal carcinoma surgery: systematic review and meta-analysis. Int J Med Robot 8(3):360–370CrossRefPubMed
19.
Ahmed J, Cao H, Panteleimonitis S, Khan J, Parvaiz A (2017) Robotic vs laparoscopic rectal surgery in high-risk patients. Colorectal Dis 19(12):1092–1099CrossRefPubMed
20.
Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27(9):3297–3307CrossRefPubMed
21.
22.
23.
Lee L, de Lacy B, Gomez Ruiz M, Liberman AS, Albert MR, Monson JRT, Lacy A, Kim SH, Atallah SB (2018) A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low-rectal adenocarcinoma. Ann Surg 270(6):1110–1116CrossRef
24.
Gietelink L, Wouters MW, Tanis PJ, Deken MM, Ten Berge MG, Tollenaar RA, van Krieken JH, de Noo ME (2015) Reduced circumferential resection margin involvement in rectal cancer surgery: results of the Dutch surgical colorectal audit. J Natl Compr Canc Netw 13(9):1111–1119CrossRefPubMed
25.
Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711CrossRefPubMed
26.
Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCICCTG CO16 randomised clinical trial. Lancet 373:821–828CrossRefPubMedCentralPubMed
27.
Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312CrossRefPubMed
28.
Kim J, Baek SJ, Kang DW, Roh YE, Lee JW, Kwak HD, Kwak JM, Kim SH (2017) Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum 60(3):266–273CrossRefPubMed
29.
Hellan M, Ouellette J, Lagares-Garcia JA, Rauh SM, Kennedy HL, Nicholson JD et al (2015) Robotic rectal cancer resection: a retrospective multicenter analysis. Ann Surg Oncol 22:2151–2158CrossRefPubMed
30.
Gómez Ruiz M, Alonso Martin J, Cagigas Fernández C, Martín Parra JI, Real Noval H, Martín Rivas B, Toledo Martínez E, Castillo Diego J, Gómez Fleitas M (2016) Short- and mid-term outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Our experience after 198 consecutive cases. Eur J Surg Oncol 42(6):848–854. https://​doi.​org/​10.​1016/​j.​ejso.​2016.​03.​006(Epub 2016 Mar 29)CrossRefPubMed
31.
32.
Dindo D, Demartines N, Clavien PA (2004) FACS classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedCentralPubMed
33.
34.
Jaap Bonjer H (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332CrossRefPubMed
35.
Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH (2010) Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 17(6):1614–1620CrossRefPubMed
36.
Kim CW, Baik SH, Roh YH, Kang J, Hur H, Min BS, Lee KY, Kim NK (2015) Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis. Medicine 94(22):e823CrossRefPubMedCentralPubMed
37.
Metadata
Title
Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital
Authors
Thalia Petropoulou
Shwan Amin
Publication date
01-02-2021
Publisher
Springer London
Published in
Journal of Robotic Surgery / Issue 1/2021
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI
https://doi.org/10.1007/s11701-020-01087-2

Other articles of this Issue 1/2021

Journal of Robotic Surgery 1/2021 Go to the issue

Original Article

Reducing the cost of robotic hysterectomy: assessing the safety and efficacy of using prograsp forceps in lieu of needle holder for vaginal cuff closure

Brief Communication

Single-port versus multi-port: will “one for all” ever become a new standard for robot-assisted radical prostatectomy?

Original Article

Readmission and complications after robotic surgery: experience of 10,000 operations at a comprehensive cancer center

Letter to the Editor

The use of robot-assisted surgery for visceral abdominal aneurysms treatment

Original Article

Comparisons of surgical outcomes between transperitoneal and retroperitoneal approaches in robot-assisted laparoscopic partial nephrectomy for lateral renal tumors: a propensity score-matched comparative analysis

Original Article

Learning curve of robotic-assisted laparoscopic pyeloplasty (RALP) in children: how to reach a level of excellence?