Amjad Parvaiz

Robotic versus laparoscopic rectal surgery in high-risk patients

Laparoscopic rectal surgery is associated with a steep learning curve and high conversion rate despite progress in equipment design and consistent practice. The robotic system has shown an advantage over the laparoscopic approach due to stable three‐dimensional views, improved dexterity and better ergonomics. These factors make the robotic approach more favourable for rectal surgery. The aim of this study was to compare the perioperative outcomes of laparoscopic and robotic rectal cancer surgery in high‐risk patients.

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

Tailored robotic abdominoperineal resection with the da Vinci Xi for a re-growth of rectal tumour after complete clinical response - a video vignette.

Controversy persists as to the optimal surgical technique for abdominoperineal excision of the rectum (APER).(1–3). Extra-levator dissection has been advocated by certain groups who claim to have better R0 resection rates and a reduced incidence of perforation (4–6). However, such a radical approach may result in poorer wound healing, prolonged hospital stay and increased wound morbidity (7). In this operative video we present an abdominoperineal resection using the da Vinci Xi on a 34-year-old lady who had a low rectal adenocarcinoma. This article is protected by copyright. All rights reserved.

Standardized approach to robotic right colectomy - a video vignette

Robotic approach to colonic surgery is one of the latest minimal invasive techniques evolving over the last few years. Robotic platform offers the advantage of stable immersive 3D high-definition vision, fully wristed instruments leading to added precision for surgeons [1]⁠. Oncological safety of robotic colonic surgery is comparable with laparoscopic approach and this has already been established. This article is protected by copyright. All rights reserved.

Tailor-made robotic anterior resection and hysterectomy - a video vignette

In this video we describe a standardized approach to a technically difficult procedure (Low anterior resection and en - bloc hysterectomy) using the Da Vinci Xi. Along with the video there is a detailed commentary of the steps, the possible pitfalls and advice for the most effective approach to this operation. The patient is a 55-years- old lady with Adenocarcinoma. This article is protected by copyright. All rights reserved.

Laparoscopic en bloc total mesorectal excision post chemoradiotherapy - a video vignette.

The role of laparoscopy in rectal surgery is recognised as an important development in recent years with large multicentre trials demonstrating the safety and feasibility of this approach (1–3). However, total mesorectal excision (TME) surgery in locally advanced rectal cancers remains challenging, often resulting in the adoption of an open approach by the surgical community in such patients. In this operative video we demonstrate a laparoscopic TME on a 72-year-old male patient with body mass index (BMI) 30, with locally advanced low rectal cancer (T4b anterior rectal cancer) who received long course neoadjuvant chemoradiotherapy. Surgery was performed at 12 weeks post treatment. The tumour was involving the left seminal vesicle, therefore an en bloc resection of the seminal vesicle was performed to achieve R0 resection. A standardised approach as previously described for laparoscopic TME was employed during this procedure (4). This article is protected by copyright. All rights reserved.

Robotic TME for a T4 rectal cancer after radiotherapy - a video vignette

Neoadjuvant treatment plays an important role in the downstaging of rectal cancer. Some patients who are treated in this way will develop a complete clinical response (1). The adoption of a “watch and wait” policy for patients who have undergone complete clinical response is now accepted in many centres (2,3). An intensive follow-up protocol, including clinical, endoscopic and magnetic resonance imaging (MRI) assessment every four months for the first 2 years is recommended (3). Studies have shown that despite some excellent responses to the initial treatment, up to 30% of patients will develop a regrowth requiring surgical resection (1–3). This article is protected by copyright. All rights reserved.

Robotic lower anterior resection for a regrowth following complete clinical response - a video vignette

Chemoradiation is increasingly being recognised as an important factor for downstaging rectal cancer before surgery. A proportion of these patients would develop a complete clinical response following neo-adjuvant chemoradiation (1). This article is protected by copyright. All rights reserved.

Role of laparoscopy in multi-visceral resection for colorectal cancer

A laparoscopic approach is considered to be standard practice for elective colorectal resections (1). Although, several studies have shown better short-term clinical and equivalent oncological outcomes (2,3), this technique largely remains confined to resection of primary locally resectable tumours. With increasing experience and improvement in instrumentation, an increasing number of centres are using laparoscopy for the resection of locally advanced colorectal cancers (4). This article is protected by copyright. All rights reserved.