Diego I. Ramos-Valadez

A Three-Arm (Laparoscopic, Hand-Assisted, and Robotic) Matched-Case Analysis of Intraoperative and Postoperative Outcomes in Minimally Invasive Colorectal Surgery

PURPOSE: Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. METHODS: Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. RESULTS: There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P < .01) and hand-assisted (P < .001) techniques; however, this difference was not maintained in cases with low pelvic anastomoses. The overall mean length of stay was 3.3 ± 1.8 days with no significant difference between the groups. Pathological analysis of malignant cases revealed a median lymph node extraction of 17 with no significant difference among the 3 modalities. CONCLUSION: In this 3-arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

Robotic-assisted single-incision laparoscopic partial cecectomy.

Single‐incision laparoscopic surgery is an emerging approach in the field of minimally invasive colon and rectal surgery. This modality utilizes a ‘scarless’ incision concealed within the umbilicus, and results in improved cosmesis with the potential for reduced trauma, pain and length of hospital stay. However, unique technical challenges have curbed its adaptation. Robotic‐assisted technique may help overcome these limitations when applied to the single‐incision approach.

Robotic-assisted laparoscopic surgery for restorative proctocolectomy with ileal J pouch-anal anastomosis

Abstract Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for chronic ulcerative colitis (CUC). Robotic-assisted laparoscopic surgery (RALS) has been shown to have its greatest merits in colorectal procedures involving the pelvis. The aim of this study was to evaluate the safety and feasibility of RP with IPAA using an innovative robotic technique. A total of five consecutive patients underwent RALS RP with IPAA between August 2008 and February 2010. Patient demographics, intraoperative parameters, and postoperative outcomes were tabulated and assessed. Surgery was indicated for medically intractable CUC in three patients (60%), CUC-related dysplasia in one patient (20%) and CUC-related adenocarcinoma in one patient (20%). An ileal pouch-anal anastomosis was successful in all five cases. The mean operative time was 330 min and estimated blood loss was 200 cc. There were no intraoperative complications or conversions. The mean length of hospital stay was 5.6 days and no patients developed major postoperative complications. RALS is an innovative technique offering technical and visual advantages to the colorectal surgeon and can be offered for those who are seeking restorative proctolectomy for chronic ulcerative colitis.

Single incision laparoscopic-assisted right hemicolectomy: technique and application (with video).

Purpose Most commonly employed for surgery of the gallbladder and appendix, single-incision laparoscopic surgery (SILS) is rapidly evolving in the field of minimally invasive surgery. The purpose of this report is to describe the feasibility and technique for SILS right hemicolectomy, which has not been widely reported. Methods We describe a laparoscopic right hemicolectomy with a modified single-incision technique for the management of a precancerous polyp of the ascending colon. Results The procedure was successfully performed in 105 minutes using 3 transumbilical trocars placed through a single port, and readily available nonarticulating laparoscopic instruments. In addition, we review the literature of SILS procedures involving the colon and discuss differences between our approach and those reported elsewhere. Conclusions SILS is a feasible modality applicable to minimally invasive surgery of the colon and can offer benefits to the patient.

Robotic-Assisted Laparoscopic “Salvage” Rectopexy for Recurrent Ileoanal J-Pouch Prolapse

Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive “salvage” approach involving a robotic-assisted laparoscopic rectopexy with mesh.