A difficult case of robotic splenic-flexure mobilization, performed by a trainee surgeon with a dual Davinci console.
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ABSTRACT:
SUBMITTER: Petropoulou T
PROVIDER: S-EPMC7359162 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
A difficult case of robotic splenic-flexure mobilization, performed by a trainee surgeon with a dual Davinci console.
Techniques in coloproctology 20200427 8
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Project description:IntroductionSplenic flexure mobilization (SFM) may be indicated during anterior resection to provide a tension-free anastomosis. However, to date, no score allows identifying patients who may benefit from SFM.MethodsPatients who underwent robotic anterior resection for rectal cancer were identified from a prospective register. Demographic and cancer-related variables were extracted, and predictors of SFM were identified using regression models. Thereafter, 20 patients with SFM and 20 patients without SFM were randomly selected and their pre-operative CTscan were reviewed. The radiological index was defined as 1/(sigmoid length/pelvis depth). The optimal cut-off value for predicting SFM was identified using ROC curve analysis.ResultsFive hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8 min (95% CI: 11.3 to 32.4, p < 0.001). The incidence of postoperative complications did not differ between patient with or without SFM. Realization of an anastomosis was the main predictor for SFM (OR: 42.4, 95% CI: 5.8 to 308.5, p < 0.001). In patients with colorectal anastomosis, both sigmoid length (15 ± 5.1 cm versus 24.2 ± 80.9 cm, p < 0.001) and radiological index (1 ± 0.3 versus 0.6 ± 0.2, p < 0.001) differed between patients who had SFM and patients who did not. ROC curve analysis of the radiological index indicated an optimal cut-off value of 0.8 (sensitivity: 75%, specificity: 90%).ConclusionSFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8 min. For optimal surgical planning, patients requiring SFM can be identified based on pre-operative CT using the index 1/(sigmoid length/pelvis depth) with a cut-off value set at 0.8.
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Project description:BackgroundBecause methods of performing laparoscopic left hemicolectomy differ between surgeons, standardizing the procedure is crucial to reduce complications and secure good oncologic outcomes.Materials and methodsThis is a retrospective hospital-based cohort study using a propensity score-weighted method. This study was conducted at the department of colorectal surgery in a tertiary teaching hospital between October 2007 and December 2017. The short-term and long-term outcomes of open and laparoscopic left hemicolectomy from 10 years of experience using a standardized 4-step laparoscopic procedure at one institution were compared. Short-term outcomes were postoperative morbidity and mortality. Long-term outcomes were disease-free survival and overall survival.ResultsWe enrolled 564 patients who underwent open or laparoscopic left hemicolectomy for primary colon adenocarcinoma. The open surgery and laparoscopy groups had 357 and 207 patients, respectively. Compared with the open surgery group, the laparoscopy group had significantly shorter hospital stays (open vs. laparoscopy, 10 vs. 7 d, P<0.001), less postoperative morbidity (open vs. laparoscopy, 16.5% vs. 9.2%, P<0.001), and lower risks of superficial surgical site infections, lung complications, and gastrointestinal complications. No differences were observed between the groups in postoperative mortality (open vs. laparoscopy, 0.6% vs. 0.0%, P=0.23), disease-free survival curves (P=0.69), or overall survival curves (P=0.85).ConclusionsOur standardized 4-step technique of laparoscopic left hemicolectomy is more efficient, has fewer surgical complications, and yields better short-term and similar long-term oncologic outcomes compared with open surgery.
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Project description:In the Low Anterior Resection of rectum for cancer, the section level of IMA and the need of SFM is still debated.
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