Robotic low anterior resection for a distal sigmoid colon cancer during the COVID-19 pandemic- a video vignette.
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ABSTRACT:
SUBMITTER: Kudsi OY
PROVIDER: S-EPMC7436878 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Cooperation with multiple departments is essential for the treatment of patients with rectal cancer and other pelvic cancers. In our department, we experienced two cases of rectal cancer that underwent robotic low anterior resection (LAR) and simultaneous resection of other pelvic organs (case 1 with prostatectomy and case 2 with hysterectomy) using the da Vinci Xi system. Here, we show the precise procedures of these two robotic surgeries. Under general anesthesia and lithotomy position, five da Vinci ports were symmetrically placed along the umbilical horizontal line with a 7 cm interval, and a 5 mm AirSeal Access Port was added in the right or left upper quadrant. Patients were placed with 22-degree Trendelenburg and 8-degree tilt to the right. The operators used the center port on the umbilicus as a camera port and chose the docking arms with either two-left-one-right or one-left-two-right setting depending on their preference. This port setting was quite useful for the operators from multiple departments to change the docking arms, even if their preference may be different. Moreover, assistants could use the remaining two ports to provide a well-expanded and safer surgical field. "With a familiar view" and "with a wide view" are our two concepts to safely perform extended pelvic surgeries. We have employed this symmetrical horizontal port site position as a general setting for usual rectal surgeries.
| S-EPMC6744546 | biostudies-literature
Project description: Not available
| S-EPMC7405145 | biostudies-literature
Project description: Not available
| S-EPMC9314020 | biostudies-literature
Project description:AimThe aim was to develop and operationally define 'performance metrics' that characterize a reference approach to robotic-assisted low anterior resection (RA-LAR) and to obtain face and content validity through a consensus meeting.MethodThree senior colorectal surgeons with robotic experience and a senior behavioural scientist formed the Metrics Group. We used published guidelines, training materials, manufacturers' instructions and unedited videos of RA-LAR to deconstruct the operation into defined, measurable components - performance metrics (i.e. procedure phases, steps, errors and critical errors). The performance metrics were then subjected to detailed critique by 18 expert colorectal surgeons in a modified Delphi process.ResultsPerformance metrics for RA-LAR had 15 procedure phases, 128 steps, 89 errors and 117 critical errors in women, 88 errors and 118 critical errors in men. After the modified Delphi process the final performance metrics consisted of 14 procedure phases, 129 steps, 88 errors and 115 critical errors in women, 87 errors and 116 critical errors in men. After discussion by the Delphi panel, all procedure phases received unanimous consensus apart from phase I (patient positioning and preparation, 83%) and phase IV (docking, 94%).ConclusionA robotic rectal operation can be broken down into procedure phases, steps, with errors and critical errors, known as performance metrics. The face and content of these metrics have been validated by a large group of expert robotic colorectal surgeons from Europe. We consider the metrics essential for the development of a structured training curriculum and standardized procedural assessment for RA-LAR.
| S-EPMC7818231 | biostudies-literature
Project description:BackgroundReported advantages to robotic thoracic surgery include shorter length of stay (LOS), improved lymphadenectomy, and decreased complications. It is uncertain if these benefits occur when introducing robotics into a well-established video-assisted thoracoscopy (VATS) practice. We compared the two approaches to investigate these advantages.Materials and methodsIRB approval was obtained for this project. Patients who underwent segmentectomy or lobectomy from May 2016-December 2018 were propensity-matched 2: 1 (VATS: robotic) and compared using weighted logistic regression with age, gender, Charlson Comorbidity Index, surgery type, stage, Exparel, and epidural as covariates. Complication rates, operation times, number of sampled lymph nodes, pain level, disposition, and LOS were compared using Wilcoxon rank-sum and with Rao-Scott Chi-squared tests.Results213 patients (142 VATS and 71 robot) were matched. Duration of robotic cases was longer than VATS (median 186 min (IQR 78) vs. 164 min (IQR 78.75); p < 0.001). Significantly more lymph nodes (median 11 (IQR 7.50) vs. 8 (IQR 7.00); p = 0.004) and stations were sampled (median 4 (IQR 2.00) vs. 3 (IQR 1.00); p < 0.001) with the robot. Interestingly, robotic resections had higher 72-hour pain scores (median 3 (IQR 3.25) vs. 2 (IQR 3.50); p = 0.04) and 48-hour opioid usage (median 37.50 morphine milligram equivalents (MME) (IQR 45.50) vs. 22.50 MME (IQR 37.50); p = 0.01). Morbidity, LOS, and disposition were similar (all p > 0.05).ConclusionsThe robotic approach facilitates better lymph node sampling, even in an established VATS practice.
| S-EPMC11325388 | biostudies-literature
Project description:Study aimed to assess long-term bowel function in patients who underwent low anterior resection for cancer five and more years ago. Patients who underwent low anterior resection for rectal cancer from 2010 to 2015 at National Cancer Institute were prospectively included in our study. They were interviewed using low anterior resection syndrome (LARS) score and Wexner questionnaire. We also assessed possible risk factors of postoperative bowel disorder. 150 patients were included in our study. Of them 125 (83.3%) were analysed. The median age at diagnosis was 62 years (40-79), and the average time of follow-up was 7.5 years (5-11). Overall, 58 (46.4%) patients had LARS, of them 33 (26.4%)-major LARS and 25 (20%)-minor LARS and 67 (53.6%) reported no LARS. Wexner score results were: normal in 43 (34.4%) patients, minor faecal incontinence-55 (44%), average faecal incontinence-18 (14.4%), complete faecal incontinence-9 (7.2%). 51 patients (40.8%) had tumour in the upper third rectum, 51 (40.8%)-in the middle and 23 (18.4%)-lower third. Preoperative (chemo)radiotherapy was the only significant risk factors for developing LARS in univariate analysis. Our study showed that only preoperative radiotherapy may be associated with more late problems in defecation after rectal cancer surgery.Trial registration: NCT03920202.
| S-EPMC7368023 | biostudies-literature
Project description:BackgroundLow anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience.ObjectiveThe aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders.DesignThis international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting.ParticipantsThree expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish).Main outcome measureThe primary outcome measured was the priorities for the definition of low anterior resection syndrome.ResultsThree hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome.LimitationsSampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this.ConclusionsThis is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.
| S-EPMC7034376 | biostudies-literature
Project description: Not available
| S-EPMC6486209 | biostudies-literature
Project description:IntroductionSigmoid colon anatomic dimensions have been studied to have roles in the occurrence of sigmoid volvulus; however, these studies are few in number and failed to control the confounding effect of acute sigmoid obstruction on the anatomic dimensions. The main objective of this study was to assess the role of sigmoid colon anatomic dimensions in the development of sigmoid volvulus controlling the effect of acute sigmoid obstruction on the anatomic dimensions.Materials and methodsThe study was carried out from Dec, 2019 to April, 2021 at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital, two referral hospitals in Bahir Dar city, North-Western Ethiopia to compare sigmoid anatomic dimensions among three independent groups of participants: patients with no history of sigmoid volvulus (I), those for whom elective surgery was done after non-surgical detorsion of sigmoid volvulus (II), and patients for whom emergency surgery was done for sigmoid volvulus (III). The anatomic dimensions were compared using fixed effects one-way ANOVA or Kruskal-Wallis H test at p-value ≤ .05 (two-sided) and Tukey method or Dunn-Bonferroni's test was used for post-hoc comparisons.ResultsA total of 66 consecutive eligible patients (22 for each of the three groups) were included and analyzed in the study. The means of anatomic dimensions (in cm) for groups (I, II, III) were: sigmoid colon length-SCL (35.91, 71.07, 80.86), meso-sigmoid height-MSH (17.11, 26.52, 28.86), meso-sigmoid maximal width-MSMW (9.70, 14.89,16.80), and meso-sigmoid root width-MSRW (8.34, 7.48, 8.11). SCL, MSH, MSMW, MSH/MSRW, and MSMW/MSRW were found to be statistically significantly different in patients with sigmoid volvulus. MSRW and MSH/MSMW were not different between the study groups.ConclusionA long sigmoid colon with long and wide mesentery, but with a constant base is highly likely to predispose individuals to sigmoid volvulus.
| S-EPMC8635388 | biostudies-literature
Project description:RationaleSynchronous double malignancies, including carcinoma of the ampulla of Vater and rectal carcinoma, are generally uncommon occurrences in the gastrointestinal tract.Patient concernsThe present study report a case of a 37-year-old man who was incidentally found to suffer from carcinoma of the ampulla of Vater and rectal carcinoma.DiagnosesThe duodenoscopy was performed and revealed an ulcerated and bulky ampulla of Vater, the biopsy from which revealed a moderate-differentiated adenocarcinoma, A local hospital colonoscopy confirmed a tumor located in rectal 7 cm from the anal margin and biopsy-confirmed poorly differentiated adenocarcinoma.InterventionsAbout such patient treatment, both open and laparoscopic surgery are restricted because of operation complexity, large injury, and poor cosmetic effect. surgery performed using Da Vinci robotic surgical system (DVSS).OutcomesNo evidence of recurrence or relapses was found in the first year after surgery.LessonsAlthough sporadic double malignancies are uncommon, they should be considered when evaluating cancer patients. Complex surgery performed by robotic surgery may became surgeon's preferred treatment modality.
| S-EPMC5959404 | biostudies-literature