Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature
Por:
Bianchi G, Gavriilidis P, Martínez-Pérez A, de'Angelis GL, Uzzan M, Sobhani I, Coccolini F, Schena CA, Carra MC, Spinoglio G and de'Angelis N
Publicada:
17 ago 2022
Ahead of Print:
17 ago 2022
Categoría:
Surgery
Resumen:
Purpose: Robotic surgery has been progressively implemented for colorectal procedures but is still limited for multiquadrant abdominal resections. The present study aims to describe our experience in robotic multiquadrant colorectal surgeries and provide a systematic review and meta-analysis of the literature investigating the outcomes of robotic total proctocolectomy (TPC), total colectomy (TC), subtotal colectomy (STC), or completion proctectomy (CP) compared to laparoscopy. Methods: At our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches. Results: In our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04-0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42-190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7-59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing. Conclusions: Our experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown.
Filiaciones:
Bianchi G:
Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
Department of medicine and surgery, University of Parma, Parma, Italy
Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
Gavriilidis P:
Department of surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
:
Faculty of Health Sciences, Valencian International University, Valencia, Spain
Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
de'Angelis GL:
Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
Uzzan M:
Department of Gastroenterology, APHP-Henri Mondor University Hospital, Creteil, France
Sobhani I:
Department of Gastroenterology, APHP-Henri Mondor University Hospital, Creteil, France
EC2M-EA7375 Research Team, Henri Modor Campus, Paris East University, Creteil, France
Coccolini F:
General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
Schena CA:
Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
Carra MC:
Rothschild Hospital, AP-HP, Université de Paris, Paris, France
Spinoglio G:
IRCAD Faculty Member Robotic and Colorectal Surgery-IRCAD, Strasbourg, France
de'Angelis N:
Unit of general surgery, CARE Department, Henri Mondor University Hospital, Créteil, France
EC2M-EA7375 Research Team, Henri Modor Campus, Paris East University, Creteil, France
University Paris-Est, UPEC, Créteil, France
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