Skip to main content

Advertisement

SpringerLink
Log in

Patient experiences of left-sided colorectal resection by robotic, conventional laparoscopic and open approaches: a qualitative study

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Robotic surgery (RS) is increasingly employed in colorectal surgical practice, widening the range of surgical techniques offered to patients. We investigated the perceptions of patients with colorectal cancer in relation to RS, open surgery (OS) and conventional laparoscopic surgery (CLS), to identify ideas or assumptions which, in the context of shared surgeon–patient decision-making, may affect the resultant choice of surgical technique. We also investigated salient factors affecting patients’ perioperative experience, including those of RS patients, to guide improvements in care and preoperative patient preparation.

Methods

This study was conducted on patients who underwent resection of left-sided colorectal cancer at a large UK teaching hospital from November 2020 to July 2021. Purposive sampling was used to ensure a roughly equal proportion of patients who underwent RS, CLS and OS. The patients included in the study participated in semi-structured interviews six weeks postoperatively. The interview schedule allowed discussion around patients’ experience of their surgery and postoperative recovery, and their perceptions of surgical techniques. Interview transcripts were coded manually using inductive thematic analysis, and analyst triangulation was employed to refine coding schemes and ensure reliability of emerging themes.

Results

Twenty-seven patients were recruited to the study; RS n = 9 (median age 69 [range 60–80] years); CLS n = 10 (median age 72 [range 32–82] years; OS n = 8 (median age 71 [range 60–75] years). Patients understood the technological benefits of RS but were concerned by a risk of technological failure causing patient harm. OS was understood to be associated with more pain and longer recovery than RS or CLS. Patients perceived CLS to be more technically challenging compared with OS. Less pain and smaller wounds than expected were significant positive factors in the experience of RS and CLS patients specifically. Complications and emotional impact were significant factors in the experience of all groups, for which many patients felt underprepared.

Conclusions

Patients generally have a positive view of RS and technical innovation in surgery. Concerns mostly centred around failure of technology. Many patients felt unprepared for significant factors in their perioperative experience. Surgeons and healthcare providers should be prepared to address patients’ perceptions and expectations of colorectal surgery preoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data that support the findings of this study are available on request from the corresponding author [OC]. The data are not publicly available due to them containing information that could compromise research participant privacy.

References

  1. Ruiz MG, Escribano ML, Fernández CC, Poch LC, Martínez SS (2020) Robotic surgery for colorectal cancer. Ann Gastroenterol Surg 4:646–651. https://doi.org/10.1002/ags3.12401

    Article  Google Scholar 

  2. Muaddi H, El Hafid M, Choi WJ et al (2021) Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg 273:467–473. https://doi.org/10.1097/SLA.0000000000003915

    Article  PubMed  Google Scholar 

  3. Jayne D, Pigazzi A, Marshall H et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580. https://doi.org/10.1001/jama.2017.7219

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ng KT, Tsia AKV, Chong VYL (2019) Robotic versus conventional laparoscopic surgery for colorectal cancer: a systematic review and meta-analysis with trial sequential analysis. World J Surg 43:1146–1161. https://doi.org/10.1007/s00268-018-04896-7

    Article  PubMed  Google Scholar 

  5. Trinh BB, Hauch AT, Buell JF, Kandil E (2014) Robot-assisted versus standard laparoscopic colorectal surgery. JSLS 18(e2014):00154. https://doi.org/10.4293/JSLS.2014.00154

    Article  Google Scholar 

  6. Wee IJY, Kuo LJ, Ngu JCY (2021) Urological and sexual function after robotic and laparoscopic surgery for rectal cancer: a systematic review, meta-analysis and meta-regression. Int J Med Robot 17:1–8. https://doi.org/10.1002/rcs.2164

    Article  PubMed  Google Scholar 

  7. Boys JA, Alicuben ET, DeMeester MJ et al (2016) Public perceptions on robotic surgery, hospitals with robots, and surgeons that use them. Surg Endosc 30:1310–1316. https://doi.org/10.1007/s00464-015-4368-6

    Article  PubMed  Google Scholar 

  8. McDermott H, Choudhury N, Lewin-Runacres M, Aemn I, Moss E (2020) Gender differences in understanding and acceptance of robot-assisted surgery. J Robot Surg 14:227–232. https://doi.org/10.1007/s11701-019-00960-z

    Article  PubMed  Google Scholar 

  9. Carmona C, Crutwell J, Burnham M, Polak L, Guideline Committee (2021) Shared decision-making: summary of NICE guidance. BMJ 373:n1430. https://doi.org/10.1136/bmj.n1430

    Article  PubMed  Google Scholar 

  10. Klose K, Kreimeier S, Tangermann U, Aumann I, Damm K, RHO Group (2016) Patient and person-reports on healthcare: preferences, outcomes, experiences, and satisfaction—an essay. Health Econ Rev 6:18. https://doi.org/10.1186/s13561-016-0094-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB (2014) The impact of different surgical modalities for hysterectomy on satisfaction and patient reported outcomes. Interact J Med Res 3:e11. https://doi.org/10.2196/ijmr.3160

    Article  PubMed  PubMed Central  Google Scholar 

  12. Long E, Kew F (2018) Patient satisfaction with robotic surgery. J Robot Surg 12:493–499. https://doi.org/10.1007/s11701-017-0772-3

    Article  PubMed  Google Scholar 

  13. Abelson JS, Chait AC, Shen MJ et al (2018) Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study. J Surg Res 226:140–149. https://doi.org/10.1016/j.jss.2018.01.017

    Article  PubMed  Google Scholar 

  14. Cuijpers ACM, Lubbers T, van Rens HA et al (2022) The patient perspective on the preoperative colorectal cancer care pathway and preparedness for surgery and postoperative recovery-a qualitative interview study. J Surg Oncol 126(3):544–554. https://doi.org/10.1002/jso.26920

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang R, Yao C, Hung SH (2022) Preparing for colorectal surgery: a qualitative study of experiences and preferences of patients in Western Canada. BMC Health Serv Res 22(1):730. https://doi.org/10.1186/s12913-022-08130-y

    Article  PubMed  PubMed Central  Google Scholar 

  16. Moloney R, O’Brien B, Coffey JC, Coffey A, Murphy F (2020) Patients’ perceptions after robot-assisted surgery: an integrative review. AORN J 112:133–141. https://doi.org/10.1002/aorn.13104

    Article  PubMed  Google Scholar 

  17. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101. https://doi.org/10.1191/1478088706qp063oa

    Article  Google Scholar 

  18. Denny E, Weckesser A (2019) Qualitative research: what it is and what it is not: study design: qualitative research. BJOG 126:369. https://doi.org/10.1111/1471-0528.15198

    Article  PubMed  Google Scholar 

  19. Herling SF, Palle C, Moeller AM, Thomsen T (2016) The experience of robotic-assisted laparoscopic hysterectomy for women treated for early-stage endometrial cancer: a qualitative study. Cancer Nurs 39:125–133. https://doi.org/10.1097/NCC.0000000000000260

    Article  PubMed  Google Scholar 

  20. Parker JM, Feldmann TF, Cologne KG (2017) Advances in laparoscopic colorectal surgery. Surg Clin North Am 97:547–560. https://doi.org/10.1016/j.suc.2017.01.005

    Article  PubMed  Google Scholar 

  21. National Bowel Cancer Audit (2020) Annual Report 2020. Healthcare Quality Improvement Partnership (HQIP). https://www.nboca.org.uk/content/uploads/2020/12/NBOCA-2020-Annual-Report.pdf. Accessed 23 Sept 2022

  22. Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  23. Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB (2012) Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum 55:1300–1310. https://doi.org/10.1097/DCR.0b013e31826ab4dd

    Article  PubMed  Google Scholar 

  24. Bonrath EM, Dedy NJ, Zevin B, Grantcharov TP (2013) Defining technical errors in laparoscopic surgery: a systematic review. Surg Endosc 27:2678–2691. https://doi.org/10.1007/s00464-013-2827-5

    Article  PubMed  Google Scholar 

  25. Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG z6051 randomized clinical trial. JAMA 314:1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Ahmad A, Ahmad ZF, Carleton JD, Agarwala A (2017) Robotic surgery: current perceptions and the clinical evidence. Surg Endosc 31(1):255–263

    Article  PubMed  Google Scholar 

  27. Thell CG (2011) Patient advocacy in robotic surgery. Periop Nurs Clin 6(3):235–240. https://doi.org/10.1016/j.cpen.2011.05.001

    Article  Google Scholar 

  28. Scarborough JE, Schumacher J, Kent KC, Heise CP, Greenberg CC (2017) Associations of specific postoperative complications with outcomes after elective colon resection: a procedure-targeted approach toward surgical quality improvement. JAMA 152:e164681. https://doi.org/10.1001/jamasurg.2016.4681

    Article  Google Scholar 

  29. Harnsberger CR, Maykel JA, Alavi K (2019) Postoperative Ileus. Clin Colon Rectal Surg 32:166–170. https://doi.org/10.1055/s-0038-1677003

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gehring MB, Lerret S, Johnson J et al (2020) Patient expectations for recovery after elective surgery: a common-sense model approach. J Behav Med 43:185–197. https://doi.org/10.1007/s10865-019-00097-2

    Article  PubMed  Google Scholar 

  31. Chapman SJ, Helliwell JA, Lonsdale MDS, Tiernan JP, Jayne DG (2020) Patient education about recovery after colorectal surgery: systematic scoping review. Colorectal Dis 22:1842–1849. https://doi.org/10.1111/codi.15337

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was funded by Intuitive Foundation—Clinical Robotic Research Grant.

Author information

Authors and Affiliations

  1. Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, UK

    O. Claydon, J. McCulloch, S. Kulkarni, C. Delimpalta, D. Dowsett, W. Ward, A. Stearns, J. Hernon, S. Kapur & I. Shaikh

  2. University of East Anglia, Norwich, UK

    G. C. Thorpe

Authors
  1. O. Claydon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. McCulloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. C. Thorpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Delimpalta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Dowsett
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. W. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Stearns
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Hernon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Kapur
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. I. Shaikh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jane McCulloch and Gabrielle C Thorpe. The first draft of the manuscript, and all revised versions, were written by Oliver Claydon. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to O. Claydon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study received ethical approval in our institution (Norfolk & Norwich University Hospital NHS Foundation Trust).

Informed consent

All patients provided written consent to their participation in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Claydon, O., McCulloch, J., Thorpe, G.C. et al. Patient experiences of left-sided colorectal resection by robotic, conventional laparoscopic and open approaches: a qualitative study. Tech Coloproctol 27, 537–549 (2023). https://doi.org/10.1007/s10151-023-02764-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-023-02764-8

Keywords

Search

Navigation