Skip to main content

Advertisement

SpringerLink
Log in

Robot-assisted low anterior resection in fifty-three consecutive patients: an Indian experience

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

From December 2005 to December 2009, we performed 150 laparoscopic colorectal procedures. Based on this experience, we started offering robot-assisted colorectal surgery from December 2009. This study is a prospective evaluation of consecutive patients in order to study the technical feasibility and oncological outcome of robot-assisted low anterior resection. This investigation was conducted at a single minimal access surgery institute. Between December 2009 and December 2011, 53 consecutive patients with rectal adenocarcinoma underwent a robot-assisted low anterior resection (LAR) or ultralow anterior resection (ULAR) with total mesorectal excision (TME), using the standard da Vinci ‘S’ model. Patient demographics, mean operative time, mean postoperative hospital stay, blood loss, days to first flatus, resumption of oral feeds, urinary incontinence, and sexual dysfunction were studied. Surgical and pathological outcomes such as quality of TME, free circumferential margins, and number of lymph nodes dissected were also evaluated. Robot docking and undocking times were noted. Of the 53 patients, 41 were men and 12 were women. Their mean age was 66.7 years (range 37–90 years). The ASA grades were distributed as follows: ASA I 15 (28.3 %), ASA II 25 (47.16 %), ASA III 12 (22.64 %), ASA IV 1 (1.88 %). The mean operative time was 180 min (150–230 min) and the mean blood loss was 101.6 ml (50–300 ml). The robot docking time was 10 min (15–25 min) and the undocking time was 5 min (3–10 min). The mean hospital stay was 8 days (7–15 days). None of the patients was converted to either laparoscopic or open procedure. The longitudinal and circumferential margins were negative in all patients. Histopathological reports of 45 patients showed complete TME while 8 patients showed nearly complete TME. No repositioning of the robot was needed for splenic flexure mobilization, thus decreasing the operative time. Along with TME, even the splenic flexure mobilization was achieved through the same robotic ports without undocking the robot. Robot-assisted LAR and ULAR is technically feasible, and a complete TME is possible.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  2. Clinical outcomes of surgical therapy study group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  3. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  4. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  5. Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12(11):1084–1093

    Article  PubMed  CAS  Google Scholar 

  6. Kim Nam-Kyu, Kang Jeonghyun (2010) Optimal total mesorectal excision for rectal cancer: the role of robotic surgery from an expert’s view. J Korean Soc Coloproctol 26(6):377–387

    Article  PubMed  Google Scholar 

  7. Weber P, Merola S, Wasielewski A, Ballantyne G (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1696

    Article  PubMed  Google Scholar 

  8. Hashizume M, Shimada M, Tomikawa M et al (2002) Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc 16:1187–1191

    Article  PubMed  CAS  Google Scholar 

  9. Vibert E, Denet C, Gayet B (2003) Major digestive surgery using a remote-controlled robot: the next revolution. Arch Surg 138:1002–1006

    Article  PubMed  Google Scholar 

  10. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi F, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  11. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  12. Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14:311–315

    Article  PubMed  Google Scholar 

  13. D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal disease. Dis Colon Rectum 47:2162–2168

    Article  PubMed  Google Scholar 

  14. Braumann C, Jacobi CA, Menenakos C, Borchert U, Rueckert JC, Mueller JM (2005) Computer-assisted laparoscopic colon resection with the da vinci system: our first experiences. Dis Colon Rectum 48:1820–1827

    Article  PubMed  Google Scholar 

  15. Woeste G, Bechstein WO, Wullstein C (2005) Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis 20:253–257

    Article  PubMed  Google Scholar 

  16. Ruurda JP, Draaisma WA, van Hillegesberg R, Borel Rinkes IH, Gooszen HG, Janssen LW, Simmermacher RK, Broeders IA (2005) Robot-assisted endoscopic surgery: a 4-year single centre experience. Dig Surg 22:313–320

    Article  PubMed  Google Scholar 

  17. Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M (2006) The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc 20:1389–1393

    Article  PubMed  CAS  Google Scholar 

  18. Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB (2006) Robotic assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  PubMed  CAS  Google Scholar 

  19. DeNoto G, Rubach E, Ravikumar TS (2006) A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A 16:551–556

    Article  PubMed  Google Scholar 

  20. Hellan M, Anderson C, Ellenhorn JDI, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173

    Article  PubMed  Google Scholar 

  21. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708

    Article  PubMed  CAS  Google Scholar 

  22. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22:1601–1608

    Article  PubMed  CAS  Google Scholar 

  23. Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51:1627–1632

    Article  PubMed  Google Scholar 

  24. Luca F, Cenciarelli S, Valvo M, Pozzi S, Faso FL, Ravizza D, Zampino G, Sonzogni A, Biffi R (2009) Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol 16(5):1274–1278 Epub 2009 Feb 26

    Article  PubMed  Google Scholar 

  25. Choi DJ, Kim SH, Lee PJ, Kim J, Woo SU (2009) Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients. Dis Colon Rectum 52(11):1824–1830

    Article  PubMed  Google Scholar 

  26. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16(6):1480–1487

    Article  PubMed  Google Scholar 

  27. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 5(1):CD005033

    Google Scholar 

  28. Biffi R, Luca F, Pozzi S, Cenciarelli S, Valvo M, Sonzogni A et al (2011) Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer. J Robot Surg 5(2):101–107

    Article  PubMed  Google Scholar 

  29. Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A (2010) Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 251:882–886

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr S. S Puntambekar for manuscript proofreading.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Galaxy Care Laparoscopy Institute, Karve Road, Pune, India

    R. D. Kenawadekar, R. Z. Dhange, A. Pandit, M. S. Bandawar, S. Joshi, G. Agarwal, A. P. Jagtap & S. Puntambekar

Authors
  1. R. D. Kenawadekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Z. Dhange
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Pandit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. S. Bandawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. P. Jagtap
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Puntambekar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Puntambekar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kenawadekar, R.D., Dhange, R.Z., Pandit, A. et al. Robot-assisted low anterior resection in fifty-three consecutive patients: an Indian experience. J Robotic Surg 7, 311–316 (2013). https://doi.org/10.1007/s11701-012-0383-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-012-0383-y

Keywords

Search

Navigation