Abstract
Only a handful of institutions in the country have an established robotic surgery program. Evolution of robotic surgery in the colorectal division, from inception to recent times, is presented here. All the patients undergoing robotic colorectal surgery from the inception of the program (September 2014) to August 2019 were identified. The patient and treatment details and short-term outcomes were collected retrospectively from the prospectively maintained database. The cohort was divided into four chronological groups (group 1 being the oldest) to assess the surgical trends. There were 202 patients. Seventy-one percent were male. Mean BMI was 23.25. Low rectal tumours were most common (47%). A total of 74.3% patients received neo-adjuvant treatment. Multivisceral resection was done in 22 patients, including 4 synchronous liver resections. Average operating time for standard rectal surgery was 280 min with average blood loss of 235 ml. The mean nodal yield was 14. Circumferential resection margin positivity was 6.4%. The mean hospital stay for pelvic exenteration was significantly higher than the rest of the surgeries (except for posterior exenteration and total proctocolectomy) (p = 0.00). Clavin-Dindo grade 3 and 4 complications were seen in 10% patients. As the experience of the team increased, more complex cases were performed. Blood loss, margin positivity, nodal yield, leak rates and complications were evaluated group wise (excluding those with additional procedures) to assess the impact of experience. We did not find any significant change in the parameters studied. With increasing experience, the complexity of surgical procedures performed on da Vinci Xi platform can be increased in a systematic manner. Our short-term outcomes, i.e. nodes harvested, margin positivity, hospital stay and morbidity, are on par with world standards. However, we did not find any significant improvement in these parameters with increasing experience.
Similar content being viewed by others
References
Tamhankar AS, Jatal S, Saklani A (2016) Total robotic radical rectal resection with da Vinci Xi system: single docking, single phase technique. Int J Med Robot Comput Assist Surg MRCAS 12(4):642–647
Kammar P, Sasi S, Kumar N, Rohila J, de Souza A, Saklani A (2019) Robotic posterior pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis 21(5):606
Kammar P, Verma K, Sugoor P, Saklani A Complete robotic lateral pelvic node dissection using the da Vinci Xi platform in rectal cancer – a video vignette. Colorectal Dis [Internet]. 2018 [cited 2019 Nov 11];20(11):1053–4. Available from: https://doi.org/10.1111/codi.14412
Kammar P, Bakshi G, Verma K, Sugoor P, Saklani A. Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette. Colorectal Dis [Internet]. 2018 [cited 2019 Nov 11];20(8):731–731. Available from: https://doi.org/10.1111/codi.14256
Sasi S, Rohila J, Kammar P, Kurunkar S, Desouza A, Saklani A Robotic lateral pelvic lymph node dissection in rectal cancer – a video vignette. Colorectal Dis [Internet]. 2018 [cited 2019 Nov 11];20(6):554–5. Available from: https://doi.org/10.1111/codi.14110
Jiménez-Rodríguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Color Dis 28(6):815–821
Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, Tomioka H, Mori K (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29(7):1679–1685
Sng KK, Hara M, Shin J-W, Yoo B-E, Yang K-S, Kim S-H The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc [Internet]. 2013 [cited 2019 Nov 10];27(9):3297–307. Available from: https://doi.org/10.1007/s00464-013-2909-4
Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS, Lee KY, Kim NK (2014) Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28(10):2821–2831
Foo CC, Law WL (2016) The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg 40(2):456–462
Park IJ, Choi G-S, Lim KH, Kang BM, Jun SH Multidimensional Analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg [Internet]. 2009 [cited 2019 Nov 10];13(2):275–81. Available from: https://doi.org/10.1007/s11605-008-0722-5
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91
Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, Reyes-Díaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM, Padillo J, de la Portilla F (2016) Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Color Dis 31(12):1807–1815
Al Asari S, Min BS Robotic colorectal surgery: a systematic review [Internet]. International Scholarly Research Notices. 2012 [cited 2019 Nov 10]. Available from: https://www.hindawi.com/journals/isrn/2012/293894/
Huang C-W, Yeh Y-S, Ma C-J, Choy T-K, Huang M-Y, Huang C-M, Tsai HL, Hsu WH, Wang JY (2015) Robotic colorectal surgery for laparoscopic surgeons with limited experience: preliminary experiences for 40 consecutive cases at a single medical center. BMC Surg 15:73
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al Robotics in general surgery: personal experience in a large community hospital. Arch Surg [Internet]. 2003 Jul 1 [cited 2019 Nov 10];138(7):777–84. Available from: https://jamanetwork.com/journals/jamasurgery/fullarticle/395121
Polat F, Willems LH, Dogan K, Rosman C (2019) The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study. Surg Endosc 33(11):3644–3655
Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J 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(16):1569–1580
Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J (2015) Robotic low anterior resection for rectal Cancer: a national perspective on short-term oncologic outcomes. Ann Surg 262(6):1040–1045
Halabi WJ, Kang CY, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, Pigazzi A (2013) Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes. World J Surg 37(12):2782–2790
Garfinkle R, Abou-Khalil M, Bhatnagar S, Wong-Chong N, Azoulay L, Morin N, Vasilevsky CA, Boutros M (2019) A comparison of pathologic outcomes of open, laparoscopic, and robotic resections for rectal cancer using the ACS-NSQIP proctectomy-targeted database: a propensity score analysis. J Gastrointest Surg 23(2):348–356
Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH et al (2013) Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 27(11):4157–4163
Jatal S, Pai VD, Demenezes J, Desouza A, Saklani AP Analysis of risk factors and management of anastomotic leakage after rectal cancer surgery: an Indian Series. Indian J Surg Oncol [Internet]. 2016 [cited 2019 Nov 10];7(1):37–43. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811816/
Sinukumar S, Engineer R, Saklani A (2015) Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer. Indian J Gastroenterol 34(4):320–324
Pai VD, Bhandare M, Saklani AP (2016) Laparoscopic total mesorectal excision with enbloc resection of seminal vesicle for locally advanced rectal adenocarcinoma. J Laparoendosc Adv Surg Tech A 26(3):209–212
Pokharkar A, Kammar P, D’souza A, Bhamre R, Sugoor P, Saklani A (2018) Laparoscopic pelvic exenteration for locally advanced rectal cancer, technique and short-term outcomes. J Laparoendosc Adv Surg Tech A. 28(12):1489–1494
Pubmeddev KH et al The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity s... - PubMed - NCBI [Internet]. [cited 2019 Nov 14]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29460997/
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rohila, J., Kammar, P., Pachaury, A. et al. Evolution of Robotic Surgery in a Colorectal Cancer Unit in India. Indian J Surg Oncol 11, 633–641 (2020). https://doi.org/10.1007/s13193-020-01105-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-020-01105-7