J. Sullivan

A new post has been published on Clinical Robotics.

Paolo Pietro Bianchi (Grosseto – Italy)

SUMMARY
The video shows technical aspects of robotic Total Mesorectal Excision (TME). Three robotic and two laparoscopic trocars were inserted. The cart and the arms of Da Vinci© are maintained in the same position during all the operation and the technique is full robotic. The anastomosis is performed under laparoscopic guidance with the Knight-Griffen technique.

Background/Hypothesis
The video shows technical aspects of robotic total mesorectal excision (TME) in rectal cancer

Materials & Methods
The Robotic system used was a four arms Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Three 8 mm robotic and two 12 mm laparoscopic trocars were inserted. After a laparoscopic exploration of the abdominal cavity the robot is connected. The cart and the arms of Da Vinci© are maintained in the same position during all the operation, sometimesthe assistant changes the angle of the robotic arm, just moving the trocars, without detachment of the robot. The first step is splenic flexure mobilization along the posterior plane covered by Toldt’s fascia, with a posterior dissection of the transverse mesocolon. The inferior mesenteric vessels are then divided with laparoscopic clips positioned by the assistant. Sigmoid and descending colon are mobilized with a medial to lateral approach. Then rectal dissection proceeds into the pelvis and the TME is performed. The robot is disengaged and the distal rectal division is completed laparoscopically with an EndoGIA and the anastomosis is performed under laparoscopic guidance with the Knight-Griffen technique. A loop laparoscopic ileostomy is
done when the anastomosis is performed at less then 5 cm from the anal verge

Results
From August 2008 to June 2009 27 patients with cancer of the middle and lower rectum were treated with a robotic TME. In 5 cases (18.5%) a laparoscopic mobilization of the splenic flexure was performed and the robot was connected for vascular dissection and TME, in the other 22 patients (81.5%) a full robotic operation was made. Mean operative time was 258.2 minutes.

Conclusions
Robotic anterior resection in rectal cancer is a safe and feasible operation. The learning curve for an expert laparoscopic surgeon seems to be shorter than for the same laparoscopic procedure.

A new post has been published on Clinical Robotics.

P.P. Bianchi

SUMMARY
This study evaluate feasibility, oncological safety and outcomes of robotic anterior resection for rectal cancer compared with laparoscopic rectal resection in 50 patients. In conclusion robotic resection is feasible and safe with a shorter learning curve than laparoscopic rectal resection

BACKGROUND/HYPOTHESIS
Aim of this study is to evaluate feasibility, oncological safety and short-term outcomes of robotic total mesorectal excision (R-TME) for rectal cancer compared to laparoscopic TME (L-TME).

MATERIALS & METHODS
From August 2008 to June 2009 50 patients with histological proven adenocarcinoma of middle and lower rectum were enrolled. Mean age was 64.6 years, 35 were male, mean BMI was 23. R-TME was performed in 25 patients, 37 patients (74%) received an anterior resection and 13 (26%) an abdomino-perineal resection. In 23 patient (46%) a preoperative radio-chemotherapy treatment was performed. The Robotic system used was a four arms Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA).

Results
Mean operative time was 258.2 minute for R-TME and 245.8 for L-TME (p 0.2), first bowel movements were 2.5 days in both groups (p 0.5), mean hospital stay was 6.8 days in R-TME and 6.9 days in L-TME (p 0.4). Major complications with a reoperation occurred in 2 patients in the R-TME group (one anastomotic leakage and one small bowel perforation) and in 3 patient of the L-TME group (one colonic ischemia and 2 anastomotic leakages). The overall percentage of post-operative complications was 16% in the R-TME and 24% in the L-TME (p 0.5). The total number of lymphnodes retrieved were 19.7 in R-TME and 18.2 in L-TME (p 0.7) and in both groups proximal, distal and circumferential resection margins were free of disease. Conversions were considered in case of laparotomy and were 0 in R-TME and 1 (5%) in L-TME group.

Conclusions
Robotic TME in rectal cancer is a safe and feasible operation. The oncological results and short-term outcomes are similar to the laparoscopic technique. Further studies are justified to evaluate which, between laparoscopic and robotic, is the better technique in the treatment of rectal cancer

A new post has been published on Clinical Robotics.

Gyu-Seog Choi

A new post has been published on Clinical Robotics.

Paolo Pietro Bianchi (Grosseto – Italy)

SUMMARY
In the speech are presented technical differences and results of robotic and laparoscopic rectal resections for cancer.

A new post has been published on Clinical Robotics.