Comparison of the operative outcomes and learning curves between laparoscopic and \u201cMicro Hand S\u201d robot-assisted total mesorectal excision for rectal cancer: a retrospective study

Yanlei Wang,Hao Ling,Guohui Wang,Bo Yi,Shaihong Zhu,Zheng Li

doi:10.1186/s12876-021-01834-1

Yanlei Wang, Hao Ling + Show 4 more

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https://doi.org/10.1186/s12876-021-01834-1

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Abstract

BackgroundThe Micro Hand S robot is a new surgical tool that has been applied to total mesorectal excision (TME) surgery for rectal cancer in our center. In this study, we compared the operative outcomes, functional outcomes and learning curves of the Micro Hand S robot-assisted TME (RTME) with laparoscopic TME (LTME).MethodsA total of 40 patients who underwent RTME and 65 who underwent LTME performed by a single surgeon between July 2015 and November 2018 were included in this retrospective study. Clinicopathologic characteristics, operative and functional outcomes, and learning curves were compared between the two groups. The learning curve was analyzed using the cumulative sum method and two stages (Phase 1, Phase 2) were identified and analyzed. All patients were followed up for at least 12 months.ResultsThe clinicopathologic characteristics of the two groups were similar. The learning curve was 17 cases for RTME and 34 cases for LTME. Compared with LTME, RTME was associated with less blood loss (148.2 vs. 195.0 ml, p = 0.022), and shorter length of hospital stay (9.5 vs. 12.2 days, p = 0.017), even during the learning period. With the accumulation of experience, the operative time decreased significantly from Phase 1 to Phase 2 (RTME, 360.6 vs. 323.5 min, p = 0.009; LTME, 338.1 vs. 301.9 min, p = 0.005), whereas other outcomes did not differ significantly.ConclusionsMicro Hand S robot-assisted TME is safe and feasible even during the learning period, with outcomes comparable to laparoscopic surgery but superior in terms of blood loss, length of hospital stay, and learning curve.Trial registration Clinicaltrial.gov, NCT04836741, retrospectively registered on 5 April 2021.

Highlights

Since the laparoscope was first applied in colorectal diseases in 1991 [1], laparoscopic surgery for rectal cancer has become widely accepted
There were no significant differences in age, sex, body mass index (BMI), and American Society of Anaesthesiologists (ASA) score between the two groups (Table 1)
The tumor location tended to be higher in the robot-assisted TME (RTME) group than in the laparoscopic TME (LTME) group (8.2 vs 7.5 cm, p = 0.299)

Summary

Introduction

Since the laparoscope was first applied in colorectal diseases in 1991 [1], laparoscopic surgery for rectal cancer has become widely accepted. To deliver better medical care to Chinese patients, our center in collaboration with Tianjin University developed the first Chinese surgical robot known as Micro Hand S (Wego, Qingdao, China) in 2013 (Fig. 1). This master– slave robot consists of a surgeon console, slave cart, and stereo image viewer [4]. Similar to the da Vinci surgical robot, the Micro Hand S robot is capable of 3-dimensional (3D) vision, motion scaling, tremor filtering, and wristed instrumentation with 7 degrees of freedom (DOF) It has several innovative design elements including in miniaturization, an intuitive motion mapping strategy based on mechanical constraints, a decoupled design for multi-DOF devices, and a rollpitch-roll form for the DOF arrangement of surgical instruments [4, 5]. We compared the operative outcomes, functional outcomes and learning curves of the Micro Hand S robot-assisted TME (RTME) with laparoscopic TME (LTME)

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