Robotic-assisted Colorectal Surgery Research Articles

Incidence of surgical site infection in minimally invasive colorectal surgery.

Surgical site infection (SSI) is a common complication of colorectal surgery. Minimally invasive surgery notably reduces the incidence of SSI. This study aimed to compare the incidences of SSI after robot-assisted colorectal surgery (RACS) vs that after laparoscopic assisted colorectal surgery (LACS) and to analyze associated risk factors for SSI in minimally invasive colorectal surgery. To compare the incidences of SSI after RACS and LACS, and to analyze the risk factors associated with SSI after minimally invasive colorectal surgery. Clinical data derived from patients who underwent minimally invasive colorectal surgery between October 2020 and October 2022 at the First Affiliated Hospital of Soochow University were collated. Differences in clinical characteristics and surgeryrelated information associated with RACS and LACS were compared, and possible risk factors for SSI were identified. A total of 246 patients (112 LACS and 134 RACS) were included in the study. Fortythree (17.5%) developed SSI. The proportions of patients who developed SSI were similar in the two groups (17.9% vs 17.2%, P = 0.887). Diabetes mellitus, intraoperative blood loss ≥ 100 mL, and incision length were independent risk factors for SSI. Possible additional risk factors included neoadjuvant therapy, lesion site, and operation time. There was no difference in SSI incidence in the RACS and LACS groups. Diabetes mellitus, intraoperative blood loss ≥ 100 mL, and incision length were independent risk factors for postoperative SSI.

A systematic review and meta-analysis of short-term outcomes comparing the efficacy of robotic versus laparoscopic colorectal surgery in obese patients.

This meta-analysis was conducted to evaluate and contrast the effectiveness of robotic-assisted and laparoscopic colorectal surgery in the treatment of obese patients. In February 2024, we carried out an exhaustive search of key global databases including PubMed, Embase, and Google Scholar, limiting our focus to studies published in English and Chinese. We excluded reviews, protocols lacking published results, articles derived solely from conference abstracts, and studies not relevant to our research objectives. To analyze categorical variables, we utilized the Cochran-Mantel-Haenszel method along with random-effects models, calculating inverse variances and presenting the outcomes as odds ratios (ORs) along with their 95% confidence intervals (CIs). Statistical significance was determined when p values were less than 0.05. In our final meta-analysis, we included eight cohort studies, encompassing a total of 5,004 patients. When comparing the robotic surgery group to the laparoscopic group, the findings revealed that the robotic group experienced a longer operative time (weighted mean difference (WMD) = 37.53min, 95% (CI) 15.58-59.47; p = 0.0008), a shorter hospital stay (WMD = -0.68days, 95% CI -1.25 to -0.10; p = 0.02), and reduced blood loss (WMD = -49.23mL, 95% CI -64.31 to -34.14; p < 0.00001). No significant differences were observed between the two groups regarding overall complications, conversion rates, surgical site infections, readmission rates, lymph node yield, anastomotic leakage, and intestinal obstruction. The results of our study indicate that robot-assisted colorectal surgery offers benefits for obese patients by shortening the length of hospital stay and minimizing blood loss when compared to laparoscopic surgery. Nonetheless, it is associated with longer operation times and shows no significant difference in terms of overall complications, conversion rates, rehospitalization rates, and other similar metrics.

Learning curve and surgical outcome of robotic assisted colorectal surgery with ERAS program

This study analyzed learning curve and the surgical outcome of robotic assisted colorectal surgery with ERAS program. The study results serve as a reference for future robotic colorectal surgeon who applied ERAS in clinical practice. This was a retrospective case–control study to analyze the learning curve of 141 robotic assisted colorectal surgery (RAS) by Da Vinci Xi (Xi) system and compare the surgical outcomes with 147 conventional laparoscopic (LSC) surgery in the same team. Evaluation for maturation was performed by operation time and the CUSUM plot. Patients were recruited from 1st February 2019 to 9th January 2022; follow-up was conducted at 30 days, and the final follow-up was conducted on 9th February 2022. It both took 31 cases for colon and rectal robotic surgeries to reach the maturation phase. Teamwork maturation was achieved after 60 cases. In the maturation stage, RAS required a longer operation time (mean: colon: 249.5 ± 46.5 vs. 190.3 ± 57.3 p < 0.001; rectum 314.9 ± 59.6 vs. 223.6 ± 63.5 p < 0.001). After propensity score matching, robotic surgery with ERAS program resulted in significant shorter length of hospital stay (mean: colon: 5.5 ± 4.5 vs. 10.0 ± 11.9, p < 0.001; rectum: 5.4 ± 3.5 vs. 10.1 ± 7.0, p < 0.001), lower minor complication rate (colon: 6.0% vs 20.0%, p = 0.074 ; rectum: 11.1% vs 33.3%, p = 0.102), and no significant different major complication rate (colon: 2.0% vs 6.0%, p = 0.617; rectum: 7.4% cs 7.4%, p = 1.0) to conventional LSC. Learning curve for robotic assisted colorectal surgery takes 31 cases. Robotic surgery with ERAS program brings significant faster recovery and fewer complication rate compared to laparoscopy in colorectal surgery.

Robotic-Assisted versus Laparoscopic Proctectomy with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Analysis of Clinical and Financial Outcomes from a Tertiary Referral Center.

Robotic-assisted colorectal surgery is gaining popularity, but limited data are available on the safety, efficacy, and cost of robotic-assisted restorative proctectomy with the construction of an ileal pouch and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). A retrospective study was conducted comparing consecutively performed robotic-assisted and laparoscopic proctectomy with IPAA between 1 January 2016 and 31 September 2021. In total, 67 adult patients with medically refractory UC without proven dysplasia or carcinoma underwent surgery: 29 operated robotically and 38 laparoscopically. There were no differences between both groups regarding postoperative complications within 30 days according to Clavien-Dindo classification' grades 1-5 (51.7% vs. 42.1%, p = 0.468) and severe grades 3b-5 (17.2% vs. 10.5%, p = 0.485). Robotic-assisted surgery was associated with an increased urinary tract infection rate (n = 7, 24.1% vs. n = 1, 2.6%; p = 0.010) and longer operative time (346 ± 65 min vs. 281 ± 66 min; p &lt; 0.0001). Surgery costs were higher when operated robotically (median EUR 10.377 [IQR EUR 4.727] vs. median EUR 6.689 [IQR EUR 3.170]; p &lt; 0.0001), resulting in reduced total inpatient profits (median EUR 110 [IQR EUR 4.971] vs. median EUR 2.853 [IQR EUR 5.386]; p = 0.001). Robotic-assisted proctectomy with IPAA can be performed with comparable short-term clinical outcomes to laparoscopy but is associated with a longer duration of surgery and higher surgery costs. As experience increases, some advantages may become evident regarding operative time, postoperative recovery, and length of stay. The robotic procedure might then become cost-efficient.

Robot-Assisted Colorectal Surgery

Minimally invasive surgery for colorectal disease has now become the standard treatment in Republic of Korea. However, there are limitations to the laparoscopic approach, such as an unstable camera support, a limited range of motion, and poor ergonomics. Recent advances in technology have led to the introduction of robotic surgical systems in colorectal surgery to overcome these shortcomings. Robot-assisted colorectal surgery has clear advantages in many aspects. Surgery involving the rectum benefits the most among colorectal diseases owing to technical difficulties in rectum dissection. The concept of robotic surgery is not different from laparoscopic surgery in that it is a minimally invasive surgery, and abundant research demonstrates comparable results from both modalities for postoperative complications, oncological outcomes, and functional outcomes. However, the cost of robot-assisted surgery limits surgeons to performing robotic surgeries in only selected cases. Improvements regarding cost-effectiveness and more convincing studies that support benefits of robotic surgery are needed to popularize robot-assisted colorectal surgery.

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

Right hemicolectomy and anterior resection using the Versius® robotic surgical system: A technical note

As robotic assisted colorectal surgery increases in prevalence new systems are entering the market, each of which requires technique modifications. In this technical note we describe technical insights and tips gained from our extensive experience of 150 colorectal resections using the Versius® system from CMR Surgical. The triad of optimal bedside unit placement, port placement, and arm configuration is described for right hemicolectomy and anterior resection.

TU4.1 Single-center experience in robotic-assisted colorectal surgery during COVID pandemic: First 72 cases

AimTo present an analysis of the first 2-years’ experience of robotic-assisted colorectal procedures (RACP) using the DaVinci Xi platform.MethodsThis data were prospectively collected and include 72 RACP between February 2020 and December 2021.Indications were: malignancy in 74.3%, diverticular disease 10%, inflammatory bowel disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent volvulus 1.4%.ResultsOver the 13-month study period, 72 RACP were performed including elective 57 cases and 15 semi-elective cases. These comprised: 25 right hemicolectomies, 25 high anterior resections, 6 extended right hemicolectomies,4 low anterior resections, 4 subtotal colectomies 2 restorative proctectomies, 3 abdominoperineal excisions of the rectum, 3 rectopexies that were performed. 51.2% were female and 48.6% were male with a median age of 45 years (22–85 years) and the median body mass index was 31 (18–46) kg/m2. Preoperative American Society of Anaesthesiology scores were reported as 1–2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The median length of stay was 5 days (1–35), with readmission rate within 30 days of 8.6% (n=6) that were resolved conservatively. The mean operating time was 268 minutes and the mean console operative time was 158 minutes, with only 3 (4.3%) reported cases of conversion to open. The incidence of postoperative complications was 24.3% (Clavien–Dindo (CD) I/II- 12.9%, CD III- 10%, and CD V-1 case with superimposed COVID 19 within 30 days.ConclusionRACP is a safe and viable modality in the treatment of colorectal conditions and can be introduced safely with appropriate guidance and proctorship.

TU4.2 Robotic surgery for colorectal cancer: a single-center experience

AimTo present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH.MethodsWe report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay.ResultsThe first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III.The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM.ConclusionWe report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.

Clinical Application of the Concept of Rapid Rehabilitation in Perioperative Care of Patients with Robot-assisted Colorectal Cancer Surgery by Da Vinci

Clinical Application of the Concept of Rapid Rehabilitation in Perioperative Care of Patients with Robot-assisted Colorectal Cancer Surgery by Da Vinci

Robotic-assisted colorectal surgery - initial results.

The mini invasive procedure in colorectal surgery is gaining ground as an alternative to conventional surgery. Colorectal surgery has significantly evolved since the advent of the automatic stapler devices and subsequently with the minimally invasive approach. The next logical step - the robotic assisted surgery was developed to satisfy surgeons' needs to the area of colorectal surgery and to offer a new and safer method to patients. The evidence for benefits of its use in this area appears to be promising.

Is Robotic Assisted Colorectal Cancer Surgery Equivalent Compared to Laparoscopic Procedures during the Introduction of a Robotic Program? A Propensity-Score Matched Analysis.

Simple SummaryThe introduction of a robotic program is challenging and requires extensive experience in minimally invasive surgery. Short-term outcomes and oncological quality should not differ between robotic and laparoscopic surgery. To our knowledge, no data on the quality of surgery at the time of introduction of the robotic platform are available. The aim of this study was to compare short-term outcomes and oncological findings of robotic-assisted colorectal resections with those of conventional laparoscopic surgery within the first three years after the introduction of the robotic platform.Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological findings compared to conventional laparoscopic surgery within the first three years after the introduction. Methods: All colorectal cancer patients from two centers that either received robotic-assisted or conventional laparoscopic surgery were included in a comparative study. A propensity-score-matched analysis was used to reduce confounding differences. Results: A laparoscopic resection (LR Group) was performed in 82 cases, and 93 patients were treated robotic-assisted surgery (RR Group). Patients’ characteristics did not differ between groups. In right-sided resections, an intracorporeal anastomosis was significantly more often performed in the RR Group (LR Group: 5 (26.31%) vs. RR Group: 10 (76.92%), p = 0.008). Operative time was shown to be significantly shorter in the LR Group (LR Group: 200 min (150–243) vs. 204 min (174–278), p = 0.045). Conversions to open surgery did occur more often in the LR Group (LR Group: 16 (19.51%) vs. RR Group: 5 (5.38%), p = 0.004). Postoperative morbidity, the number of harvested lymph nodes, quality of resection and postoperative tumor stage did not differ between groups. Conclusion: In this study, we could clearly demonstrate robotic-assisted colorectal cancer surgery as effective, feasible and safe regarding postoperative morbidity and oncological findings compared to conventional laparoscopy during the introduction of a robotic system.

Continuous Infusion of Iohexol to Monitor Perioperative Glomerular Filtration Rate.

Continuous monitoring of the glomerular filtration rate (GFR) in the perioperative setting could provide valuable information about acute kidney injury risk for both clinical and research purposes. This pilot study aimed to demonstrate that GFR measurement by a continuous 72 hrs iohexol infusion in patients undergoing colorectal cancer surgery is feasible. Four patients undergoing robot-assisted colorectal cancer surgery were recruited from elective surgery listings. GFR was determined preoperatively by the single-sample iohexol clearance method, and postoperatively at timed intervals by a continuous iohexol infusion for 72 hrs. Plasma concentrations of creatinine and cystatin C were measured concurrently. GFR was calculated as (iohexol infusion rate (mg/min))/(plasma iohexol concentration (mg/mL)). The association of the three different filtration markers and GFR with time were analysed in generalized additive mixed models. The continuous infusion of iohexol was established in all four patients and maintained throughout the study period without interfering with ordinary postoperative care. Postoperative GFR at 2 hours were elevated compared to the preoperative measurements for patients 1, 2, and 3, but not for patient 4. Whereas patients 1, 2, and 3 had u-shaped postoperative mGFR curves, patient 4 demonstrated a linear increase in mGFR with time. We conclude that obtaining continuous measurements of GFR in the postoperative setting is feasible and can detect variations in GFR. The method can be used as a tool to track perioperative changes in renal function.

Operative and Survival Outcomes of Robotic-Assisted Surgery for Colorectal Cancer in Elderly and Very Elderly Patients: A Study in a Tertiary Hospital in South Korea.

Materials and Methods Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75–80 years), middle-old (MO: 81–85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups. Results Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m2 (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups (p = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868–59.047, p = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875–0.992, p = 0.027) and CSS (HR of 0.928, 95% CI 0.861–0.999, p = 0.047) in elderly patients. Conclusion Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.

Robotic versus laparoscopic low anterior resection for rectal cancer: A systematic review and meta-analysis

The purpose of the review is to establish the safety and efficacy of robotic-assisted colorectal surgery (RAS) and laparoscopic colorectal surgery (LAS) for colorectal disease based on randomized controlled trial studies. The objective of this study is to evaluate two different operative interventions for short-term outcomes. The short-term outcomes include the conversion rate to open operation, intraoperative bleeding, operation time, length of hospital stay, number of lymph nodes harvested, peri-operative complications, and clear pathological resection margins. A search of MEDLINE at EBSCOhost, EMBASE, and Cochrane Library for articles from 1991 to 2020 was performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RAS and LAS. A meta-analysis was performed using the Review Manager (RevMan5.3) software. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity. Ten randomized controlled trial studies were included in the meta-analysis; 687 patients underwent RAS and 794 patients underwent LAS. The results revealed that conversion rates [relative risk (RR) =0.36, 95% confidence index (CI) =0.23–0.55, P < 0.00001], estimated blood losses [mean deviation (MD) = -15.01, 95% CI = -23.93–6.08, P = 0.0010], length of hospital stay (MD = -0.78, 95% CI = -1.11–0.46, P < 0.00001), and complications [odds ratio (OR) =1.04, 95% CI = 0.73–1.48, P = 0.97] were significantly reduced following RAS compared to that with LAS. There were no significant differences in operation time (MD = 0.61, 95% CI = -3.48–4.71, P = 0.77), number of lymph nodes harvested (MD = -0.08, 95% CI = -1.03–0.88, P = 0.87), and circumferential resection margin non-involvement (OR = 1.40, 95% CI = 0.88–2.25, P = 0.16) between the two techniques. The meta-analysis favored the robot-assisted technique. RAS is a promising technique and is a safe and effective alternative to LAS for colorectal surgery. The advantages of RAS include lower conversion rates, shorter hospital stay, and less intraoperative bleeding and complications. Further studies are required to define the effects of RAS on quality of life and long-term oncologic outcomes.

Robotic Versus Laparoscopic Colorectal Resection: Are We There Yet?

Background: Laparoscopy-assisted surgery (LAS) for colorectal cancer (CRC) was first described in 1991 and robotic-assisted surgery (RAS) for CRC was first reported in 2002; robotic-assisted colorectal surgery (RACS) is becoming increasingly popular. However, data comparing its outcomes to other established techniques remain limited to small case series. Our primary goal was to review the mortality outcome difference between laparoscopic versus robotic elective colon resection at a small, community hospital.Study design: We conducted a retrospective review of 2089 patients at the South Atlantic division for cases who underwent robotic and laparoscopic colectomies at our division in 2014-2018. All cases were elective surgeries and analysis was performed within these two subgroups.Results: In this study, 306 patients underwent robotic colorectal surgery versus 1783 patients who underwent laparoscopic-assisted colorectal surgery. Readmission rate within 30 days of operation was significantly lower for laparoscopic-assisted colorectal resection (LACR) versus RACS (445.4% vs. 53.9%, p= 0.006). However, the length of hospital stay was significantly shorter for RACS with a median of three days (interquartile range {IQR}: 2-5) versus four days (IQR: 3-7) for LACR (p=0.0001). There were no significant differences between the two groups for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, or rate of conversion to an open procedure.Conclusion: Our study showed a similar outcome between LACR and RACS for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, and rate of conversion to an open procedure. Also, our study showed a readmission rate within 30 days of operation was significantly lower for LACR versus RACS. However, the length of hospital stay was significantly shorter for RACS with a median of three days when compared to LACR. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.

SP1.2.4A Single Centre experience in Robot-assisted Colorectal Surgery: First 70 cases

Abstract Aim To analyse the short-term outcome of robot-assisted colorectal surgery (RACS) in a single centre. Methods All the patients who underwent RACS using the DaVinci Xi platform between June 2018 and December 2020 were included in our study. RACS was performed by two consultant team. Data was collected from a prospectively maintained database. Results Over the 31-month study period, 70 RACS were performed with no 30-day mortality. Male to female ratio was 4:3, with mean age was 66 years (SD 12). The mean body mass index was 28.7 (SD 5.1). Pre-operative American society of anaethesiology (ASA) score was reported as 1-2 in 65% of patients and 35% as 3. Indication for surgery was malignancy in 89% (62/70) of patients and the remainder benign pathology. Type of surgery performed was high anterior resection (AR) in 39% (27/70) patients, low AR 33% (23/70), right hemicolectomies 21% (15/70), Hartmann’s procedure 3% (2/70), abdominoperineal resections 3% (2/70), and left hemicolectomy 1% (1/70). The mean operating time was 295 minutes (SD 92), with only 1 reported case of conversion to open. Complete resection (R0) was achieved in 95% (59/62) of malignant resections. The mean lymph nodes harvested were 19 (range 7-36). Post-operative complications occurred in 23% (16/70) of patients, including 6% (4/66) anastomotic leaks. The mean length of stay was 8 days (range 1-53), with readmission rate of 14% (10/70). Conclusion The robotic minimally invasive technique can be safely introduced for major colorectal resections without excessive morbidity.

SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve

Abstract Aim To analyse the evolution of robot-assisted colorectal surgery (RACS). Methods All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11. Results Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3. Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%. RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = &amp;lt;0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59). Conclusion The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.

A rare cause of lower gastrointestinal bleeding treated with robotic colorectal surgery

BackgroundMetastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma.Case presentationA 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB.Conclusion This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.

Sex, Type of Surgery, and Surgical Site Infections Are Associated with Perioperative Cortisol in Colorectal Cancer Patients.

Excessive endocrine response to trauma negatively affects patients’ well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1β, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-α but did not correlate with changes in IL-6 or interferon (IFN)-γ at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient’s sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.