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S1-1
Robotic Colorectal Surgery with a Four-Arm da Vinci System: The Preliminary Report of Single Surgeon, Single Institution
田宇峰Yu-Feng Tian
Department of General Surgery, Chi-Mei medical center |
Objectives: Robotic colorectal surgery may be a way to overcome the limitations of laparoscopic surgery. This study reports a preliminary, single surgeon experience of robotic colectomy by using a four-arm da Vinci systemR. The technique details and short-term outcome are discussed.
Methods: We conducted a retrospective study of patients undergoing robotic colorectal surgery. Twenty-one patients with a histologically proved colorectal cancer were enrolled. Outcome measures were conversion rate, mortality, complication rate, operative time (including docking time and console time), blood loss, number of lymph nodes harvested, macroscopic and microscopic evaluation of resection margins and learning curve.
Results: A total of 21 patients (median age, 63 years [range, 40-82 years]) underwent robotic colectomy with four-arm da Vinci systemR. We adopted hybrid technique for 4 patients and totally robotic technique for 17 patients. We introduced totally robotic technique with dual docking method for rectal cancer. Of the patients, 17 (80.9%) patients received low anterior resection (LAR), 1(4.8%) patient received anterior resection (AR), 2(9.5%) patients received right hemicolectomy(RH) and 1(4.8%) patient received left hemicolectomy(LH). There were 4(5.9%) patients with the previous abdominal operative history and 2(9.5%) patients with neoadjuvant chemoradiation. Median preoperative Carcinoembryonic antigen (CEA) was 29.4ng/mL. No patients were converted to open or laparoscopic colectomy. Mortality rate was 0%. No anastomotic leakage was noted and one patient encountered postoperative ileus. The median operative time was 142.7min (range, 93-235min). For dual docking method group, the median first docking time was 13.8 min (range, 5-68 min) and then median second docking time was 8.4min (range, 2-20min). The median first console time was 47.5min (range, 26-60min) and then median second console time was min (range, 26-130min). After 5 cases, the first plateau of learning curve can be achieved. Median number of nodes retrieved was 17 (range, 12-30) and all resection margins were negative. Two patients received protective ileostomy after operation.
Conclusions: Robotic colorectal surgery with four-arm da Vinci systemR is a feasible and safe approach, according to oncological principles. With good understanding of the robotic concepts, using four-arm da Vinci systemR shows a better advantage of assistant replacement. This approach shows promising short-term outcomes and may facilitate the adoption of minimally invasive colorectal surgery. Randomized clinical trials and longer follow-ups are needed to evaluate a possible influence of robotic colorectal surgery on patient survival.
Keywords: robotic surgery, colorectal cancer, da Vinci system |
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