TY - JOUR
T1 - Robotic endoscopic cooperative surgery for colorectal tumors
T2 - a feasibility study (with video)
AU - Okamoto, Nariaki
AU - Al-Taher, Mahdi
AU - Mascagni, Pietro
AU - Vazquez, Alain García
AU - Takeuchi, Masashi
AU - Marescaux, Jacques
AU - Diana, Michele
AU - Dallemagne, Bernard
N1 - Funding Information:
Jacques Marescaux is the President of IRCAD, which is partly funded by KARL STORZ and Medtronic. Michele Diana is members of the Advisory Board of Diagnostic Green. Michele Diana is the recipient of the ELIOS grant. Nariaki Okamoto, Mahdi Al-Taher, Pietro Mascagni, Alain García Vazquez, Masashi Takeuchi and Bernard Dallemagne have no conflicts of interest or financial ties to disclose.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/1
Y1 - 2022/1
N2 - Background: Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR). Methods: LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25 cm from the anal verge. Desired resection margins were marked endoscopically and two stay sutures were placed either robotically or laparoscopically. A mucosa-to-submucosa dissection was performed endoscopically along the markings. Complete full-thickness dissection was performed cooperatively. The specimen was withdrawn endoscopically. The colon was closed using a self-fixating running suture. Abdominal contaminations, operating times, complications, and complete resections were evaluated and compared between LECS-CR and RECS-CR. Results: The mean number of colonies of Escherichia coli in the RECS group was significantly lower than in the LECS group (36.7 ± 30.2 vs. 142.2 ± 78.4, respectively, p < 0.05). Operating time was comparable (118 ± 11.2 vs. 98.6 ± 25.7, respectively, p = 0.22). Two stenoses occurred in the LECS group. R0 resection was achieved in all cases. Conclusion: This study suggests that RECS-CR is feasible and has the potential to reduce intestinal content leakage, potentially preventing postoperative infections.
AB - Background: Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR). Methods: LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25 cm from the anal verge. Desired resection margins were marked endoscopically and two stay sutures were placed either robotically or laparoscopically. A mucosa-to-submucosa dissection was performed endoscopically along the markings. Complete full-thickness dissection was performed cooperatively. The specimen was withdrawn endoscopically. The colon was closed using a self-fixating running suture. Abdominal contaminations, operating times, complications, and complete resections were evaluated and compared between LECS-CR and RECS-CR. Results: The mean number of colonies of Escherichia coli in the RECS group was significantly lower than in the LECS group (36.7 ± 30.2 vs. 142.2 ± 78.4, respectively, p < 0.05). Operating time was comparable (118 ± 11.2 vs. 98.6 ± 25.7, respectively, p = 0.22). Two stenoses occurred in the LECS group. R0 resection was achieved in all cases. Conclusion: This study suggests that RECS-CR is feasible and has the potential to reduce intestinal content leakage, potentially preventing postoperative infections.
KW - Endoscopic submucosal dissection
KW - Full-thickness resection of colorectal tumors
KW - Laparoscopic endoscopic cooperative surgery
KW - Robotic and endoscopic cooperative colorectal surgery
KW - Robotic endoscopic cooperative surgery
KW - Robotic surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=85118554499&partnerID=8YFLogxK
U2 - 10.1007/s00464-021-08786-3
DO - 10.1007/s00464-021-08786-3
M3 - Article
C2 - 34741202
AN - SCOPUS:85118554499
SN - 0930-2794
VL - 36
SP - 826
EP - 832
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 1
ER -
