Early results of novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using Da Vinci XI: initial clinical experience

SUMMARY OBJECTIVE: The aim of this study is to evaluate the early results of robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction, regarding the operative time, operative and early postoperative complications, hospital stay, and pathological reports in a series of 10 patients. METHODS: From November 2016 to October 2019, case series study on patients diagnosed with RC was included in this study. All robotic-assisted low anterior resection of the rectum, vaginal removal of the specimen, colorectal anastomosis, and loop ileostomies were performed using the Da Vinci XI system. RESULTS: The mean age of patient was 64.8 (58-72) years. Low anterior resection was performed to seven patients, and very low anterior resection was performed to three patients. Total mesorectal excision of the rectum, transvaginal specimen extraction, transanal anastomoses, and protective ileostomy were performed in all 10 patients. The mean operative time was 275±30.50 min, and estimated blood loss was 50±10.50 mL. No patient required conversion to conventional surgery. Negative circumferential resection, proximal, and distal margins were accomplished negative. Mean number of lymph nodes harvested was 20±5.5. According to the pathological reports, all were adenocarcinoma. T1 stage was 80.0%, and T2 stage was 20.0%. Lymph node metastasis accounted for 80.0%. CONCLUSIONS: To our literature search, this is the first study reporting the early outcomes of the novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using the Da Vinci Xi system. It can be performed safely and successfully in selected patients by providing an excellent cosmetic body image, which may be important for women.

Suporte básico de vida e suporte avançado de vida em cardiologia: proposta de uma nova estratégia para abordagem e prevenção das intercorrências clínicas em cirurgia dermatológica / Basic life support and advanced cardiac life support: proposal of a new strategy to approach and prevent clinical events in dermatologic surgery

Com o aumento da complexidade cirúrgica e comorbidades da população, o risco de intercorrências clínicas em cirurgia dermatológica aumentou nas últimas décadas. Para sua abordagem foi criado um fluxograma baseado na tríade decisória formada pelo estado físico do paciente, grau de sedação e porte do procedimento, indicando o tipo de suporte cardiovascular em cada procedimento. Pacientes submetidos a cirurgias de "porte pequeno" e ASA < 2 devem receber suporte básico de vida; os submetidos a cirurgias de "porte pequeno" e ASA > 2, a cirurgias de "porte médio" ou a sedação profunda devem receber suporte avançado de vida em cardiologia.

Since complexity of surgical procedures has increased, and patients' co-morbidities have become more frequent, the risk of clinical complications in dermatologic surgery has also increased in the past decades. In order to better assess these risks, a flowchart based on a ruling triad consisting of the patient's health status, sedation level, and procedure complexity was developed to establish the type of cardiovascular support adequate to each procedure. Patients undergoing small surgeries with ASA < 2 should be assigned to basic life support; patients undergoing small surgeries with ASA > 2, and those undergoing medium-sized surgeries or deep sedation should be assigned to advanced cardiac life support (ACLS).