Transition from laparoscopic to robotic approach in rectal cancer: a single-center short-term analysis based on the learning curve.

As a novel procedure becomes more and more used, knowledge about its learning curve and its impact on outcomes is useful for future implementations. Our aim is (i) to identify the phases of the robotic rectal surgery learning process and assess the safety and oncological outcomes during that period, (ii) to compare the robotic rectal surgery learning phases outcomes with laparoscopic rectal resections performed before the implementation of the robotic surgery program. We performed a retrospective study, based on a prospectively maintained database, with methodological quality assessment by STROBE checklist. All the procedures were performed by the same two surgeons. A total of 157 robotic rectal resections from June 2018 to January 2022 and 97 laparoscopic rectal resections from January 2018 to July 2019 were included. The learning phase was completed at case 26 for surgeon A, 36 for surgeon B, and 60 for the center (both A & B). There were no differences in histopathological results or postoperative complications between phases, achieving the same ratio of mesorectal quality, circumferential and distal resection margins as the laparoscopic approach. A transitory increase of major complications and anastomotic leakage could occur once overcoming the learning phase, secondary to the progressive complexity of cases. Robotic rectal cancer surgery learning curve phases in experienced laparoscopic surgeons was completed after 25-35 cases. Implementation of a robotic rectal surgery program is safe in oncologic terms, morbidity, mortality and length of stay.

Impact of barium enema on acute diverticulitis recurrence: A retrospective cohort study of 349 patients.

OBJECTIVE: Acute diverticulitis (AD) is becoming a health concern with its increasing incidence. One of the accepted theories of the possible causes of diverticular perforation is the impaction of fecal residuals into some diverticula. We aimed to evaluate whether barium impaction had a negative effect by promoting diverticular inflammation or rupture and thereby AD recurrence. METHODS: A retrospective cohort study (January 2005-December 2015) was conducted at the Reina Sofia University Hospital of Cordoba, Spain with follow-up for patients received barium enema or not after their first episode of AD. Factors related to disease recurrence and its severity were analyzed. RESULTS: In total, 349 patients were included and subdivided into the barium enema group (n = 141) and control group (n = 208), respectively. In the studied cohort, 72 (20.6%) patients suffered recurrence of AD, which was almost twice as frequent in the barium enema group than in the control group (27.7% vs 15.9%, P = 0.008). Patients who had undergone barium enema were more likely to present a higher Hinchey grade at recurrence than that observed in the index presentation (30.8% vs 9.1%, P = 0.024). Age <50 years, female sex, absence of treatment with rifaximin and especially barium enema, showed a trend to a higher probability of AD recurrence over time. However, no statistically significant differences were found. CONCLUSIONS: We failed to conclude that barium enema increased AD recurrence. Patients undergo barium enema are more likely to show a higher Hinchey grade at recurrence than that observed in their index presentation.