Efficiency of the Robotic Platform in Improving the Rate of Sphincter Preservation in Patients With Mid and Low Rectal Cancer.

Background: The aim of this study was to investigate whether the robotic platform can have a positive impact on the rate of sphincter preservation in patients with rectal tumors, undergoing robotic total mesorectal excision (TME), in comparison with laparoscopic or open TME. We also analyzed and compared short-term outcomes. Methods: A prospectively collected robotic database was reviewed and compared with the trust and national data. Three groups were designed according to the surgical technique: open, laparoscopic and robotic. This includes all resections for mid and low rectal cancer which were performed with the robotic platform, over a period of 4 years, versus the trust data for the same period. Results: Two hundred ninety-seven patients with mid and low rectal cancers were analyzed. Demographics for the groups (gender, age, and body mass index) were similar but distance from anal verge was shorter in the robotic group (7 vs. 8.5 cm, P < 0.001). The percentage of abdominoperineal resection (APR) rate was significantly lower in the robotic group (13.5% vs. 39.6% vs. 52.4% for the open group, P < 0.001). Median length of stay, complication rate, and positive circumferential resection margin (CRM) rate for the robotic group were also statistically significantly lower than those for both laparoscopic and open groups. Conclusion: Robotic surgery for mid and low rectal cancer is safe and feasible, and could help surgeons perform ultra-low anterior resections, rather than APRs and save patients' sphincters. Positive CRM is low, which could lead to improved oncological outcomes.

Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital.

Robotics in colorectal surgery has been in the market for 17 years now, and continuously gaining popularity; three-dimensional steady views, great range of motion, tremor filtration, augmented dexterity, and articulated instruments, help surgeons to overcome some of the difficulties of laparoscopy and enables them to reach very low into the pelvis. The objective of our study is to present our experience with robotic, total and partial mesorectal excision and evaluate the efficiency of robotic surgery in the group of patients with rectal tumours. This is a prospective, observational study. The procedures were undertaken in a Teaching hospital in United Kingdom, for 4 years period (11/2014-02/2019). The SI Davinci system was used. Technical and oncological outcomes were assessed. The analysis included 85 patients (49 male) who underwent rectal resections. 80 patients (94%) had cancer. Davinci total mesorectal excision (61) and partial mesorectal excision (24) with single side-docking technique. We reviewed the efficiency of the robotic platform in patients with rectal tumours. Median age was 65 (37-89) years and BMI was 27 kg/m2 (19-37.7). 61 patients had tumours within 10 cm from anal verge. There were no deaths and no intraoperative complications. One patient was converted to open, due to system failure. Five patients returned to theatre and two had radiologic drain of a pelvic collection. Median length of hospital stay was 6 days and total operative time was 285 min; after 46 cases, the operative time reduced statistically significant. We removed 35 lymph nodes on average (6-119). R0 resection achieved in 83 patients (97.6%). 75 patients had their sphincters preserved (88.2%). The limitation is that it is a single-institution observational study. Robotic rectal cancer surgery is safe and effective with high rate of sphincter preservation. Our data for short-term outcomes are favourable against previously published data.

Spontaneous resolution of solitary rectal ulcer syndrome during pregnancy: report of a case.

Solitary rectal ulcer syndrome is a rare condition that is associated with disordered defecation and is thought to be an ischemic injury from repeated mucosal trauma. Treatment is designed to alleviate the underlying defecatory problems and is only moderately successful. We report an interesting case of solitary rectal ulcer syndrome in a young woman, which was resistant to standard nonoperative management but completely resolved during two pregnancies only to recur when she was not pregnant, and we suggest a possible hormonal explanation for this unique occurrence.

Reversal of loop ileostomy under spinal anaesthesia.

BACKGROUND AND AIMS: Traditionally, loop ileostomy is reversed under general anaesthetic. In patients with severe cardiorespiratory disease, many surgeons opt for a one-stage, low Hartmann's procedure to avoid a second general anaesthetic to reverse a defunctioning stoma. Closure of loop ileostomy under spinal anaesthetic would allow high-risk patients to avoid a permanent stoma and a general anaesthetic. PATIENTS AND METHODS: Seven patients (6 of whom were men) had reversal of loop ileostomy under spinal anaesthetic. The median age was 63 years (range 43--70). Six patients had significant co-morbidity with a median American Society of Anesthesiologists (ASA) grade of 3. The ileostomy was reversed in a side-to-side fashion using a linear stapler. The small bowel wall was infiltrated with local anaesthetic prior to firing the stapler. RESULTS AND FINDINGS: All patients tolerated the procedure without discomfort. Patients started feeding on the first postoperative day. Analgesia requirements postoperatively were minimal. No complications occurred due to the anaesthetic technique. CONCLUSION: With careful patient selection, preparation and a gentle and meticulous surgical technique, reversal of loop ileostomy can be achieved under spinal anaesthesia, thereby, saving high-risk patients with low tumours (suitable for sphincter preservation) from having a one-stage resection with permanent stoma.