Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have bec...Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have become available in Europe:Hugo™RAS and Versius®.We present the firstprospective case series comparing these three robotic systems.Methods:This exploratory,prospective study enrolled 45 consecutive adult patients undergoing robotic colon resection between February and December 2024,as part of the COMPAR trial.Two experienced colorectal surgeons performed all procedures across two surgical units.Each robotic platform was used in 15 cases.The primary outcomes were conversion to laparoscopy or open surgery and intra-operative complications.The secondary outcomes included post-operative recovery,oncological results,and platform-specifictechnical parameters.Results:The mean age was 66.8 years and 68.9%of patients underwent surgery for colon cancer.No conversions occurred in the Da Vinci group,whereas 2 and 3 conversions to laparoscopy were recorded with Hugo™RAS and Versius®,respectively.One intra-operative instrument malfunction occurred with Hugo™RAS,and one surgical complication was reported in each group.No significantdifferences emerged in post-operative recovery or oncological outcomes.Versius®cases required more frequent use of laparoscopic energy devices(p<0.001).Hugo™RAS was associated with a longer total operating room time(p=0.022)and longer incision length(p=0.005).Conclusion:Robotic colorectal surgery with all three platforms is feasible when performed by expert surgeons.While early outcomes are encouraging,larger comparative trials are needed to confirmdifferences in recovery and oncological efficacy.展开更多
BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of...BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.展开更多
Monosegment 4±1 Associating Liver Partition and Portal Vein ligation for Staged hepatectomy(ALPPS)for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy,triggering a rap...Monosegment 4±1 Associating Liver Partition and Portal Vein ligation for Staged hepatectomy(ALPPS)for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy,triggering a rapid and significant increase in future liver remnant(FLR)with promising oncological outcomes.We report two cases of segment 4+1 monosegment ALPPS for multiple colorectal liver metastases performed at our institution.In the literature,seven similar cases have been reported.Short and long term outcomes of our two patients were reported along with a review of data from the literature.Our patients showed a FLR increase from 13%to 37%and from 14%to 41%of total liver volume,respectively.This was compared to a median growth from 19%at baseline to 34%before stage 2,in the literature.After 20 and 27 months since resection both patients are alive and disease-free.In the literature,median overall survival and disease free survival were 13 months(range,5–24 months)and 5 months(range,3–23 months),respectively.Segment 4±1 ALPPS is associated with promising oncological outcomes and a significant FLR growth.It may be safely performed in selected patients as a salvage procedure,reducing the risk of the dropout of two-stage hepatectomy.展开更多
文摘Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have become available in Europe:Hugo™RAS and Versius®.We present the firstprospective case series comparing these three robotic systems.Methods:This exploratory,prospective study enrolled 45 consecutive adult patients undergoing robotic colon resection between February and December 2024,as part of the COMPAR trial.Two experienced colorectal surgeons performed all procedures across two surgical units.Each robotic platform was used in 15 cases.The primary outcomes were conversion to laparoscopy or open surgery and intra-operative complications.The secondary outcomes included post-operative recovery,oncological results,and platform-specifictechnical parameters.Results:The mean age was 66.8 years and 68.9%of patients underwent surgery for colon cancer.No conversions occurred in the Da Vinci group,whereas 2 and 3 conversions to laparoscopy were recorded with Hugo™RAS and Versius®,respectively.One intra-operative instrument malfunction occurred with Hugo™RAS,and one surgical complication was reported in each group.No significantdifferences emerged in post-operative recovery or oncological outcomes.Versius®cases required more frequent use of laparoscopic energy devices(p<0.001).Hugo™RAS was associated with a longer total operating room time(p=0.022)and longer incision length(p=0.005).Conclusion:Robotic colorectal surgery with all three platforms is feasible when performed by expert surgeons.While early outcomes are encouraging,larger comparative trials are needed to confirmdifferences in recovery and oncological efficacy.
文摘BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
文摘Monosegment 4±1 Associating Liver Partition and Portal Vein ligation for Staged hepatectomy(ALPPS)for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy,triggering a rapid and significant increase in future liver remnant(FLR)with promising oncological outcomes.We report two cases of segment 4+1 monosegment ALPPS for multiple colorectal liver metastases performed at our institution.In the literature,seven similar cases have been reported.Short and long term outcomes of our two patients were reported along with a review of data from the literature.Our patients showed a FLR increase from 13%to 37%and from 14%to 41%of total liver volume,respectively.This was compared to a median growth from 19%at baseline to 34%before stage 2,in the literature.After 20 and 27 months since resection both patients are alive and disease-free.In the literature,median overall survival and disease free survival were 13 months(range,5–24 months)and 5 months(range,3–23 months),respectively.Segment 4±1 ALPPS is associated with promising oncological outcomes and a significant FLR growth.It may be safely performed in selected patients as a salvage procedure,reducing the risk of the dropout of two-stage hepatectomy.
