Objective:Robotic colorectal surgery(RCS)provides a stable,magnifiedthree-dimensional visual field and enhanced ergonomics enabling precise dissection and tremor suppression.We postulate that this technique is associa...Objective:Robotic colorectal surgery(RCS)provides a stable,magnifiedthree-dimensional visual field and enhanced ergonomics enabling precise dissection and tremor suppression.We postulate that this technique is associated with less tissue trauma and improved postoperative outcomes than laparoscopic colorectal surgery(LCS).This study aimed to explore the inflammatoryresponse following RCS by measuring postoperative C-reactive protein(CRP)levels and compare them with LCS data reported in the literature.Methods:This single centre retrospective study included consecutive elective robotic colon and rectum resections via the da Vinci®Xi platform for benign and malignant colorectal tumours,performed by a single surgeon between January 2017 and December 2023 at the Sydney Adventist Hospital,Sydney.CRP values were measured on post-operative days(PODs)3 and 5.A narrative review of the literature was performed via EMBASE,MEDLINE via PubMed and Google Scholar from inception to December 2024 for comparative CRP values following LCS.Descriptive statistical comparisons were performed between the RCS and LCS.Results:One hundred ninety-three patients were identifiedin the RCS cohort.The median age was 73 y(range:62–83 y).Most colectomies were performed for adenocarcinoma(90.2%),with right hemicolectomy being the most common type of procedure(49.3%).The median CRP levels on PODs 3 and 5 were 83.10 mg/L(IQR:49.80–124.12 mg/L)and 26.20 mg/L(IQR:17.70–80.00 mg/L),respectively.The reported CRP after LCS was heterogeneous,with mean POD 3 values ranging from 69 mg/L to 99.5 mg/L,and mean POD 4–5 values ranging from 62.4 mg/L to 72.85 mg/L.Conclusions:There were similar,if not lower,POD 3 and 5 CRP values,suggesting that RCS was probably non-inferior to LCS regarding postoperative tissue trauma.In particular,there appeared to be a quicker recovery of the inflammatory response with RCS.展开更多
AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response...AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.展开更多
文摘Objective:Robotic colorectal surgery(RCS)provides a stable,magnifiedthree-dimensional visual field and enhanced ergonomics enabling precise dissection and tremor suppression.We postulate that this technique is associated with less tissue trauma and improved postoperative outcomes than laparoscopic colorectal surgery(LCS).This study aimed to explore the inflammatoryresponse following RCS by measuring postoperative C-reactive protein(CRP)levels and compare them with LCS data reported in the literature.Methods:This single centre retrospective study included consecutive elective robotic colon and rectum resections via the da Vinci®Xi platform for benign and malignant colorectal tumours,performed by a single surgeon between January 2017 and December 2023 at the Sydney Adventist Hospital,Sydney.CRP values were measured on post-operative days(PODs)3 and 5.A narrative review of the literature was performed via EMBASE,MEDLINE via PubMed and Google Scholar from inception to December 2024 for comparative CRP values following LCS.Descriptive statistical comparisons were performed between the RCS and LCS.Results:One hundred ninety-three patients were identifiedin the RCS cohort.The median age was 73 y(range:62–83 y).Most colectomies were performed for adenocarcinoma(90.2%),with right hemicolectomy being the most common type of procedure(49.3%).The median CRP levels on PODs 3 and 5 were 83.10 mg/L(IQR:49.80–124.12 mg/L)and 26.20 mg/L(IQR:17.70–80.00 mg/L),respectively.The reported CRP after LCS was heterogeneous,with mean POD 3 values ranging from 69 mg/L to 99.5 mg/L,and mean POD 4–5 values ranging from 62.4 mg/L to 72.85 mg/L.Conclusions:There were similar,if not lower,POD 3 and 5 CRP values,suggesting that RCS was probably non-inferior to LCS regarding postoperative tissue trauma.In particular,there appeared to be a quicker recovery of the inflammatory response with RCS.
文摘AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.
