Maria Carmela Giuffrida, Luca Pellegrino, Alessandra Marano, Diego Sasia, Gaspare Cannata, Felice Borghi. Santa Croce e Carle Hospital
INTRODUCTION: The robotic stapler with the EndoWrist™ technology (Intuitive Surgical, Inc.) includes a larger range of motion and articulation compared to the laparoscopic device, and may provide some benefits in difficult areas like the pelvis. To date, few studies have been published on the application of robotic endowristed stapling. We present our preliminary experience using the robotic stapler in low anterior rectal resection (LARR) with total mesorectal excision (TME) for rectal cancer.
METHODS AND PROCEDURES: Between March 2016 and September 2017, 24 patients underwent elective robotic LARR with TME and primary colorectal anastomosis within the ERAS program. Patient demographic, intra-operative data and post-operative outcomes were compared between the EndoWrist™ 45 robotic stapler group (RS group) and the laparoscopic stapler group (LS group).
RESULTS: The two groups were homogeneous in terms of demographic and clinical characteristics. Thirteen (10 males) and 11 patients (8males) were included in RS and in LS group, respectively. Seven patients received preoperative chemoradiation in RS group, 8 in LS group. There was no difference in intra-operative blood loss and total operative time. The median number of stapler fires for patients in RS group and in LS group was 2 (range, 1-3) and 3 (range, 2-4), respectively. Loop-ileostomy was fashioned in 8 patients in RS group (61.5%) and 8 patients in LS group (72.7%). The 30 days mortality was nil. Two cases of anastomotic leaks have been detected in RS group (15.4%), 2 cases (18.2%), occurred in LS group, all treated conservatively. The mean length of postoperative stay was 6.5 ± 5.7 days in RS group, 6.9 ± 3.9 days in LS group.
CONCLUSION(S): In our preliminary experience the application of robotic stapler during LARR with TME has shown to be safe and feasible with acceptable morbidity. Even if our case series is pretty small, fewer stapler fires were required in the RSG compared to LSG. We believe that the robotic stapler might lead to a more precise firing during pelvic surgery: it can explain the trend toward a decreased number of fires, that has been well documented in literature to be related to a lower risk of anastomotic leak. Further high quality studies are required to confirm these findings.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87362
Program Number: P199
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster