Federico Gheza, MD, Alberto Mangano, MD, Mario A Masrur, MD, Pier C Giulianotti, MD, FACS. UIC
Introduction: in the huge and exponentially increasing amount of laparoscopic and robotic publications in general surgery, role of adhesiolysis (AL) is underestimated: even if considered as conversion reason in some series, most of them are not included in the outcomes for early conversion or a priori open approach. Our goal is to clarify if the robot can increase the number of successful minimally invasive approaches in patients needing extensive AL.
Methods and procedures: our prospectively collected, IRB approved database was retrospectively queried for concomitant extensive adhesiolysis, performed by the same surgeon.
Results: we identified 113 cases of extensive AL meeting all the requirements, from October 2007 to March 2017.Ninety-two patients underwent minimally invasive AL (58 robot assisted, 34 pure laparoscopic). The conversion rate was significantly different in the two groups with a corrected p of 0.05. The Odds Ratio was 4.75, with a risk ratio of 2.13 (0.95 C.I.: 1.28 – 3.54). No other perioperative factors showed significance, so that a multivariate analysis was not beneficial. No mortality and no misdiagnosed perforations from our database and during medical record review were recorded. In the robotic group, conversion was always related to enteroenteric adhesions and never to parietal adhesions. In the laparoscopic group 7 patients were converted. Among those, 4 AL failures were due to parietal adhesions. we had a total of 5 iatrogenic injuries, with no difference in the two groups. 4 of those were minor deserosalizations with only 1 full thickness injury in the laparoscopic group. For patients in which the Veress technique failed we found an augmented risk (almost twice) of iatrogenic injury during AL.
Conclusions: We described a better performance in treating intraperitoneal adhesions in the robotic group, with a lower conversion rate, without any increase in iatrogenic injury. The robot was found to be extremely effective in omental and parietal AL, with no failures for this type of adhesions. .
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88403
Program Number: P789
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster