Yoshiyuki Sakamoto, PhD, Hajime Morohashi, PhD, Takuya Miura, PhD, Kentarou Satou, MD, Kenichi Hakamada, PhD. Hirosaki University
Introduction: Robot-assisted colectomy may compensate for some of the disadvantages of conventional laparoscopic surgery by providing detailed high-vision three-dimensional images and magnified vision, forceps joint function, and preventing hand tremors. These attributes of robot surgery may be particularly useful when accurate R0 resection and nerve preservation are required in cases of rectal resection. We performed robot-assisted colectomy for the first time in January 2016. For the first 4 patients whom we treated (the first-stage group), we invited a visiting expert from a high-volume center to perform the procedure jointly with our hospital’s surgeons by using a dual console. For the subsequent 6 patients (the second-stage group), the procedure was performed by our hospital staff alone. In this report, we describe our experience of introduction of robot-assisted colectomy and discuss issues for the future.
Patients and Methods: The operative procedure was sigmoid colectomy, low anterior resection, and intersphincteric resection. The median number of lymph nodes dissected was 15.6. The mean operating time was 337 minutes for the first-stage group and 365 minutes for the second-stage group. The median console time was 206 minutes for the first-stage group and 193 minutes for the second-stage group, with no significant differences between the two groups. The mean operating time other than console time was 127 minutes for the first-stage group and 171 minutes for the second-stage group, significantly longer in the latter group. The mean amount of hemorrhage was 15.5 g in the first-stage group and 31 g in the second-stage group. No significant differences were found between the two groups in the mean length of postoperative hospital stay. None of the patients in either group developed a complication of Clavien-Dindo grade III or higher.
Conclusions: The use of Dual Console system was particularly useful for the introduction of robot-assisted surgery in our hospital. For the patients whom we treated, we found almost no difference in console time between the first- and second-stage groups. The high-quality instruction received via the dual console was considered to have had a beneficial effect on the operators’ learning curve. However, the operations that were set up other than console time, such as roll-in and docking, took significantly longer in the second-stage group when the proctor was not present, and more experience is necessary to reduce the time required for set-up. As this procedure is used in more cases, the focus should be clarifying the advantages of robot-assisted surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87568
Program Number: P799
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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