Evaluation of an established colorectal robotic programme at an NHS district general hospital: audit of outcomes and systematic review of published data.

Autor: Vaughan-Shaw PG; Western General Hospital, EH42XU, Edinburgh, UK., Joel AS; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Farah M; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Ofoezie F; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Harji D; Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK., Liane M; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Choudhary S; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Royle JT; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Holtham S; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK., Farook G; Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK. G_farook@hotmail.com.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Oct 24; Vol. 408 (1), pp. 416. Date of Electronic Publication: 2023 Oct 24.
DOI: 10.1007/s00423-023-03152-4
Abstrakt: Introduction: Robotic-assisted surgery (RAS) offers potential advantages over traditional surgical approaches. This study aimed to assess outcomes from a district general hospital (DGH) robotic colorectal programme against published data.
Materials and Methods: The robotic programme was established following simulator, dry/wet lab training, and proctoring. We performed a case series analysing technical, patient, and oncological outcomes extracted from a prospective database of colorectal RAS cases (2015-2022). A registered systematic review (PROSPERO CRD42022300773; PubMed, Web of Science, EMBASE) of single-centre colorectal series from established robotic centres (n>200 cases) was completed and compared to local data using descriptive summary statistics. Risk of bias assessment was performed using an adapted version of the Cochrane ROBINS-I tool.
Results: Two hundred thirty-two RAS cases were performed including 122 anterior resections, 56 APERs, 19 rectopexies, and 15 Hartmann's procedures. The median duration was 325 (IQR 265-400) min. Blood loss was < 100 ml in 97% of cases with 2 (0.9%) cases converted to open. Complications (Clavien-Dindo 3-5) occurred in 19 (8%) patients, with 3 (1.3%) deaths in < 30 days. Length of stay was 7 (IQR 5-11) days. In 169 rectal cancer cases, there were 9 (5.3%) cases with a positive circumferential or distal margin and lymph node yield of 17 (IQR 13-24). A systematic review of 1648 abstracts identified 13 studies from established robotic centres, totaling 4930 cases, with technical, patient, and oncological outcomes comparable to our own case series.
Conclusions: Outcomes from our robotic colorectal programme at a UK DGH are comparable with the largest published case series from world-renowned centres. Training and proctoring together with rolling audit must accompany the expansion of robotic surgery to safeguard outcomes.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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