Update on Robotic Gastrointestinal Surgery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 23498

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Special Issue Editors

Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
Interests: colorectal surgery; upper GI surgery; surgical oncology; robotics; minimally invasive surgery
Special Issues, Collections and Topics in MDPI journals
University of Milan, Italy

Special Issue Information

Dear Colleagues,

Since the introduction of robotic surgery in the early 2000s, several studies have demonstrated its safety and feasibility in various complicated procedures including esophageal, gastric, and colorectal surgery—for both benign and malignant pathologies—hepatobiliopancreatic surgery, and gynecological and urological procedures.

Robot-assisted surgery provides the advantages of a magnified tridimensional view and of movement stability without tremor, which facilitate a precise dissection. The EndoWrist instrument also facilitates dissection at difficult angles, thus enabling surgery in complex conditions.

Even if some of the advantages of robotic surgery have been defined, we are still far from clearly recognizing precise indications for a robotic approach in gastrointestinal surgery

With this Special Issue, we aim to investigate the conditions supporting the robotic approach in gastrointestinal surgery toward the definition of golden standard robotic procedures as stablished in urological surgery for prostatectomy.

Prof. Dr. Marco Milone
Prof. Dr. Paolo Pietro Bianchi 
Guest Editors

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Keywords

  • Robotic
  • Minimally invasive surgery
  • Esophageal
  • Gastric
  • Colorectal
  • Pancreatic
  • Hepatic

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Published Papers (11 papers)

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Editorial

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2 pages, 159 KiB  
Editorial
Robotic Gastrointestinal Surgery: State of the Art and Future Perspectives
by Marco Milone and Paolo Pietro Bianchi
J. Pers. Med. 2023, 13(3), 568; https://doi.org/10.3390/jpm13030568 - 22 Mar 2023
Cited by 1 | Viewed by 797
Abstract
Since its inception, robotic surgery has made incredible progress and has undergone significant development in an extremely short period of time [...] Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)

Research

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11 pages, 251 KiB  
Article
Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience
by Michele Manigrasso, Sara Vertaldi, Pietro Anoldo, Anna D’Amore, Alessandra Marello, Carmen Sorrentino, Alessia Chini, Salvatore Aprea, Salvatore D’Angelo, Nicola D’Alesio, Mario Musella, Antonio Vitiello, Giovanni Domenico De Palma and Marco Milone
J. Pers. Med. 2021, 11(7), 621; https://doi.org/10.3390/jpm11070621 - 30 Jun 2021
Cited by 2 | Viewed by 1457
Abstract
The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition [...] Read more.
The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)

Review

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13 pages, 1915 KiB  
Review
Update on Robotic Total Mesorectal Excision for Rectal Cancer
by Simona Giuratrabocchetta, Giampaolo Formisano, Adelona Salaj, Enrico Opocher, Luca Ferraro, Francesco Toti and Paolo Pietro Bianchi
J. Pers. Med. 2021, 11(9), 900; https://doi.org/10.3390/jpm11090900 - 08 Sep 2021
Cited by 4 | Viewed by 2129
Abstract
The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized [...] Read more.
The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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10 pages, 2842 KiB  
Review
Update on Robotic Rectal Prolapse Treatment
by Giampaolo Formisano, Luca Ferraro, Adelona Salaj, Simona Giuratrabocchetta, Andrea Pisani Ceretti, Enrico Opocher and Paolo Pietro Bianchi
J. Pers. Med. 2021, 11(8), 706; https://doi.org/10.3390/jpm11080706 - 23 Jul 2021
Cited by 4 | Viewed by 3350
Abstract
Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have [...] Read more.
Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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10 pages, 528 KiB  
Review
Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer
by Giuseppe Giuliani, Francesco Guerra, Lorenzo De Franco, Lucia Salvischiani, Roberto Benigni and Andrea Coratti
J. Pers. Med. 2021, 11(7), 638; https://doi.org/10.3390/jpm11070638 - 06 Jul 2021
Cited by 3 | Viewed by 1561
Abstract
Background. Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical [...] Read more.
Background. Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy. Methods. The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy. Results. According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy. Conclusions. The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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16 pages, 285 KiB  
Review
Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art
by Fabio Rondelli, Alessandro Sanguinetti, Andrea Polistena, Stefano Avenia, Claudio Marcacci, Graziano Ceccarelli, Walter Bugiantella and Michele De Rosa
J. Pers. Med. 2021, 11(6), 584; https://doi.org/10.3390/jpm11060584 - 21 Jun 2021
Cited by 6 | Viewed by 1945
Abstract
Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision [...] Read more.
Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
11 pages, 1552 KiB  
Review
Robotic versus Laparoscopic Surgery for Spleen-Preserving Distal Pancreatectomies: Systematic Review and Meta-Analysis
by Gianluca Rompianesi, Roberto Montalti, Luisa Ambrosio and Roberto Ivan Troisi
J. Pers. Med. 2021, 11(6), 552; https://doi.org/10.3390/jpm11060552 - 13 Jun 2021
Cited by 16 | Viewed by 2626
Abstract
Background: When oncologically feasible, avoiding unnecessary splenectomies prevents patients who are undergoing distal pancreatectomy (DP) from facing significant thromboembolic and infective risks. Methods: A systematic search of MEDLINE, Embase, and Web Of Science identified 11 studies reporting outcomes of 323 patients undergoing intended [...] Read more.
Background: When oncologically feasible, avoiding unnecessary splenectomies prevents patients who are undergoing distal pancreatectomy (DP) from facing significant thromboembolic and infective risks. Methods: A systematic search of MEDLINE, Embase, and Web Of Science identified 11 studies reporting outcomes of 323 patients undergoing intended spleen-preserving minimally invasive robotic DP (SP-RADP) and 362 laparoscopic DP (SP-LADP) in order to compare the spleen preservation rates of the two techniques. The risk of bias was evaluated according to the Newcastle–Ottawa Scale. Results: SP-RADP showed superior results over the laparoscopic approach, with an inferior spleen preservation failure risk difference (RD) of 0.24 (95% CI 0.15, 0.33), reduced open conversion rate (RD of −0.05 (95% CI −0.09, −0.01)), reduced blood loss (mean difference of −138 mL (95% CI −205, −71)), and mean difference in hospital length of stay of −1.5 days (95% CI −2.8, −0.2), with similar operative time, clinically relevant postoperative pancreatic fistula (ISGPS grade B/C), and Clavien–Dindo grade ≥3 postoperative complications. Conclusion: Both SP-RADP and SP-LADP proved to be safe and effective procedures, with minimal perioperative mortality and low postoperative morbidity. The robotic approach proved to be superior to the laparoscopic approach in terms of spleen preservation rate, intraoperative blood loss, and hospital length of stay. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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12 pages, 1097 KiB  
Review
Updates on Robotic CME for Right Colon Cancer: A Qualitative Systematic Review
by Wanda Petz, Simona Borin and Uberto Fumagalli Romario
J. Pers. Med. 2021, 11(6), 550; https://doi.org/10.3390/jpm11060550 - 12 Jun 2021
Cited by 6 | Viewed by 2756
Abstract
Background. Complete mesocolic excision (CME) is a surgical technique introduced with the aim of ameliorating the oncologic results of colectomy. Various experiences have demonstrated favorable oncologic results of CME in comparison with standard colectomy, in which the principles of CME are not respected. [...] Read more.
Background. Complete mesocolic excision (CME) is a surgical technique introduced with the aim of ameliorating the oncologic results of colectomy. Various experiences have demonstrated favorable oncologic results of CME in comparison with standard colectomy, in which the principles of CME are not respected. The majority of the literature refers to open or laparoscopic CME. This review analyses current evidence regarding robotic CME for right colectomy. Methods. An extensive Medline (Pub Med) search for relevant case series, restricted to papers published in English, was performed, censoring video vignettes and case reports. Results. Fourteen studies (ten retrospective, four comparative series of robotic versus laparoscopic CME) were included, with patient numbers ranging from 20 to 202. Four different approaches to CME are described, which also depend on the robotic platform utilized. Intraoperative and early clinical results were good, with a low conversion and anastomotic leak rate and a majority of Clavien–Dindo complications being Grades I and II. Oncologic adequacy of the surgical specimens was found to be good, although a homogeneous histopathologic evaluation was not provided. Conclusions. Further large studies are warranted to define long-term oncologic results of robotic right colectomy with CME and its eventual benefits in comparison to laparoscopy. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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Other

16 pages, 3239 KiB  
Systematic Review
Robotic Surgery and Functional Esophageal Disorders: A Systematic Review and Meta-Analysis
by Sara Vertaldi, Anna D’Amore, Michele Manigrasso, Pietro Anoldo, Alessia Chini, Francesco Maione, Marcella Pesce, Giovanni Sarnelli, Giovanni Domenico De Palma and Marco Milone
J. Pers. Med. 2023, 13(2), 231; https://doi.org/10.3390/jpm13020231 - 27 Jan 2023
Cited by 3 | Viewed by 1119
Abstract
The functional disease of the esophago-gastric junction (EGJ) is one of the most common health problems. It often happens that patients suffering from GERD need surgical management. The laparoscopic fundoplication has been considered the gold standard surgical treatment for functional diseases of the [...] Read more.
The functional disease of the esophago-gastric junction (EGJ) is one of the most common health problems. It often happens that patients suffering from GERD need surgical management. The laparoscopic fundoplication has been considered the gold standard surgical treatment for functional diseases of the EGJ. The aim of our meta-analysis is to investigate functional outcomes after robotic fundoplication compared with conventional laparoscopic fundoplication. A prospective search of online databases was performed by two independent reviewers using the search string “robotic and laparoscopic fundoplication”, including all the articles from 1996 to December 2021. The risk of bias within each study was assessed with the Cochrane ROBINS-I and RoB 2.0 tools. Statistical analysis was performed using Review Manager version 5.4. In addition, sixteen studies were included in the final analysis, involving only four RCTs. The primary endpoints were functional outcomes after laparoscopic (LF) and robotic fundoplication (RF). No significant differences between the two groups were found in 30-day readmission rates (p = 0.73), persistence of symptomatology at follow-up (p = 0.60), recurrence (p = 0.36), and reoperation (p = 0.81). The laparoscopic fundoplication represents the gold standard treatment for the functional disease of the EGJ. According to our results, the robotic approach seems to be safe and feasible as well. Further randomized controlled studies are required to better evaluate the advantages of robotic fundoplication. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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26 pages, 5604 KiB  
Systematic Review
The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis
by Marco Milone, Michele Manigrasso, Pietro Anoldo, Anna D’Amore, Ugo Elmore, Mariano Cesare Giglio, Gianluca Rompianesi, Sara Vertaldi, Roberto Ivan Troisi, Nader K. Francis and Giovanni Domenico De Palma
J. Pers. Med. 2022, 12(2), 307; https://doi.org/10.3390/jpm12020307 - 18 Feb 2022
Cited by 10 | Viewed by 2504
Abstract
Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic [...] Read more.
Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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25 pages, 8193 KiB  
Systematic Review
Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes
by Michele Manigrasso, Sara Vertaldi, Alessandra Marello, Stavros Athanasios Antoniou, Nader Kamal Francis, Giovanni Domenico De Palma and Marco Milone
J. Pers. Med. 2021, 11(7), 640; https://doi.org/10.3390/jpm11070640 - 06 Jul 2021
Cited by 15 | Viewed by 2127
Abstract
Background: Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. Methods: a search of the [...] Read more.
Background: Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. Methods: a search of the studies comparing robotic and laparoscopic or open esophagectomy was performed trough the medical libraries, with the search string “robotic and (oesophagus OR esophagus OR esophagectomy OR oesophagectomy)”. Outcomes were: postoperative complications rate (anastomotic leakage, bleeding, wound infection, pneumonia, recurrent laryngeal nerves paralysis, chylotorax, mortality), intraoperative outcomes (mean blood loss, operative time and conversion), oncologic outcomes (harvested nodes, R0 resection, recurrence) and recovery outcomes (length of hospital stay). Results: Robotic approach is superior to open surgery in terms of blood loss p = 0.001, wound infection rate, p = 0.002, pneumonia rate, p = 0.030 and mean number of harvested nodes, p < 0.0001 and R0 resection rate, p = 0.043. Similarly, robotic approach is superior to conventional laparoscopy in terms of mean number of harvested nodes, p = 0.001 pneumonia rate, p = 0.003. Conclusions: robotic surgery could be considered superior to both open surgery and conventional laparoscopy. These encouraging results should promote the diffusion of the robotic surgery, with the creation of randomized trials to overcome selection bias. Full article
(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)
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