Dataset Information

Early experience with the ARTISENTIAL^® articulated instruments in laparoscopic low anterior resection with TME.

ABSTRACT:

Background

The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL^® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL^®.

Methods

Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL^® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed.

Results

Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47-80 years) and a median body mass index of 28 kg/m² (range 23-33 kg/m²). The median time to rectal transection was 155 min (range 118-280 min) and the median total operative time was 276 min (range 192-458 min). The median estimated blood loss was 30 ml (range 5-70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12-28). Total mesorectal excision (TME) quality was 'good' in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7-14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality.

Conclusions

Low anterior resection with ARTISENTIAL^® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL^® in comparison with standard laparoscopic instruments through a larger study.

SUBMITTER: Darwich I

PROVIDER: S-EPMC9018813 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Early experience with the ARTISENTIAL<sup>®</sup> articulated instruments in laparoscopic low anterior resection with TME.

Darwich I I Abuassi M M Aliyev R R Scheidt M M Alkadri M A MA Hees A A Demirel-Darwich S S Chand M M Willeke F F

Techniques in coloproctology 20220210 5

<h4>Background</h4>The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL<sup>®</sup> instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL<sup>®</sup>.<h4>Methods</h4>Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen ...[more]

PMID: 35141794

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Project description:BackgroundThere is no criterion to guide and evaluate the anastomosis of laparoscopic low anterior resection (LAR). We developed a new technique for precise anastomosis. This study endeavored to evaluate the effectiveness and safety of this new technology.MethodsPatients with mid-low rectal cancer who underwent laparoscopic LAR in our department were enrolled retrospectively between January 1, 2021 and July 1, 2023. During the LAR, the distance between the sacral promontory and the rectal stump was measured and used to determine the length of the sigmoid colon, which was preserved for anastomose. The demographic characteristics and short-term outcomes were analyzed.ResultsForty-nine patients (26 men, 23 women) with low and middle rectal cancer were retrospectively enrolled in the study. The distance of the tumor from the anal verge was 6.4 ± 2.7 cm. The operative time was 193 ± 42 min. All patients underwent precise anastomosis, among which 12 patients underwent freeing of the splenic flexure of the colon. According to our criteria, there was no redundant or tense state of the colon anterior to the sacrum after the anastomosis. Only one patient had a postoperative anastomotic leak (Grade B). All 15 patients receiving neoadjuvant chemoradiotherapy underwent terminal ileostomy. No postoperative death occurred within 30 days of the surgery. The median follow-up time in our study was 12 months. One patient developed a single metastasis in the right lobe of the liver in the eighth month after surgery and underwent microwave radiofrequency ablation, which did not recur in the four months of postoperative follow-up, and the rest of the patients survived disease-free without recurrence of metastasis.ConclusionsPrecise measurement of the proximal colon of the anastomosis can ensure accurate and convenient colorectal anastomosis and this may be a technique worthy of clinical application. However, its effectiveness needs to be further verified in a multicenter clinical trial.

Project description:BackgroundThe position of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision can affect genito-urinary function, bowel function, oncological outcomes, and the incidence of anastomotic leakage. Ligation to the inferior mesenteric artery at the origin or preservation of the left colic artery are both widely performed in rectal surgery. The aim of this study is to compare the incidence of genito-urinary dysfunction, anastomotic leak and oncological outcomes in laparoscopic anterior rectal resection with total mesorectal excision with high or low ligation of the inferior mesenteric artery in a controlled randomized trial.Methods/designThe HIGHLOW study is a multicenter randomized controlled trial in which patients are randomly assigned to high or low inferior mesenteric artery ligation during laparoscopic anterior rectal resection with total mesorectal excision for rectal cancer. Inclusion criteria are middle or low rectal cancer (0 to 12 cm from the anal verge), an American Society of Anesthesiologists score of I, II, or III, and a body mass index lower than 30. The primary end-point measure is the incidence of post-operative genito-urinary dysfunction. The secondary end-point measure is the incidence of anastomotic leakage in the two groups. A total of 200 patients (100 per arm) will reliably have 84.45 power in estimating a 20% difference in the incidence of genito-urinary dysfunctions. With a group size of 100 patients per arm it is possible to find a significant difference (α = 0.05, β = 0.1555). Allowing for an estimated dropout rate of 5%, the required sample size is 212 patients.DiscussionThe HIGHLOW trial is a randomized multicenter controlled trial that will provide evidence on the merits of the level of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision in terms of better preserved post-operative genito-urinary function.Trial registrationClinicalTrials.gov Identifier: NCT02153801 Protocol Registration Receipt 29/5/2014.

Dataset Information

Early experience with the ARTISENTIAL^® articulated instruments in laparoscopic low anterior resection with TME.

Background

Methods

Results

Conclusions

Publications

Early experience with the ARTISENTIAL<sup>®</sup> articulated instruments in laparoscopic low anterior resection with TME.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Early experience with the ARTISENTIAL® articulated instruments in laparoscopic low anterior resection with TME.

Background

Methods

Results

Conclusions

Publications

Early experience with the ARTISENTIAL<sup>®</sup> articulated instruments in laparoscopic low anterior resection with TME.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Early experience with the ARTISENTIAL^® articulated instruments in laparoscopic low anterior resection with TME.