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Many benefits of minimally invasive surgery are lost in the obese, but robotic-assisted laparoscopic surgery (RALS) may offer advantages in this population. Our goal was to compare outcomes for RALS in obese and non-obese patients. A prospective database was reviewed for colorectal resections using RALS. Patients were stratified into obese (BMI > 30 kg/m2) and non-obese cohorts (BMI

There is an increasing emphasis on optimizing and measuring surgical quality. The safety and efficacy of minimally invasive techniques have been proven; however, direct comparison of outcomes across platforms has not been performed. Our goal was to compare operative times and quality across three minimally invasive platforms in colorectal surgery. A prospective database was reviewed for elective minimally invasive surgery (MIS) cases from 2008 to 2014. Patients were stratified into multiport laparoscopic, single-incision laparoscopic (SILS) or robotic-assisted laparoscopic approaches (RALS). Demographics, perioperative, and postoperative outcomes were analyzed. Multivariate regression analysis was used to predict the demographic and procedural factors and outcomes associated with each platform. The main outcome measures were operative time and surgical quality by approach. A total of 1055 cases were evaluated—28.4 % LAP, 18.5 % RALS, and 53.1 % SILS. RALS had the most complex patients, pathology, and procedures. The main diagnosis for RALS was rectal cancer (49.5 %), patients predominantly underwent pelvic surgery (72.8 %), had higher rates of neoadjuvant chemoradiation (p

Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients. Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m2) and non-obese cohorts (BMI

Background Our goal was to evaluate the learning curve for transversus abdominis plane (TAP) block placement and identify issues that impede successful placement. Methods Three novices were prospectively evaluated performing ultrasound-guided TAP blocks in 10 consecutive patients. Operators were assessed on medication knowledge, setup/placement, procedural steps, and performance time. Times were compared to an expert for efficiency and competence. The main outcome measures were procedures needed for competence and variables associated with increased coaching/procedure time. Results In the 30 patient sample, the mean body mass index (BMI) was 30.9 (standard deviation [SD], 5.79). Fifteen patients were obese (BMI > 30), seven (23.3%) super obese (BMI > 35), and 15 had prior abdominal surgery. The mean setup time was 107.5 s (SD, 87), right-side placement was 131.8 s (SD, 60.3), left-side placement 114.8 s (SD, 40.5), and total time 354 s (SD, 111). By the second attempt, all operators were fluent in the medication and setup. At block 3, operators 1 and 3 reached competence in performance time; by block 4, all three operators reached time competence. After reaching competence, outliers in procedure times were only experienced for extremes in BMI ( 35). Additional coaching was needed in four patients with prior abdominal surgery to decipher the correct planes. Conclusions Based on our pilot, by four attempts, novices reach appropriate speeds with progressively less coaching to safely and efficiently place TAP blocks. Extremes of BMI and prior abdominal surgery impact procedural time and may required additional coaching to facilitate placement. Given the promising results, further work on developing best practices for education and implementation is warranted.

Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS has comparable or improved outcomes compared to multiport laparoscopy but technical limitations when operating in the pelvis. To address these limitations, we developed an innovative SILS+1 approach using a single Pfannenstiel incision for pelvis access with one additional umbilical port. Our goal was to compare outcomes for SILS and SILS+1 in lower abdominal and pelvic colorectal surgery.Review of a prospectively maintained database identified patients who underwent an elective reduced port laparoscopic lower abdominal/pelvic colorectal procedure from 2009 to 2014. Cases were stratified by approach: SILS versus SILS+1 then matched 1:2 on age, gender, body mass index (BMI), comorbidity, and procedure. Demographic, perioperative, and postoperative outcome variables were evaluated. The main outcome measures were operative time, conversion rate, length of stay, complication, morbidity, and mortality rates.One hundred thirty-two reduced port AR/LAR patients were evaluated-44 SILS and 88 SILS+1. The groups were similar in age, gender, BMI, and ASA class. The primary diagnosis in both cohorts was diverticulitis (90.9 % SILS, 87.5 % SILS+1), and main procedure performed an anterior rectosigmoidectomy (86.4 % SILS, 88.2 % SILS+1). Significantly more SILS+1 patients had previous abdominal surgery (p = 0.01). The operative time was significantly shorter in SILS+1 (mean 166.6 [SD 48.4] vs. 178.0 [SD 70.0], p = 0.03). The conversion rate to multiport or open surgery was also significantly lower with SILS+1 compared to SILS (1.1 vs. 11.4 %, p = 0.02). Postoperatively, the length of stay across the groups was similar. SILS trended towards higher complication and readmission rates (NS). There were no unplanned reoperations or mortality in either group.SILS+1 facilitates pelvic and lower abdominal colorectal surgery, with shorter operative times and lower conversion rates. The additional port improved visualization and outcomes without any impact on length of stay, readmission, or complication rates.

delivery (74 vs 47%, p

Background Many benefits of minimally invasive surgery are lost in the obese, but robotic-assisted laparoscopic surgery (RALS) may offer advantages in this population. Our goal was to compare outcomes for RALS in obese and non-obese patients.

S A T A b st ra ct s therapy to treat LRRC remains controversial. Therefore, we retrospectively analyzed patients who underwent surgical treatment for LRRC, to evaluate the perioperative outcome and the prognosis. Methods: Forty-five patients (male-female ratio, 25:20), who underwent surgical treatment for LRRC in a single institution between 1990 and 2014, were clinicopathologically analyzed. Results: The mean age at surgical treatment for LRRC was 60 years old (range 36-87). Thirty-four patients (76%) were diagnosed as LRRC within three years after surgery for the primary tumor. Total pelvic exenteration, abdominoperineal resection or low anterior resection, and simple tumor excision were performed in 7, 27, and 11 patients, respectively. The median operative time, blood loss and hospital stay were 530 min, 2213 ml and 53 days, respectively. Out of 45 patients, 32 patients (71%) had curative (R0) resection and 13 patients (29%) had non-curative resection. The complications, such as intrapelvic abscess, urinary tract dysfunction, wound infection, and intestinal obstruction, were observed in 35 patients (75%) after surgical treatment for LRRC. There was no surgery-related death. Threeyear survival rate of all 45 patients and 35 patients with R0 resection were 53% and 73%, respectively. No three-year survivors were observed in the patients with non-curative resection. Conclusions: Although surgical treatment for LRRC is highly invasive, curative (R0) resection improves the outcome of the patients with LRRC.

As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.