Combined endoscopic robotic surgery for complex colonic polyp resection: case series

• Published in: Surgical endoscopy Vol. 36; no. 6; pp. 3852 - 3857
• Main Authors: Jones, Austin T., Broome, Jacob M., Zelhart, Matthew D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenoma - surgery; Colectomy - methods; Colon - surgery; Colonic Polyps - surgery; Endoscopy; Gastroenterology; Gynecology; Hepatology; Humans; Intraoperative Complications - surgery; Laparoscopy; Laparoscopy - methods; Length of stay; Medicine; Medicine & Public Health; Polyps; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - methods; Surgery; Treatment Outcome; Tumors; Combined approach; Colon; Complex polyps; Robotic; Endoscopic
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-021-08702-9

Background
The study objective was to evaluate combined endoscopic and robotic surgery, a novel surgical technique modifying traditional combined endoscopic laparoscopic surgery through robotic assistance, and characterize a series of patients who underwent the modified operative technique.
Methods
A retrospective case series was performed. The first thirty-seven consecutive patients who underwent combined endoscopic robotic surgery by a single colorectal surgeon from March 2018 to October 2019 were included. Main outcome measures included operative time, intra-operative complication, 30-day post-operative complication, and hospital length of stay.
Results
Combined endoscopic and robotic surgery was performed in 37 cases, 32 (86.5%) of which saw the technique through to completion. Median operative room time was 73 min (range 31–184 min). No intraoperative complications occurred and 2 (6.3%) experienced 30-day post-operative complications. Median hospital length of stay was 1.1 days (range 0.2–2.0 days). Median polyp size was 35 mm (range 20–130 mm). Polyps were resected from the following locations: cecum (37.5%), ascending colon (28.1%), transverse colon (21.9%), descending colon (3.1%), sigmoid colon (6.3%), and rectum (3.1%). Pathology demonstrated 77.4% tubular adenoma, 12.9% sessile serrated adenoma, 6.5% dysplasia, and 3.2% signet cell adenocarcinoma.
Conclusion
Combined endoscopic robotic surgery was associated with decreased operative time, complication rates, and hospital length of stay compared to literature-reported statistics for combined endoscopic laparoscopic surgery. Increased confidence with 3-dimensional visualization and intracorporeal suturing using combined endoscopic and robotic surgery was noted. Additional studies are needed to further define the role of robotics in combined endoscopic surgery.