Feasibility Study Of Da Vinci Robot-Assisted Surgery For Total Proctocolectomy

Objective To investigate the feasibility and safety of Da Vinci robot-assisted surgery for total proctocolectomy.Methods The clinical data of 46 patients with familial adenomatous polyposis(FAP),multiple primary colorectal cancer(MPCRC),ulcerative colitis(UC)and colonicslow transit constipation(CSTC)admitted to No.940 Hospital of the Joint Logistic Support Force of the People’s Liberation Army(formerly Lanzhou General Hospital of Lanzhou Military Area Command)Colorectal and Anal Surgery Department from October 2015 to December 2020 were retrospectively analyzed.All patients must meet the following criteria: preoperative diagnosis with total proctocolectomy,informed consent from the patient,and preoperative ASA body mass score of the patient ≤3.According to different surgical methods,6 patients underwent robot-assisted total proctocolectomy(robot group);Laparoscopic total proctocolectomy was performed in 27 patients(laparoscopic group).Thirteen patients underwent opentotal proctocolectomy(open group).Collect of three groups of patients age,sex,body mass index,basic disease history,history of abdominal surgery,patients with ASA preoperative physical grade level,such as preoperative data and operation time,intraoperative blood loss,intraoperative blood transfusion history such as intraoperative data and postoperative abdominal drainage volume and exhaust time,urine tube indwelling time,postoperative hospital stay,hospital expenses and the postoperative complications such as postoperative data,and statistical analysis of the data of three groups of patients.Results In the robot group,there were 6 patients,including 4 males and 2 females,aged50.7±17.4 years old and BMI 20.8±3.6kg/m~2.One patient had a history of abdominal surgery,and one patient had basic diseases.There were 4 cases of FAP,including 2 cases complicated with rectal malignancy,1 case complicated with colonic malignancy,and 2 cases with CSTC.In the laparoscopic group,there were 27 patients(9 males and 18 females,age 43.9±12.1 years old,BMI 22.2±3.8kg/m~2).5 cases had a history of abdominal surgery,and 6 cases were complicated with underlying diseases.There were 14 cases of FAP,including 4 cases with colonic malignancy,3 cases with rectal malignancy,12 cases with CSTC,and 1 case with UC.In the open group,there were 13 patients,8 males and 5 females,age 49.7±15.9 years old,BMI 24.7±3.2kg/m~2;9 cases had a history of abdominal surgery,and 6 cases were complicated with underlying diseases.There were 6 FAP patients,3 CSTC patients,and 4 MPCRC patients.There was no significant difference in clinical general data among the three groups(P BBB 0 0.05).The operative time of the three groups were 356.7±65.3min,265.4±66.7min and 266.5±45.8min,respectively.The operative time of the robot group was longer than that of the laparoscopic group and the open group(P < 0.05).The intraoperative blood loss of the three groups was 150.0±63.3ml,135.2±58.9ml and 442.3±207.0ml,respectively.The blood loss in the open group was more than that in the laparoscopic group and the robot group(P<0.05).In terms of conversion to laparotomy,there were 3 cases in the robot group and 2 cases in the laparoscopic group,P=0.008,the difference was statistically significant,and the conversion rate in the robot group was higher.There were 22 cases of postoperative complications,including 4 cases in the robot group,10 cases in the laparoscopic group,and 8 cases in the open group.The comparative analysis showed no statistical significance(P>0.05).There were no significant differences in intraoperative blood transfusion history,total number of lymph nodes,postoperative drainage volume,total number of lymph nodes,anal exhaust time,urinary catheter indwelling time and hospital stay in the three groups(P>0.05).The hospitalization expenses of the three groups were69912.1±5367.2 yuan,57439.0±16354.1 yuan and 51782.3±36585.3 yuan,respectively,which showed that the hospitalization expenses of the robot group were higher than those of the laparoscopic group and the open group(P<0.05).There was no death in the three groups.Conclusion Preliminary clinical study shows that Da Vinci surgical robot assisted total colorectal resection is feasible and safe.Robot total colorectal resection under certain advantages in the aspect of intraoperative blood loss,in addition,the image clarity,staffing and energy consumption and operation stability,also has certain advantages,but some patients had serious bowel oedema,expansion,adhesion,operation difficulty,will further prolong the acting time and increase the risk of anesthesia,pneumoperitoneum can therefore be selective application in clinical practice.There was no significant difference in intraoperative and postoperative complications among the three groups.Although the robot has the disadvantages of high operating cost,long operation time and high open rate,it still has certain advantages in total colorectal resection,so it should be considered comprehensively.The sample size of this study is small and it is a retrospective single-center study.A large sample,multi-center and prospective clinical study is needed to further clarify the feasibility and safety of this study.