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Robotic endoscopic cooperative surgery for colorectal tumors: a feasibility study (with video)

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Abstract

Background

Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR).

Methods

LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25 cm from the anal verge. Desired resection margins were marked endoscopically and two stay sutures were placed either robotically or laparoscopically. A mucosa-to-submucosa dissection was performed endoscopically along the markings. Complete full-thickness dissection was performed cooperatively. The specimen was withdrawn endoscopically. The colon was closed using a self-fixating running suture. Abdominal contaminations, operating times, complications, and complete resections were evaluated and compared between LECS-CR and RECS-CR.

Results

The mean number of colonies of Escherichia coli in the RECS group was significantly lower than in the LECS group (36.7 ± 30.2 vs. 142.2 ± 78.4, respectively, p < 0.05). Operating time was comparable (118 ± 11.2 vs. 98.6 ± 25.7, respectively, p = 0.22). Two stenoses occurred in the LECS group. R0 resection was achieved in all cases.

Conclusion

This study suggests that RECS-CR is feasible and has the potential to reduce intestinal content leakage, potentially preventing postoperative infections.

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Acknowledgements

The authors would like to thank Guy Temporal and Christopher Burel for their assistance in proofreading the article, Takeshi Urade for advice on experimental design, Jean-Paul Caspar, Elena Mihalache, Alain Rohfritsch, and Pascal Michel for their support in the experimental platform during the experiments.

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Authors and Affiliations

  1. IRCAD, Research Institute Against Digestive Cancer, 1, place de l’Hôpital, 67091, Strasbourg, France

    Nariaki Okamoto, Mahdi Al-Taher, Masashi Takeuchi, Jacques Marescaux, Michele Diana & Bernard Dallemagne

  2. Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands

    Mahdi Al-Taher

  3. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Pietro Mascagni

  4. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France

    Pietro Mascagni & Alain García Vazquez

  5. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Masashi Takeuchi

  6. Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France

    Michele Diana & Bernard Dallemagne

Authors
  1. Nariaki Okamoto
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  2. Mahdi Al-Taher
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  4. Alain García Vazquez
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  5. Masashi Takeuchi
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  6. Jacques Marescaux
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Corresponding author

Correspondence to Nariaki Okamoto.

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Disclosures

Jacques Marescaux is the President of IRCAD, which is partly funded by KARL STORZ and Medtronic. Michele Diana is members of the Advisory Board of Diagnostic Green. Michele Diana is the recipient of the ELIOS grant. Nariaki Okamoto, Mahdi Al-Taher, Pietro Mascagni, Alain García Vazquez, Masashi Takeuchi and Bernard Dallemagne have no conflicts of interest or financial ties to disclose.

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Okamoto, N., Al-Taher, M., Mascagni, P. et al. Robotic endoscopic cooperative surgery for colorectal tumors: a feasibility study (with video). Surg Endosc 36, 826–832 (2022). https://doi.org/10.1007/s00464-021-08786-3

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  • DOI: https://doi.org/10.1007/s00464-021-08786-3

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