title: Totally robotic rectal resection: an experience of the first 100 consecutive cases.
abstract: BACKGROUND
  Robotic surgery provides an alternative option for a minimal access approach. It provides a stable platform with high definition three-dimensional views and improved access, which enhances the capabilities for precise dissection in a narrow surgical field. These distinctive features have made it an attractive option for colorectal surgeons.
  
  
  OBJECTIVE
  The aim of this study was to present a standardised technique for single-docking robotic rectal resection and to analyse clinical outcomes of the first 100 robotic rectal procedures performed in a single centre between May 2013 and April 2015.
  
  
  METHODS
  Prospectively collected data related to 100 consecutive patients who underwent single-docking robotic rectal surgery was analysed for surgical and oncological outcomes.
  
  
  RESULTS
  Sixty-six patients were male, the median age was 67 years (range-24-92). Eighteen patients had neo-adjuvant chemoradiotherapy whilst 23 patients had BMI >30. Procedures performed included anterior resection (n = 74), abdominoperineal resection (n = 10), completion proctectomy (n = 9), restorative proctectomy with ileal pouch-anal anastomosis (IPAA) (n = 5) and Hartmann's procedure (n = 2). The median operating time was 240 min (range-135-456), and median blood loss was 10 ml (range 0-200). There was no conversion or intra-operative complication. Median length of stay was 7 days (range, 3-48) and readmission rate was 12 %. Thirty-day mortality was zero. Postoperatively, two patients had an anastomotic leak whilst two had small bowel obstruction. The median lymph node harvest was 18 (range, 6-43).
  
  
  CONCLUSIONS
  The single-docking robotic technique should be considered as an alternative option for rectal surgery. This approach is safe and feasible and in our study it has demonstrated favourable clinical outcomes.
authors.affiliation: Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK. drjag@hotmail.co.uk.
authors.forename: J
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nasir
authors.affiliation: Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.
authors.forename: K
authors.initials: K
authors.lastname: Flashman
authors.affiliation: Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.
authors.forename: J
authors.initials: J
authors.lastname: Khan
authors.affiliation: Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.|Head of Laparoscopic & Robotic Programme, Colorectal Cancer Unit, Champalimaud Clinical Foundation, Lisbon, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Parvaiz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D012004:Rectal Neoplasms / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome
keywords: Colorectal; Minimally invasive surgery; Pelvic surgery; Robotic surgery
references.citation: Ann R Coll Surg Engl. 2009 Oct;91(7):541-4
references.pmid: 19833012
references.citation: N Engl J Med. 2004 May 13;350(20):2050-9
references.pmid: 15141043
references.citation: Ann Surg Oncol. 2009 Jun;16(6):1480-7
references.pmid: 19290486
references.citation: Int J Med Robot. 2011 Jun;7(2):123-6
references.pmid: 21328677
references.citation: Ann Surg Oncol. 2010 Nov;17(11):2856-62
references.pmid: 20567918
references.citation: Dis Colon Rectum. 2003 Dec;46(12):1633-9
references.pmid: 14668588
references.citation: Br J Surg. 2004 Sep;91(9):1111-24
references.pmid: 15449261
references.citation: Int J Colorectal Dis. 2014 Jan;29(1):1-8
references.pmid: 23995270
references.citation: Colorectal Dis. 2006 Jun;8(5):375-88
references.pmid: 16684081
references.citation: Cancer Treat Rev. 2008 Oct;34(6):498-504
references.pmid: 18468803
references.citation: Ann Surg Oncol. 2012 Nov;19(12):3727-36
references.pmid: 22752371
references.citation: Arch Surg. 2003 Jul;138(7):777-84
references.pmid: 12860761
references.citation: Ann Surg Oncol. 2007 Nov;14(11):3168-73
references.pmid: 17763911
references.citation: Dis Colon Rectum. 2002 Dec;45(12):1689-94; discussion 1695-6
references.pmid: 12473897
references.citation: Colorectal Dis. 2006 Sep;8 Suppl 3:30-2
references.pmid: 16813590
references.citation: Colorectal Dis. 2015 Mar;17(3):185
references.pmid: 25678329
references.citation: Colorectal Dis. 2013;15(10):1211-26
references.pmid: 23711242
references.citation: Surg Clin North Am. 2003 Dec;83(6):1293-304, vii
references.pmid: 14712866
references.citation: Dis Colon Rectum. 2013 Feb;56(2):253-62
references.pmid: 23303155
references.citation: Surg Endosc. 2012 Apr;26(4):956-63
references.pmid: 22044968
references.citation: Clin Colon Rectal Surg. 2009 Nov;22(4):218-24
references.pmid: 21037812
references.citation: Surg Endosc. 2009 Feb;23(2):447-51
references.pmid: 19057962
references.citation: J Korean Soc Coloproctol. 2010 Dec;26(6):377-87
references.pmid: 21221237
references.citation: World J Surg Oncol. 2015 Mar 12;13:103
references.pmid: 25885046
references.citation: Surg Clin North Am. 2003 Dec;83(6):1321-37
references.pmid: 14712869
references.citation: Int J Colorectal Dis. 2014 Sep;29(9):1105-11
references.pmid: 24942499
references.citation: Minerva Chir. 2005 Oct;60(5):401-16
references.pmid: 16210989
references.citation: J Cancer. 2012;3:49-57
references.pmid: 22315650
references.citation: Surg Endosc. 2006 Nov;20(11):1713-8
references.pmid: 17008953
references.citation: Colorectal Dis. 2015 May;17(5):375-81
references.pmid: 25515638
references.citation: Int J Colorectal Dis. 2013 Jun;28(6):815-21
references.pmid: 23242270
references.citation: Surg Endosc. 2013 Aug;27(8):2704-11
references.pmid: 23392980
references.citation: World J Surg. 2012 Nov;36(11):2722-9
references.pmid: 22855217
references.citation: Lancet Oncol. 2013 Mar;14(3):210-8
references.pmid: 23395398
references.citation: World J Surg. 2011 Feb;35(2):409-14
references.pmid: 21052997
references.citation: Dis Colon Rectum. 2014 Sep;57(9):1066-74
references.pmid: 25101602
references.citation: ISRN Surg. 2012;2012:293894
references.pmid: 22655207
references.citation: World J Surg. 2010 Aug;34(8):1954-8
references.pmid: 20458584
references.citation: Ann Surg. 2015 Apr;261(4):716-22
references.pmid: 25072446
references.citation: Yonsei Med J. 2008 Dec 31;49(6):891-6
references.pmid: 19108010