New Article
Setting up a Specialized Robotic Colorectal Centre in Greece: Our Initial Experience
Intro
It is widely accepted that specialized surgeons and high volume centers could result in better oncological outcomes
When it comes to colorectal surgery for cancer, and especially in ‘’high risk’’ patients, it is widely accepted now that specialized surgeons and high-volume centers could result in better oncological outcomes.
However, in many European countries (Greece included), sub-specialization is not mandatory and there are still ‘’general ‘’ surgeons, performing most resections, including these for cancer; this could lead to impairment of oncological results, as well as bad short-term outcomes too
We aim to present our experience, setting up a specialized Robotic Colorectal Center in Greece.
Method
Our program started in end of 2019. We use a Da Vinci SI system and we attempt a robotic approach in all referrals.
The primary surgeon has completed an international robotic colorectal fellowship in UK and is a qualified member of the European Academy of Robotic Colorectal Surgery (EARCS).
We have a dedicated same theatre team and we use a single side docking technique
and standardized technique, as described by the European Robotic group.
All patients are within an established ERAS Protocol.
We use Augmented Reality and create personalized interactive 3d models of the vascular anatomy (innersight lab platform)
We perform CME + D3 lymphadenectomies for right colon cancers
We perform Natural Orifice Transluminal Extraction Colectomies
Results
60 high risk patients are included so far.
94% had cancer and 70% had previous abdominal surgeries
The median age is 72 y.o (35-82) and BMI is 31mg/m2(20-43).
The length of stay is 3 days (2-26).
Complication rate is 12%- We only had 2 serious complications (Clavien-Dindo IIIc and IV); this was one death from pulmonary embolism and one return to theatre due to obstructive ileus.
The median lymph node harvested is 30 for the whole group (15-31) and 41 (35-48) for the subgroup of CME with D3 patients.
Quality of total mesorectal excision (Quirke classification) is grade I or II in all patients and all patients had a negative CRM.
We performed the first robotic cme in Europe with AR Tools
We also performed the first robotic NOTES In Europe and we continue performing this operation wherever its indicated
Conclusion
Robotic surgery and combination with new technologies of AR and AI, allow us to perform innovative techniques and radical resections; thus increase survival, with very good quality of life for our patients.
