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Defining Anastomotic Leak and the Clinical Relevance of Leaks
Clin Colon Rectal Surg DOI: 10.1055/s-0041-1735265Surgeons universally dread gastrointestinal anastomotic leaks, yet the precise definition is not widely agreed on despite international consensus guidelines. Likewise, leaks are not uniformly reported which makes comparisons across studies flawed. Leak rates range from 1 to 3% for ileocolonic, 0.5 to 18% for colorectal, and 5 to 19% for coloanal anastomoses. The sequelae of an anastomotic leak vary but generally correlate with the need for a change in clinical management, from minimal changes to the need for reoperation. Short- and long-term outcomes can be life-altering or...
Source: Clinics in Colon and Rectal Surgery - October 1, 2021 Category: Surgery Authors: Ellis, C. Tyler Maykel, Justin A. Tags: Review Article Source Type: research

Anuradha R. Bhama, MD, FACS, FASCRS
Clin Colon Rectal Surg DOI: 10.1055/s-0041-1735255 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - October 1, 2021 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Robotic Transanal Surgery for Rectal Cancer
Clin Colon Rectal Surg 2021; 34: 317-324 DOI: 10.1055/s-0041-1729864Robotic transanal surgery is the culmination of major developments in rectal cancer management and minimally invasive surgery. It is the result of continuous efforts to tackle the challenges inherent to rectal cancer surgery. This latest technology holds great promise and excitement for the care of the rectal cancer patient. In this article, we will describe the evolution of transanal rectal cancer surgery and describe how the convergence of transanal transabdominal, transanal endoscopic microsurgery, transanal minimally invasive surgery (TAMIS), transanal...
Source: Clinics in Colon and Rectal Surgery - September 9, 2021 Category: Surgery Authors: Marks, John H. Perez, Rafael E. Salem, Jean F. Tags: Review Article Source Type: research

Robotic Intracorporeal Anastomosis
We describe the technical details for the proper performance of an iso- and anti-peristaltic anastomosis including the set up of the robotic platform and the performance of the anastomosis. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 8, 2021 Category: Surgery Authors: Lagares-Garcia, Jorge A. Tags: Review Article Source Type: research

Options for Low Rectal Cancer: Robotic Total Mesorectal Excision
Clin Colon Rectal Surg 2021; 34: 311-316 DOI: 10.1055/s-0041-1726449Low rectal cancers (LRCs) may offer a difficult technical challenge even to experienced colorectal surgeons. Although laparoscopic surgery offers a superior exposure of the pelvis when compared with open approach, its role in rectal cancer surgery has been controversial. Robotic platforms are well suited for difficult pelvic surgery due to its three-dimensional visualization, degree of articulation of instruments, precise movements, and better ergonomics. The robot may be suitable especially in the anatomically narrow pelvis such as in male and obese patie...
Source: Clinics in Colon and Rectal Surgery - September 8, 2021 Category: Surgery Authors: Quezada-Diaz, Felipe F. Smith, J. Joshua Tags: Review Article Source Type: research

Robotic Surgery in Crohn's Disease
Clin Colon Rectal Surg 2021; 34: 286-291 DOI: 10.1055/s-0041-1729862Surgery for Crohn's disease presents unique challenges secondary to the inflammatory nature of the disease. While a minimally invasive approach to colorectal surgery has consistently been associated with better patient outcomes, adoption of laparoscopy in Crohn's disease has been limited due to these challenges. Robotic assisted surgery has the potential to overcome these challenges and allow more complex patients to undergo a minimally invasive operation. Here we describe our approach to robotic assisted surgery for terminal ileal Crohn's disease. [...] T...
Source: Clinics in Colon and Rectal Surgery - September 8, 2021 Category: Surgery Authors: Gunnells, Drew Cannon, Jamie Tags: Review Article Source Type: research

Augmented Reality: Moving Robotics Forward
Clin Colon Rectal Surg 2021; 34: 345-352 DOI: 10.1055/s-0041-1726353Compared with other fields, adoption of robotics in colorectal surgery remains relatively slow. One of the reasons for this is that the expected benefits of robotics, such as greater accuracy, speed, and better patient outcomes, are not born out in evidence comparing use of robotics for colorectal procedures to conventional laparoscopy. But evidence also suggests that outcomes with colorectal robotic procedures depend on the experience of the surgeon, suggesting that a steep learning curve is acting as a barrier to the benefits of robotics being realized. ...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Hachach-Haram, Nadine Miskovic, Danilo Tags: Review Article Source Type: research

Immunofluorescence in Robotic Colon and Rectal Surgery
Clin Colon Rectal Surg 2021; 34: 338-344 DOI: 10.1055/s-0041-1729866The indocyanine green fluorescence imaging system is a surgical tool with increasing applications in colon and rectal surgery that has received growing acceptance in various surgical disciplines as a potentially valid method to enhance surgical field visualization, improve lymph node retrieval, and decrease anastomotic leak. Small noncomparative prospective trials have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion and that its use may impact anastomotic leak rates. However, larger prospective a...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Bobel, Matthew C. Altman, Ariella Gaertner, Wolfgang B. Tags: Review Article Source Type: research

Robotics for Acute Care in Colorectal Surgery
Clin Colon Rectal Surg 2021; 34: 328-333 DOI: 10.1055/s-0041-1726448Robotic surgery is growing exponentially in elective colorectal procedures, but utilization of robotics in urgent and emergency procedures remains low. Robotic surgery can be safely utilized for the management of several acute colorectal operations such as anastomotic leaks, perforated diverticulitis, and more. This chapter discusses safe access principles and planning, as well as technical aspects of these complex procedures, and the pathway to building a 24/7 robotic access culture. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, Ne...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Friedman, Garrett Tags: Review Article Source Type: research

Robotic Reversal of Hartmann's Procedure
Clin Colon Rectal Surg 2021; 34: 325-327 DOI: 10.1055/s-0041-1734021The Hartmann's procedure first described in 1920 is a gold standard for a variety of emergent procedures of the sigmoid colon. A standardized approach to a robotic reversal of a Hartmann's procedure is described to reestablish bowel continuity. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Bardakcioglu, Ovunc Tags: Review Article Source Type: research

Robotic Surgery for Complicated Diverticular Disease
Clin Colon Rectal Surg 2021; 34: 297-301 DOI: 10.1055/s-0041-1729863Diverticular disease is common, and increasing in prevalence worldwide. The treatment for acute and chronic diverticular disease has a huge clinical and economic burden. Surgery is standard for complicated diverticulitis, and there are several benefits to using robotic surgery in these cases. Complicated diverticular disease can result in fistula, fibrosis, and deranged anatomy, which present technical challenges to the surgeon. Understanding and anticipating these anatomical challenges is key to successful surgery. While fears of conversion in complicated...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Ali, Fadwa Raskin, Elizabeth Tags: Review Article Source Type: research

Teaching and Training Surgeons in Robotic Colorectal Surgery
Clin Colon Rectal Surg 2021; 34: 280-285 DOI: 10.1055/s-0041-1729861Robotic surgery is becoming more popular among practicing physicians as a new modality with improved visualization and mobility (1–2). As patients also desire minimally invasive procedures with quicker recoveries, there is a desire for new surgical residents and fellows to pursue robotic techniques in training (3–4). To develop a new colorectal robotics training program, an institution needs a well-formulated plan for the trainees and mentors with realistic expectations. The development of a robotics training program has potential obstacles, including ...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Soliman, Mark K. Tammany, Alison J. Tags: Review Article Source Type: research

Safety with Innovation in Colon and Rectal Robotic Surgery
Clin Colon Rectal Surg 2021; 34: 273-279 DOI: 10.1055/s-0041-1726352Robotic colorectal surgery has been touted as a possible way to overcome the limitations of laparoscopic surgery and has shown promise in rectal resections, thus shifting traditional open surgeons to a minimally invasive approach. The safety, efficacy, and learning curve have been established for most colorectal applications. With this and a robust sales and marketing model, utilization of the robot for colorectal surgery continues to grow steadily. However, this disruptive technology still requires standards for training, privileging and credentialing, an...
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Keller, Deborah S. Jenkins, Christina N. Tags: Review Article Source Type: research

Robotic Colorectal Surgery: Beyond the Basics
Clin Colon Rectal Surg 2021; 34: 271-272 DOI: 10.1055/s-0041-1729923 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Keller, Deborah S. Raskin, Elizabeth Tags: Preface Source Type: research

Deborah Susan Keller, MS, MD and Elizabeth Raskin, MD
Clin Colon Rectal Surg 2021; 34: 269-270 DOI: 10.1055/s-0041-1729924 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - September 3, 2021 Category: Surgery Authors: Steele, Scott Tags: Introduction to the Guest Editors Source Type: research