选取60例重度肥胖行腹腔镜胃袖状切除术患者，分为观察组和对照组，结果表明两组在手术时间、吊肝时间、术中出血量方面的差异均有统计学意义（均 P<0.05）；钉仓数量差异无统计学意义（ P>0.05）。W形吊肝法在重度肥胖患者腹腔镜胃袖状切除术中是安全、有效的。

Background Current expectations are that surgeons should be technically proficient in minimally invasive low anterior resection (LAR)—both laparoscopic and robotic-assisted surgery. However, methods to effectively train surgeons for both approaches are under-explored. We aimed to compare two different training programs for minimally invasive LAR, focusing on the learning curve and perioperative outcomes of two trainee surgeons. Methods We reviewed 272 consecutive patients undergoing laparoscopic or robotic LAR by surgeons A and B, who were novices in conducting minimally invasive colorectal surgery. Surgeon A was trained by first operating on 80 cases by laparoscopy and then 56 cases by robotic-assisted surgery. Surgeon B was trained by simultaneously performing 80 cases by laparoscopy and 56 by robotic-assisted surgery. The cumulative sum (CUSUM) method was used to evaluate the learning curves of operative time and surgical failure. Results For laparoscopic surgery, the CUSUM plots showed a longer learning process for surgeon A than surgeon B (47 vs. 32 cases) for operative time, but a similar trend in surgical failure (23 vs. 19 cases). For robotic surgery, the plots of the two surgeons showed similar trends for both operative times (23 vs. 25 cases) and surgical failure (17 vs. 19 cases). Therefore, the learning curves of surgeons A and B were respectively divided into two phases at the 47th and 32nd cases for laparoscopic surgery and at the 23rd and 25th cases for robotic surgery. The clinicopathological outcomes of the two surgeons were similar in each phase of the learning curve for each surgery. Conclusions For surgeons with rich experience in open colorectal resections, simultaneous training for laparoscopic and robotic-assisted LAR of rectal cancer is safe, effective, and associated with accelerated learning curves.

BACKGROUND:A Chinese surgical robot, Micro Hand S, was introduced for clinical use as a novel robotic platform. This study aimed to comprehensively compare the early experience of the Micro Hand S robot-assisted total mesorectal excision (TME) with conventional approaches. METHODS:Between May 2017 and April 2018, 99 consecutive patients who underwent open, laparoscopic and Micro Hand S robot-assisted TME (O-/L-/RTME) for rectal cancer were included. Clinical and pathological outcomes were retrospectively analyzed. Surgical success as the primary endpoint was defined as the absence of (i) conversion, (ii) incomplete TME, (iii) involved circumferential and distal resection margins (CRM/DRM), (iv) severe complications. RESULTS:The rate of surgical success was similar (89.7 vs. 86.4 vs. 84.6%, p = 0.851) in the three groups and the respective incidences were as follows: conversion (not applicable, 4.5 vs. 2.3%, p = 1.000), incomplete TME (6.9 vs. 6.8 vs. 3.8%, p = 0.980), involved CRM/DRM (0 vs. 2.3 vs. 3.8%, p = 0.592), severe complications (3.4 vs. 4.5 vs. 7.7%, p = 0.844). Compared with open and laparoscopic surgery, the robotic surgery was associated with longer operative time, less blood loss, earlier first flatus time and liquid intake time, and shorter length of hospital stay (p < 0.05). CONCLUSIONS:The Micro Hand S assisted TME is safe and feasible, showing comparable outcomes than conventional approaches, with superiority in blood loss, recovery of bowel function, length of hospital stay, but with increased operative time.

Background The Micro Hand S robot is a new surgical tool that has been applied to total mesorectal excision (TME) surgery for rectal cancer in our center. In this study, we compared the operative outcomes, functional outcomes and learning curves of the Micro Hand S robot-assisted TME (RTME) with laparoscopic TME (LTME). Methods A total of 40 patients who underwent RTME and 65 who underwent LTME performed by a single surgeon between July 2015 and November 2018 were included in this retrospective study. Clinicopathologic characteristics, operative and functional outcomes, and learning curves were compared between the two groups. The learning curve was analyzed using the cumulative sum method and two stages (Phase 1, Phase 2) were identified and analyzed. All patients were followed up for at least 12 months. Results The clinicopathologic characteristics of the two groups were similar. The learning curve was 17 cases for RTME and 34 cases for LTME. Compared with LTME, RTME was associated with less blood loss (148.2 vs. 195.0 ml, p = 0.022), and shorter length of hospital stay (9.5 vs. 12.2 days, p = 0.017), even during the learning period. With the accumulation of experience, the operative time decreased significantly from Phase 1 to Phase 2 (RTME, 360.6 vs. 323.5 min, p = 0.009; LTME, 338.1 vs. 301.9 min, p = 0.005), whereas other outcomes did not differ significantly. Conclusions Micro Hand S robot-assisted TME is safe and feasible even during the learning period, with outcomes comparable to laparoscopic surgery but superior in terms of blood loss, length of hospital stay, and learning curve. Trial registration Clinicaltrial.gov, NCT04836741, retrospectively registered on 5 April 2021.

OBJECTIVE:Robotic surgery (RS) has been increasingly used for the resection of rectal cancer, and its advantages over laparoscopic surgery (LS) have been demonstrated. However, few studies focused on the severity of postoperative complications. This study aimed to compared the postoperative complications within 30 days after RS over LS according to the Clavien-Dindo (C-D) classification. METHODS:A literature research of PubMed, Embase, Cochrane Library and Web of Science were systematically performed. The studies comparing the complications of RS and LS for rectal cancer based on the C-D classification were enrolled. Primary outcomes were C-D grade III, IV, V, III-V (severe complications). RESULTS:Seventeen studies (3193 patients) were included in the final analysis: 1554 underwent RS and 1639 underwent LS. The RS group was associated with significantly lower rates of severe complications (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), C-D grade IV (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), and anastomotic leak (OR = 0.66, 95% CI 0.48-0.91, P = 0.01). There was no significant difference in C-D grade III, C-D grade I, II, I-II (minor complications), overall complications, bleeding, wound complications, postoperative ileus, urinary retention, readmission, reoperation between two groups. CONCLUSIONS:Robotic surgery is safe for rectal cancer and may be an effective alternative to laparoscopic surgery, with lower rates of severe complications, C-D grade IV, and anastomotic leak. Further large randomized controlled trials are necessary to confirm this conclusion.

Background As the first domestically produced Chinese surgical robot for clinical use, the Micro Hand S robot has been applied to total mesorectal excision (TME) for rectal cancer in our center since 2017. The aim of this study was to evaluate the safety and feasibility of the Micro Hand S robot-assisted TME (R-TME) in comparison with laparoscopic TME (L-TME).Methods Between May 2017 and February 2018, patients who underwent R-TME and L-TME in the Third Xiangya Hospital were included in this study. The data including intraoperative outcomes, postoperative outcomes, pathological outcomes, and functional outcomes were analyzed and compared. Results Totally, 30 patients underwent L-TME and 21 patients underwent R-TME. The patient characteristics of the two groups were similar. Regarding intraoperative and postoperative outcomes, the R-TME group had significantly less blood loss (95.2 vs. 130.0 ml, p = 0.022), shorter time to first flatus (2.1 vs. 2.9 d, p = 0.017) and first liquid intake (2.8 vs. 3.7 d, p = 0.027) than the L-TME group. There was no significant difference in the operative time, conversion, protective ileostomy, length of hospital stay, pain score, complications, and 30-day mortality between the two groups (p > 0.05). In addition, the pathological and functional outcomes also did not differ significantly.Conclusion The Micro Hand S robot-assisted total mesorectal excision is safe and feasible with short-term outcomes comparable to laparoscopic surgery. Prospective and large sample size trials are needed to further confirm this conclusion.