Robotic colorectal surgery using the Senhance® robotic system: a single center experience.

BACKGROUND: The aim of this study was to evaluate the initial experience of a single robotic center with the Senhance® robotic systems (TransEnterix Surgical Inc, Morrisville, NC, USA) in colorectal surgery. METHODS: We performed a retrospective analysis of prospectively collected data of patients who underwent colorectal surgery using the Senhance® robotic systems, from November 2018 to November 2020. Perioperative, intraoperative, and short-term postoperative data were assessed. RESULTS: There were 57 patients (28 women and 29 men, mean age 61.7 ± 6.2 years [range 23-84 years]). Forty-eight (84.2%) patients underwent surgery for colorectal cancer (22 colon cancer and 26 rectal cancer) and 9 (15.8%) for benign conditions. Mean operating time was 194 min ± 57.8 min (range 90-380 min). In total, 27(47.4%) operations were performed on the colon and 30 (52.6%) on the rectum; mean length of postoperative hospital stay was 8 ± 6.2 days (range 3-48 days). There were 2 (3.4%) conversions to open surgery. No intraoperative complications occurred. Seven patients (12.3%) had postoperative complications 3 (5.3%) of whom had to be treated under general anesthesia. There was no mortality. In 48 patients operated on for colorectal cancer, the mean lymph-node harvest was 18 ± 7.9 (range 7-38 lymph nodes). In the rectal cancer group of 26 patients, the distal resection margin was 3.3 ± 1.8 cm. CONCLUSIONS: In our experience, surgery using the new Senhance® robotic system was safe and feasible in surgery of the colon and rectum. Randomized controlled trials comparing this type of colorectal surgery with laparoscopic and/or other types of robotic surgery are needed.

Validity and reliability of a Lithuanian version of low anterior resection syndrome score.

BACKGROUND: Up to 90 % of patients undergoing low anterior resection complain of increased daily bowel movements, urgency, and a variable degree of incontinence. A symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer has recently been developed and validated. The aim of our study was to adapt the low anterior resection syndrome (LARS) scale questionnaire to the Lithuanian language, and assess its psychometric properties. METHODS: The LARS questionnaire was translated into Lithuanian by the Scientific Advisory Committee of the Medical Outcomes Trust using a standard procedure of double-back translation. The Lithuanian version of the LARS (LARS-LT) questionnaire was completed by 111 patients who underwent low anterior resection with total mesorectal excision in the period from January 1, 2008, to December 31, 2012, at the National Cancer Institute. An anchor question from the Wexner score assessing the impact of bowel function on lifestyle was included. A subgroup of 20 patients completed the LARS-LT questionnaire twice. Validity was tested using a factor analysis, and internal reliability was estimated using the Cronbach's alpha and intraclass correlation coefficients. RESULTS: Twenty-seven patients (25 %) had no LARS, 26 (24 %) had minor LARS, and 55 (56 %) had major LARS. The response rate was 60.7 %. The LARS-LT showed significantly high reliability and internal consistency [Cronbach's α = 0.88, interclass correlation coefficient-0.86 (0.71-0.98)]. The LARS score showed significant correlations with the lifestyle question (p < 0.05). It could not detect differences between female and male patient groups (p = 0.33), patients' age (p = 0.45), patients who had/had not undergone radiation therapy (p = 0.07), and those in whom the distal edge of the tumor was close to or far from the anal verge (p = 0.17). CONCLUSIONS: The Lithuanian version of the LARS-LT shows acceptable psychometric properties and can be considered a valuable and specific instrument to assess bowel function in rectal cancer patients, both for research purposes and in clinical practice.

Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study.

OBJECTIVE: To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth. DESIGN: Prospective observational cohort study. SETTING: University hospital and outpatient clinics in Lithuania. POPULATION: A total of 280 pregnant women followed up until 1 month after delivery. METHODS: Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not. MAIN OUTCOME MEASURES: Incidence, time and risk factors of haemorrhoids and fissures. RESULTS: In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn>3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period. CONCLUSIONS: Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn>3800 g, straining during delivery for more than 20 minutes being independently associated risk factors.