Browsing by Author "Larach, Jose Tomas"

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    Application of a hybrid robotic and transanal total mesorectal excision approach to resect a bulky low rectal gastrointestinal stromal tumour
    (2022) Rajabifard, Pedram; Larach, Jose Tomas; Mohan, Helen; Heriot, Alexander G.; Warrier, Satish Kumar
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    Beyond transanal total mesorectal excision: short-term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision
    (2021) Larach, Jose Tomas; Rajkomar, Amrish K. S.; Smart, Philip J.; McCormick, Jacob J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane.
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    Impact of the approach on conversion to open surgery during minimally invasive restorative total mesorectal excision for rectal cancer
    (2023) Larach, Jose Tomas; Kong, Joseph; Flynn, Julie; Wright, Timothy; Mohan, Helen; Waters, Peadar S.; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
    BackgroundThe aim of this study is to explore the impact of the approach on conversion in patients undergoing minimally invasive restorative total mesorectal excision within a single unit.MethodsA retrospective cohort study was conducted. Patients with rectal cancer undergoing minimally invasive restorative total mesorectal excision between January 2006 and June 2020 were included. Subjects were classified according to the presence or absence of conversion. Baseline variables and short-term outcomes were compared. Regression analyses were conducted to assess the relationship between the approach and conversion.ResultsDuring the study period, 318 patients underwent a restorative proctectomy. Of these, 240 met the inclusion criteria. Robotic and laparoscopic approaches were undertaken in 147 (61.3%) and 93 (38.8%) cases, respectively. A transanal approach was utilised in 62 (25.8%) cases (58.1% in combination with a robotic transabdominal approach). Conversion to open surgery occurred in 30 cases (12.5%). Conversion was associated with an increased overall complication rate (P = 0.003), surgical complications (P = 0.009), superficial surgical site infections (P = 0.02) and an increased length of hospital stay (P = 0.006). Robotic and transanal approaches were both associated with decreased conversion rates. The multiple logistic regression analysis, however, showed that only a transanal approach was independently associated with a lower risk of conversion (OR 0.147, 0.023-0.532; P = 0.01), whilst obesity was an independent risk factor for conversion (OR 4.388, 1.852-10.56; P < 0.00).ConclusionsA transanal component is associated with a reduced conversion rate in minimally invasive restorative total mesorectal excision, regardless of the transabdominal approach utilised. Larger studies will be required to confirm these findings and define which subgroup of patients could benefit from transanal component when a robotic approach is undertaken.
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    Laparoscopic colon surgery: time to leave the urinary catheter in the operating room?
    (2024) Riquoir, Christophe; Vela, Javier; Lascano, Raquel; Urrejola, Gonzalo; Bellolio, Felipe; Molina, Maria Elena; Miguieles, Rodrigo; Larach, Jose Tomas
    Introduction'Fast track' guidelines have incorporated multimodal measures to optimize perioperative outcomes in surgery, with laparoscopy being a pivotal component for its advantages in early recovery. In this setting, current recommendations regarding the use of a urinary catheter suggest its removal within the first 24-hours postoperatively. However, few studies have assessed the feasibility of leaving the operating room without it. The purpose of this study is to compare the perioperative outcomes of patients undergoing elective laparoscopic colonic resections leaving the operating room with and without a urinary catheter.MethodsA retrospective study was conducted utilizing prospectively collected data from patients undergoing elective colon resections over a 17-month period. The patients were classified into two groups based on the presence or absence of a urinary catheter upon leaving the operating room, and subsequently, their perioperative outcomes were compared.ResultsA total of 107 patients met the inclusion criteria (n = 28 with a urinary catheter and n = 79 without). Cancer was the most prevalent diagnosis (83.2%), and right hemicolectomy the most frequently performed surgery (32.7%). Two events of urinary catheter reinsertions were reported, both in the no-catheter group (0% vs 2.53%, p = 0.969), and there were no cases of urinary tract infections. The overall and severe complications rates exhibited no significant differences (25% vs. 26.6%, p = 1, and 7.14% vs. 5.06%, p = 1) and the length of stay was similar (p = 0.220).ConclusionRemoving the urinary catheter before leaving the operating room appears to be safe and associated with very low rates of urinary retention in selected patients undergoing laparoscopic colonic or upper rectal resections.
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    Laparoscopic extended right colectomy with complete mesocolic excision and en bloc splenectomy for a distal transverse colon cancer-A video vignette
    (2024) Vela, Javier; Riquoir, Christophe; Alvarado, Juan; Besser, Nicolas; Larach, Jose Tomas
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    Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study
    (2024) Vela, Javier; Riquoir, Christophe; Jarry, Cristian; Silva, Felipe; Besser, Nicolas; Urrejola, Gonzalo; Molina, Maria Elena; Miguieles, Rodrigo; Bellolio, Felipe; Larach, Jose Tomas
    BackgroundRetrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC.MethodsConsecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM).ResultsTwo hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient = - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases).ConclusionThe learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.
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    Robotic colorectal surgery in Australia: evolution over a decade
    (2021) Larach, Jose Tomas; Flynn, Julie; Kong, Joseph; Waters, Peadar S.; McCormick, Jacob J.; Murphy, Declan; Stevenson, Andrew; Warrier, Satish K.; Heriot, Alexander G.
    Background: Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years.
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    Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes
    (2022) Larach, Jose Tomas; Flynn, Julie; Wright, Timothy; Rajkomar, Amrish K. S.; McCormick, Jacob J.; Kong, Joseph; Smart, Philip J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. Methods Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. Results Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4-6] days versus 5 [3-8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (+/- 12.9) compared to 21.8 (+/- 7.5) with RCC (p < 0.001). Conclusion In our series, RCME was associated with a higher lymph node harvest and a similar morbidity profile compared to RCC. Further studies are required to validate these results and provide long-term oncologic outcomes.
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    Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes
    (2023) Larach, Jose Tomas; Flynn, Julie; Tew, Michelle; Fernando, Diharah; Apte, Sameer; Mohan, Helen; Kong, Joseph; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
    BackgroundAlthough several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform.MethodsConsecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs.ResultsDuring the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 +/- 83.4 versus 243 +/- 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 +/- 8235 versus A$15,525 +/- 6382; P < 0.001) and overall costs (A$34,350 +/- 14,770 versus A$26,083 +/- 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA >= 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1).ConclusionRobotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.