Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 15, 2022; 12(1): 1-7
Published online Jul 15, 2022. doi: 10.5412/wjsp.v12.i1.1
Freehand-robot-assisted laparoscopic colorectal surgery: Initial experience in the Trinidad and Tobago
Shamir O Cawich, Yardesh Singh, Vijay Naraynsingh, Ramdas Senasi, Tan Arulampalam
Shamir O Cawich, Vijay Naraynsingh, Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
Yardesh Singh, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
Ramdas Senasi, Department of Surgery, South Tyneside and Sunderland NHS Trust, South Shields NE34 0PL, United Kingdom
Tan Arulampalam, Department of General Surgery, Colchester Hospital University National Health Services Foundation Trust, Colchester, Essex, England, Colchester CO4 5JL, United Kingdom
Author contributions: Cawich SO wrote the paper and reviewed the paper for scientific accuracy; Naraynsingh V and Singh Y collected data and reviewed the mansucript for accuracy; Sensai R and Arulampalam T analyzed data and reviewed the manuscript for scientific accuracy.
Institutional review board statement: The study was reviewed and approved by the University of the West Indies' Institutional Review Board [(Approval No. CREC-SA.1615/06/2022].
Informed consent statement: This was an observational study of anonymized patient records. Consequently, the Institutional Review Board reviewed the protocols and exempted the participants from individual consent.
Conflict-of-interest statement: There are no conflicts of interest declared by any of the authors.
Data sharing statement: Data are available from the corresponding author upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shamir O Cawich, FRCS, Full Professor, Department of Surgery, University of the West Indies, St. Augustine Campus St. Augustine, St Augustine, Trinidad and Tobago. socawich@hotmail.com
Received: January 30, 2022
Peer-review started: January 30, 2022
First decision: March 25, 2022
Revised: May 11, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 15, 2022
Processing time: 163 Days and 4.1 Hours
Abstract
BACKGROUND

Laparoscopic colorectal surgery is still developing in the Anglophone Caribbean, having been first performed in the region in the year 2011. We report the initial outcomes using a robot camera holder to assist in laparoscopic colorectal operations.

AIM

To report our initial experience using the FreeHand® robotic camera holder (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) for laparoscopic colorectal surgery in Trinidad & Tobago.

METHODS

We retrospectively collected data from all patients who underwent laparoscopic colorectal resections using the Freehand® (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) robotic camera holder between September 30, 2021 and April 30, 2022. The following data were recorded: patient demographics, robotic arm setup time, operating time, conversions to open surgery, conversions to a human camera operator, number and duration of intra-operative lens cleaning. At the termination of the operation, before operating notes were completed, the surgeons were administered a questionnaire recording information on ergonomics, user-difficulty, requirement to convert to a human camera operator and their ability to carry out effective movements to control the robot while operating.

RESULTS

Nine patients at a mean age of 58.9 ± 7.1 years underwent colorectal operations using the FreeHand robot: Right hemicolectomies (5), left hemicolectomy (1), sigmoid colectomies (2) and anterior resection (1). The mean robot docking time was 6.33 minutes (Median 6; Range 4-10; SD ± 1.8). The mean duration of operation was 122.33 ± 78.5 min and estimated blood loss was 113.33 ± 151.08 mL. There were no conversions to a human camera holder. The laparoscope was detached from the robot for lens cleaning/defogging an average of 2.6 ± 0.88 times per case, with cumulative mean interruption time of 4.2 ± 2.15 minutes per case. The mean duration of hospitalization was 3.2 ± 1.30 days and there were no complications recorded. When the surgeons were interviewed after operation, the surgeons reported that there were good ergonomics (100%), with no limitation on instrument movement (100%), stable image (100%) and better control of surgical field (100%).

CONCLUSION

Robot-assisted laparoscopic colorectal surgery is feasible and safe in the resource-poor Caribbean setting, once there is appropriate training.

Keywords: Laparoscopic; Robotic; Minimally invasive; Colorectal

Core Tip: This study demonstrates that robot-assisted laparoscopic colorectal surgery is feasible in the resource poor Caribbean setting, but requires appropriate user training to ensure safe introduction of the technology.