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Experience-based Procedure Card for Robotic-assisted Low Anterior Resection Using the Indian SSI Mantra Robot
Somashekhar, S. P.; Agrawal, Kushal1; Ashwin, K. R.1; Kumar, C. Rohit1; Dixit, Jagannath1; Fernandes, Aaron Marian1; Girish, G.1; Patil, Darshan1; Sugara, Medha1; Voleti, Srikarthik1 Abstract
Introduction:
Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. This article introduces the procedure card for the Indian SSI Mantra Robotic platform in rectal cancer surgeries. It unveils a unique docking and port placement technique, enhancing procedural efficiency and outcomes. This marks the first comprehensive guide tailored for the multi-cart, open-console Indian Robot, representing a significant advancement in leveraging innovative technology for better surgical results.
Methods:
This procedure card has been developed based on the collective experience gained from 32 patients who underwent rectal cancer surgeries with the Indian SSI Mantra Robot. Detailed analysis of docking time, operative duration, intraoperative variables, and postoperative outcomes was undertaken to formulate this procedure card.
Results:
In our study, participants averaged 47.62 years old with a mean body mass index of 31.51 kg/m2. Most underwent robotic-assisted low anterior resection (RA-LAR) (87.50%), while a smaller portion had robotic-assisted abdominoperineal resection (RA-APR) (12.50%). All surgeries were completed robotically without conversion to open surgery. Operative time averaged 4.5 h, console time 3.5 h, and docking time 21 min. We retrieved an average of 26 lymph nodes. Minimal blood loss was observed (54 mL for RA-LAR and 96 mL for RA-APR), with no positive margins on histopathological examination. Patients stayed in the hospital for an average of 4.52 days postsurgery. Most had Foley catheters removed on postoperative day 1, with only 11.11% needing re-catheterization. Our port placement and docking technique prevented instrument clashing, and the robotic instruments offered excellent maneuverability throughout the procedure.
Conclusion:
In summary, our study offers a concise guide for RA-LAR with the Indian SSI Mantra Robot. With no open surgery conversions and positive outcomes in operative times, blood loss, and oncological measures, this resource aids surgeons in adopting robotic techniques for rectal cancer surgeries, enhancing patient care and advancing minimally invasive colorectal surgery.
