Browsing by Author "Waters, Peadar S."

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    Fellowship training in robotic colorectal surgery within the current hospital setting: an achievable goal?
    (2021) Waters, Peadar S.; Flynn, Julie; Larach, José T.; Diharah, Fernando; Peacock, Oliver; Foster, Jake D.; Flood, Michael; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
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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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    Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short-term outcomes
    (2022) Tomas Larach, Jose; Flynn, Julie; Fernando, Diharah; Mohan, Helen; Rajkomar, Amrish; Waters, Peadar S.; Kong, Joseph; McCormick, Jacob J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim To explore the feasibility and safety of robotic beyond total mesorectal excision (TME) surgery for primary and recurrent pelvic malignancy. Methods Patients undergoing robotic beyond TME resections for primary or recurrent pelvic malignancy between July 2015 and July 2021 in a public quaternary and a private tertiary centre were included. Demographic and clinical data were recorded and outcomes analysed. Results Twenty-four patients (50% males) were included, with a median age of 58 (45-70.8) years, and a BMI of 26 (24.3-28.1) kg/m(2). Indication for surgery was rectal adenocarcinoma in nineteen, leiomyosarcoma in two, anal squamous cell carcinoma in one and combined rectal and prostatic adenocarcinoma in two patients. All patients required resection of at least one adjacent pelvic organ including genitourinary structures (n = 23), internal iliac vessels (n = 3) and/or bone (n = 2). Eleven patients had a restorative procedure. Of the 13 nonrestorative cases, nine needed perineal reconstruction with a flap. There was one conversion due to bleeding. The mean operating time was 370 (285-424) min, and the median blood loss was 400 (200-2,000) ml. The median length of stay was 16 (9.3-23.8) days. Fourteen patients (58.3%) had postoperative complications; eight of them (33.3%) were Clavien-Dindo III or more complication. Twenty-three (95.8%) patients had an R0 resection. During a median follow-up of 10 (7-23.5) months, five patients (20.8%) had systemic recurrences. No local recurrences were identified during the study period. Conclusion Implementation of robotic beyond TME surgery for primary and recurrent pelvic malignancy is feasible within a highly specialised setting.
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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 pelvic side-wall dissection and en-bloc excision for locally advanced and recurrent rectal cancer: outcomes on feasibility and safety
    (2022) Lokuhetty, Naradha; Tomas Larach, Jose; Rajkomar, Amrish K. S.; Mohan, Helen; Waters, Peadar S.; Heriot, Alexander G.; Warrier, Satish K.
    Background: Global differences exist in managing lateral pelvic nodes in rectal cancer. Recent studies demonstrate improved local recurrence rates in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision (TME) for advanced lower rectal cancer. This study aims to report on the safety and feasibility of the robotic approach in patients undergoing pelvic sidewall lymph node dissection or en-bloc sidewall resection for advanced lower rectal cancer.