Emergency General Surgery
Conditions
Brief summary
Background Abdominal surgical emergencies account for 20-30% of visceral surgery procedures. However, these emergencies are responsible for more than half of the morbidity in our discipline, with a surgical site infection rate four times higher than in elective surgery, and significantly higher rates of surgical revision and conversion (PMID: 34225343 and 27016997 and 27120712). In cases where minimally invasive surgery is converted to laparotomy, patients are three times more likely to be admitted to critical care units (PMID: 39966134). Visceral surgery currently represents the largest and fastest-growing discipline in robotic surgery. Robotic management of emergency general surgery has been described in the literature for several years, particularly in the United States. Robotic surgery allows a shift from open procedures to minimally invasive techniques or simplifies complex laparoscopic procedures. Several literature reviews and meta-analyses report decreased laparotomy rates, reduced perioperative morbidity, and shorter average length of hospital stay (PMID: 38446451 and 38918109). Abdominal surgical emergencies account for 20-30% of visceral surgery procedures. However, these emergencies are responsible for more than half of the morbidity in our discipline, with a surgical site infection rate four times higher than in elective surgery, and significantly higher rates of surgical revision and conversion (PMID: 34225343 and 27016997 and 27120712). In cases where minimally invasive surgery is converted to laparotomy, patients are three times more likely to be admitted to critical care units (PMID: 39966134). Visceral surgery currently represents the largest and fastest-growing discipline in robotic surgery. Robotic management of emergency general surgery has been described in the literature for several years, particularly in the United States. Robotic surgery allows a shift from open procedures to minimally invasive techniques or simplifies complex laparoscopic procedures. Several literature reviews and meta-analyses report decreased laparotomy rates, reduced perioperative morbidity, and shorter average length of hospital stay (PMID: 38446451 and 38918109).Primary Objective:To assess the implementation of a robotic surgery program for emergency visceral procedures (proof of feasibility in our university hospital). Secondary Objectives: Reduce perioperative morbidity, Reduce the rate of laparotomy, Reduce the average length of hospital stay (LOS), Reduce postoperative admission to critical care, Reduce operative time.
Interventions
PROCEDUREEmergency General surgery patients with robotic approach for the surgery
vPrimary Endpoint: The proportion of procedures performed robotically versus laparoscopically or via laparotomy for selected indications. Secondary Endpoints: A 5% change in perioperative morbidity, laparotomy rate, LOS, critical care admission rate, and operative time. Included Pathologies (for patients eligible for laparoscopy) : Acute cholecystitis with predictors of intraoperative difficulty. Bowel obstruction requiring bowel resection (in presence of CT signs of visceral compromise: poor enhancement of bowel loops, pneumoperitoneum). Complicated acute diverticulitis with perforation and peritonitis. Penetrating abdominal trauma with hemodynamic stability requiring surgery (e.g., bowel resection-anastomosis). Right or left colectomy for other etiologies. Splenectomy in hemodynamically stable or embolized patients.
Sponsors
Centre Hospitalier Universitaire de Nice
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Acute cholecystitis with predictors of intraoperative difficulty. * Bowel obstruction requiring bowel resection (in presence of CT signs of visceral compromise: poor enhancement of bowel loops, pneumoperitoneum). * Complicated acute diverticulitis with perforation and peritonitis. * Penetrating abdominal trauma with hemodynamic stability requiring surgery (e.g., bowel resection-anastomosis). * Right or left colectomy for other etiologies. * Splenectomy in hemodynamically stable or embolized patients.
Exclusion criteria
* Hemodynamic instability. * Uncomplicated acute appendicitis. * Acute cholecystitis without predictors of intraoperative difficulty.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Implementation of a robotic surgery program for emergency visceral procedures | Postoperative day 30 | To assess the implementation of a robotic surgery program for emergency visceral procedures (proof of feasibility in our university hospital).The team will screen patients who will meet the inclusion criteria and the first score will be : were we able to purpose robotic approach fr the patient. Then if we were able to do it, and if not, the reason why (OT nurse difficulty ? technical issue ? other ?). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluating robotic general emergencies procedures (Change perioperative morbidity) | Postoperative day 30. | Clavien-Dindo Classification ( grade 1 to 5) vs an historical cohort |
| Evaluating robotic general emergencies procedures (Change the rate of laparotomy) | Postoperative day 30 | Pourcentage vs historical data |
| Evaluating robotic general emergencies procedures (Change the average length of hospital stay ) | Postoperative day 30 | (LOS)-(in days, vs historical data) |
| Evaluating robotic general emergencies procedures (Change postoperative admission to critical care) | Postoperative day 30 | Pourcentage vs historical data |
| Evaluating robotic general emergencies procedures (Change operative time) | Postoperative day 30 | In minutes, vs historical data |
Countries
France
Contacts
Primary ContactDamien Massalou
Outcome results
None listed