Addressing the challenges restoring clinical services during the COVID-19 pandemic by harnessing the alignment of clinical and management leadership: an example from a large colorectal service.

Background: The COVID-19 pandemic has posed the greatest operational challenge to the English National Health Service since its inception. Elective surgical services have struggled due to the need to protect both staff and patients from viral exposure, and perioperative COVID-19 infection has been associated with significant excess mortality.

Interventions: In this brief report, we describe how through necessity, it has provided an opportunity to redesign services for the benefit of both patients and organisations, with attendant improvement in activity compared with prepandemic metrics.

A Delphi consensus statement for digital surgery.

The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term 'digital surgery'. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice.

An Observational Analysis of a Novel Digital Rectoscope.

Background: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view.

Minimal access rectal cancer surgery: an observational study of patient outcomes from a district general hospital with over a decade of experience with robotic rectal cancer surgery.

Aim: Robotic surgery for colorectal cancer has become established more slowly than in other specialities. The aim of this study was to assess the risks and benefits of the use of robotic rectal cancer surgery in comparison with laparoscopic surgery within the confines of a subspecialist rectal cancer service in a district general hospital.

Method: Outcomes from consecutive patients undergoing minimal access rectal cancer surgery between July 2008 and January 2020 were analysed.

The 'hub and spoke model' for the management of surgical patients during the COVID-19 pandemic.

During the on-going COVID-19 pandemic a number of key public health services have been severely impacted. These include elective surgical services due to the synergetic resources required to provide both perioperative surgical care whilst also treating acute COVID-19 patients and also the poor outcomes associated with surgical patients who develop COVID-19 in the perioperative period. This article discusses the important principles and concepts for providing important surgical services during the COVID-19 pandemic based on the model of the RMCancerSurgHub which is providing surgical cancer services for a population of approximately 2 million people across London during the pandemic.

Experiences of a "COVID protected" robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic.

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a "COVID protected" robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems.

Preclinical evaluation of the versius surgical system, a new robot-assisted surgical device for use in minimal access general and colorectal procedures.

Objective: To evaluate the utility of a new robot-assisted surgical system (the Versius Surgical System, CMR Surgical, Cambridge, UK) for use in minimal access general and colorectal surgery, in a preclinical setting. Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is designed to assist surgeons in performing minimal access surgery and overcome some of the challenges associated with currently available surgical robots.

Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis.

Background: Individual trials comparing hand-sewn with stapled closure of loop ileostomy show different outcomes due to lack of statistical power. A systematic review, with a pooled analysis of results, might provide a more definitive answer. This review aimed to compare hand-sewn with stapled anastomotic technique for closure of a loop ileostomy and looked at the effect of bowel resection on the complication rates.

To divert or not to divert: A retrospective analysis of variables that influence ileostomy omission in ileal pouch surgery.

Hypothesis: A model could be developed to identify patients who can safely undergo restorative proctocolectomy (RPC) without proximal diversion.

Design: Logistic regression analysis was used to identify independent factors favoring omission of ileostomy at the time of RPC. A propensity nomogram was developed and validated using measures of calibration, discrimination, and subgroup analysis.

The influence of circumferential resection margins on long-term outcomes following rectal cancer surgery.

Purpose: Circumferential resection margin involvement after rectal cancer surgery is associated with local recurrence and decreased survival, but definitions of "safe" margins vary. This study assessed the influence of various circumferential margins on long-term outcome from rectal cancer surgery.

Methods: Data were extracted from a rectal cancer database of patients undergoing rectal resection at a tertiary referral center between 1971 and 1996.

The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases.

Background And Aims: Loop ileostomies are used currently in surgical practice to reduce the consequences of distal anastomotic failure following colorectal resection. It is often assumed that reversal of a loop ileostomy is a simple and safe procedure. However, many studies have demonstrated high morbidity rates following loop ileostomy closure.

Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy.

Objective: To compare outcomes following abdominal surgery with or without the use of chewing gum in the early postoperative period.

Data Sources: MEDLINE, Embase, Ovid, and Cochrane databases.

Study Selection: Randomized controlled trials reporting 1 or more outcomes related to functional postoperative recovery.

Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy.

Objective: To evaluate postoperative adverse events and functional outcomes of patients undergoing restorative proctocolectomy with or without proximal diversion.

Data Sources: The literature was searched by means of MEDLINE, Embase, Ovid, and Cochrane databases for all studies published from 1978 through July 15, 2005.

Study Selection: Comparative (randomized and nonrandomized) studies evaluating outcomes after restorative proctocolectomy with or without ileostomy were included.

A national perspective on the decline of abdominoperineal resection for rectal cancer.

Objective: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer between centers and over time, and to evaluate the influence of patient characteristics, including social deprivation, on APER rate.

Methods: Data on patients undergoing APER or anterior resection (AR) in England were extracted from a national administrative database for the years 1996 to 2004. The primary outcome was the proportion of patients presenting with rectal cancer undergoing APER.

Comparison of administrative data with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database.

Background: This study compared case volume and operative mortality from surgery for colorectal cancer in England derived from Hospital Episode Statistics (HES) with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database.

Materials And Methods: Data extracted from HES records for 2001-2002 for patients undergoing one of seven procedures for colorectal cancer were compared with those from the ACPGBI database. The primary endpoint was a 30-day post-operative mortality.

Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials.

Aims: To use meta-analytic techniques to compare peri-operative and short term post-operative outcomes for patients undergoing cholecystectomy via the laparoscopic or mini-open approach.

Methods: Randomised control trials published between 1992 and 2005, cited in the literature of elective laparoscopic (LC) versus mini-open cholecystectomy (MoC) for symptomatic gallstone disease were included. End points evaluated were adverse events, operative and functional outcomes.

A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer.

Background: Avoiding a permanent stoma following rectal cancer excision is believed to improve quality of life (QoL), but evidence from comparative studies is contradictory. The aim of this study was to compare QoL following abdominoperineal excision of rectum (APER) with that after anterior resection (AR) in patients with rectal cancer.

Methods: A literature search was performed to identify studies published between 1966 and 2006 comparing values of QoL following APER and AR.

Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses.

Background: The present study evaluated outcomes of patients undergoing proximal diversion using either a loop ileostomy or loop colostomy following distal colorectal resection for malignant and non-malignant disease.

Methods: A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to identify studies published between 1966 and 2006, comparing loop ileostomy and loop colostomy to protect a distal colorectal anastomosis. A random effect meta-analytical technique was used and sensitivity analysis performed on studies published since 2000, higher quality papers, those reporting on 70 or more patients, and those reporting outcomes following colorectal cancer resections.

Meta-analysis of clinical outcome after first and second liver resection for colorectal metastases.

Background: The perioperative risk and long-term survival benefit of repeat hepatectomy for patients with liver metastases from colorectal cancer, compared with that of a first liver resection, has been reported with varying results in the literature.

Methods: The literature was searched using Medline, Embase, Ovid, and Cochrane databases for all studies published from 1992 to 2006. Two authors independently extracted data using the following outcomes: postoperative complications and mortality; disease recurrence; and long-term survival.

The effect of Crohn's disease on outcomes after restorative proctocolectomy.

Purpose: This study was designed to compare postoperative adverse events and functional outcomes after ileal pouch-anal anastomosis between patients with Crohn's disease and those with non-Crohn's disease diagnoses.

Methods: A literature search was performed to identify studies published between 1980 and 2005 comparing outcomes of patients undergoing ileal pouch-anal anastomosis for Crohn's disease, ulcerative colitis, and indeterminate colitis. Random-effect, meta-analytical techniques were used and sensitivity analysis was performed.

Factors affecting circumferential resection margin involvement after rectal cancer excision.

Purpose: This study was designed to assess factors affecting rates of circumferential resection margin involvement after rectal cancer excision, the association between circumferential resection margin involvement rates for patients undergoing anterior resection and abdominoperineal excision within the same unit, and trends in outcomes between units.

Methods: Data about patients undergoing rectal cancer excision between 2000 and 2003 were extracted from the Association of Coloproctology of Great Britain and Ireland database. Multivariate logistic regression analysis was used to identify independent predictors of circumferential resection margin involvement.