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OUH without Professor Mortensen!

OUH without Professor Mortensen!. Bruce George Department of Colorectal Surgery John Radcliffe Hospital, Oxford. 24-10-15. Volume and decision making national pouch database. 1996-2008 30% hospitals < 2/year 91% hospitals < 20/8 years Low institutional volume: More extremes of age

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OUH without Professor Mortensen!

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  1. OUH without Professor Mortensen! Bruce George Department of Colorectal Surgery John Radcliffe Hospital, Oxford 24-10-15

  2. Volume and decision makingnational pouch database • 1996-2008 • 30% hospitals < 2/year • 91% hospitals < 20/8 years • Low institutional volume: • More extremes of age • More not UC • Higher failure rate Burns et al 2011

  3. The Future of Pouch Surgery • Laparoscopic colectomy • Laparoscopic pouch formation • Emergence of “re-do” pouch surgery • K pouch Information Day 2010

  4. Laparoscopic colectomy trends

  5. Totally laparoscopic J-pouch reconstruction • 0 • Mostly “laparoscopic assisted” Benlice et al (Cleveland) DCR 2015

  6. Future challenges in pouch surgery in Oxford • Maintaining high volume multidisciplinary approach • Re-do pouch operations and Kock pouch surgery • New technological advances • taTME (bottom-up surgery) • Robotic techniques

  7. minimally invasive IBD surgery single incision hand assisted multi-port

  8. taTME

  9. robotic colorectal surgery • 3-dimensional view • stable platform • “wristed” instrumentation • elimination of physiologic tremor • improved ergonomics

  10. robotic colorectal surgery • 3-dimensional view • stable platform • “wristed” instrumentation • elimination of physiologic tremor • improved ergonomics • anecdotal IBD data only • no proven outcomes benefit • cost • Initial outlay £330,000-1.4 million • Annual maintenance £55,000-95,000 • Per case cost £1000-3900

  11. Robotic developments • haptic feedback • image-guided surgery • true robots rather than robotic servers

  12. MIS in IBD • haptic feedback • image-guided surgery • true robots rather than robotic servers Google 2020 Mortensen 2015

  13. The Future of Pouch Surgery 2010 2015 Maintaining high volume, high quality MDT care Maintaining re-do and Kock pouch surgery New technologies taTME robotics • Laparoscopic colectomy • Laparoscopic pouch formation • Emergence of “re-do” pouch surgery • K pouch

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