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

2. Oxford Colorectal

3. Oxford Colorectal 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 –More not UC –Higher failure rate Burns et al 2011

4. Oxford Colorectal The Future of Pouch Surgery Laparoscopic colectomy Laparoscopic pouch formation Emergence of “re-do” pouch surgery –K pouch Information Day 2010

5. Oxford Colorectal Laparoscopic colectomy trends

6. Oxford Colorectal Totally laparoscopic J-pouch reconstruction 0 Mostly “laparoscopic assisted” OPENLAPP Incisional hernia 8.4%5.9%ns SBO admission 26%29%ns SBO re- operation 8.4%11.8%ns Benlice et al (Cleveland) DCR 2015

7. Oxford Colorectal 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

8. Oxford Colorectal minimally invasive IBD surgery multi-port hand assisted single incision

9. Oxford Colorectal taTME

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

11. Oxford Colorectal 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

12. Oxford Colorectal Robotic developments haptic feedback image-guided surgery true robots rather than robotic servers

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

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

15. Oxford Colorectal