Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

Robert K. Cleary, Department of Surgery, Saint Joseph's Mercy Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI, 48106, USA. robert.cleary@stjoeshealth.org.
Matthew Silviera, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Tobi J. Reidy, Department of Surgery, Franciscan Health, Indianapolis, IN, USA.
James McCormick, Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
Craig S. Johnson, Department of Surgery, Oklahoma Surgical Hospital, Tulsa, OK, USA.
Patricia Sylla, Division of Colorectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY, USA.
Jamie Cannon, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Henry Lujan, Colon and Rectal Surgery, Jackson Health System, Miami, FL, USA.
Andrew Kassir, Colon and Rectal Clinical, Honor Health, Scottsdale, AZ, USA.
Ron Landmann, Department of Colon Rectal Surgery, Baptist MD Andersen Cancer Center, Jacksonville, FL, USA.
Wolfgang Gaertner, Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA.
Edward Lee, Department of Surgery, Albany Medical College, Albany, NY, USA.
Amir Bastawrous, Colon and Rectal Clinic, Swedish Medical Center, Seattle, WA, USA.
Ovunc Bardakcioglu, Department of Colorectal, Las Vegas School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA.
Sushil Pandey, West Valley Colon and Rectal Surgery Center, Sun City, AZ, USA.
Vikram Attaluri, Colon and Rectal Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Mitchell Bernstein, Division of Colon and Rectal Surgery, NYU Langone Medical Center, New York, NY, USA.
Vincent Obias, Division of Colon and Rectal Surgery, The George Washington University Hospital, Washington, DC, USA.
Morris E. Franklin, Texas Endosurgery Institute, San Antonio, TX, USA.
Alessio Pigazzi, Division of Colon and Rectal Surgery, Weill Medical College Cornell University, New York, NY, USA.

Document Type

Journal Article

Publication Date

6-1-2022

Journal

Surgical endoscopy

Volume

36

Issue

6

DOI

10.1007/s00464-021-08780-9

Keywords

Extracorporeal anastomosis; Intracorporeal anastomosis; Laparoscopic right colectomy; Minimally invasive colorectal surgery; Robotic-assisted right colectomy

Abstract

BACKGROUND: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. METHODS: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. RESULTS: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. CONCLUSION: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy.

Department

Surgery

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