Implementation of totally robotic right hemicolectomy: lessons learned from a prospective cohort

Abstract

Robotics facilitates the realization of intra-corporeal anastomosis during right hemicolectomy and allows extracting the operative specimen through a C-section, offering potential benefits in terms of post-operative recovery and incidence of incisional hernia. Therefore, we progressively implemented robotic right hemicolectomy (robRHC) in our centre, and would like to report our initial experience with the technique. Consecutive patients who underwent robRHC within a single centre were prospectively included. Variables related to patients’ demographics, surgical procedures, post-operative recovery and pathological outcomes were collected. Sixty patients underwent robRHC in our centre. Indications for robRHC were colon cancer in 58 patients (96.7%) and polyps not amenable to endoscopic resection in 2 patients (3.3%). Fifty-eight patients underwent robRHC with D2 lymphadenectomy and central vessel ligation (96.7%), and two patients (3.3%) had robRHC associated with another procedure. All patients had intra-corporeal anastomosis. The mean ± operative time was of 200.4 ± 114.9 min. Two conversions (3.3%) to open surgery were performed. The mean ± SD length of stay was of 5.4 ± 3.8 days. Seven patients (11.7%) experienced a post-operative complication with a Clavien–Dindo score ≥ 2. Two patients (3.5%) had an anastomotic leak. The mean ± SD number of harvested lymph nodes was of 22.4 ± 7.6. All patients had negative pathological margins (R0 resection). To conclude, robotic RHC is a safe procedure, which can be implemented with satisfying peri- and post-operative outcomes. The potential benefits of the technique remain to be demonstrated by randomized controlled trials.

Robotic versus laparoscopic right hemicolectomy: a systematic review of the evidence

“…A propensity score-matched analysis of 192 patients who underwent either totally robotic right hemicolectomy (including intra-corporeal anastomosis) or robotic-assisted right hemicolectomy (including extra-corporeal anastomosis) showed that improved post-operative outcomes were reported when using the totally robotic approach, in terms of post-operative pain and recovery of bowel function [ 47 ]. In a prospective cohort study of totally robotic right hemicolectomy [ 48 ], we showed that intra-corporeal anastomosis was achievable in all patients, with a low conversion rate of 3.3% and a reasonable mean operative time of 200.4 ± 114.9 min (which has to be compared to operative times up to 279 min [ 33 ] and 327.5 min [ 49 ] documented in the literature). Moreover, we reported a mean number of harvested lymph nodes of 22.4 ± 7.6, a mean length of stay was of 5.4 ± 3.8 days, a post-operative morbidity of 11.7% and no mortality.…”