Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results

Mora, Laura; Pallisera‐Lloveras, Anna; Barrera, Anna Serracant; García-Nalda, Albert; Angeli, M Caraballo; Pérez, O Pino; Soto, Salvador Navarro; Serra‐Aracil, Xavier

doi:10.1111/codi.16146

Cited by 5 publications

References 16 publications

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Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study — stage 2a IDEAL framework for evaluating surgical innovation

Serra‐Aracil

Mora-López

Gomez‐Torres

et al. 2023

Langenbecks Arch Surg

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Purpose To analyze the safety and feasibility of intracorporeal resection and anastomosis in upper rectum, sigmoid, and left colon surgery, via both laparoscopic and robotic approaches. The secondary aim was to assess possible short-term differences between laparoscopic versus robotic surgery. Methods A prospective observational cohort study according to IDEAL framework exploration and assessment stage (Development, stage 2a), evaluating and comparing the laparoscopic approach and the robotic approach in left colon, sigmoid, and upper rectum surgery with intracorporeal resection and end-to-end anastomosis. Demographic, preoperative, surgical, and postoperative variables of patients undergoing laparoscopic and robotic surgery are described and compared according to the surgical technique used. Results Between May 2020 and March 2022, seventy-nine patients were consecutively included in the study, 41 operated via laparoscopy (laparoscopic left colectomy: LLC) and 38 by robotic surgery (robotic left colectomy: RLC). There were no statistically significant differences between the two groups in terms of demographic variables. In surgical variables, the median surgical times differed significantly: 198 min (SD 48 min) for LLC vs. 246 min (SD 72 min) for RLC ( p = 0.01, 95% CI: − 75.2 to − 20.5)). The only significant difference regarding postoperative complications was a higher degree of relevant morbidity in the LLC (Clavien-Dindo > II (14.6% vs. 0%, p = 0.03) and Comprehensive Complication Index (IQR 22 vs. IQR 0, p = 0.03). The pathological results were similar in both approaches. Conclusion Laparoscopic and robotic intracorporeal resection and anastomosis are feasible and safe, and obtain similar surgical, postoperative, and pathological results than described in literature. However, morbidity seems to be higher in LLC group with fewer relevant postoperative complications. The results of this study enable us to proceed to stage 2b of the IDEAL framework. Clinical trial registrations The study is registered in Clinical trials with the registration code NCT0445693.

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Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study — stage 2a IDEAL framework for evaluating surgical innovation

Serra‐Aracil

Mora-López

Gomez‐Torres

et al. 2023

Langenbecks Arch Surg

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Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

Serra-Aracil,

Gómez-Torres,

Torrecilla-Portoles

et al. 2024

Langenbecks Arch Surg

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Purpose Performing intracorporeal anastomoses in minimally invasive colon surgery appears to provide better short-term outcomes for patients with colon cancer. The aim of the study is to compare surgical aspects and short-term outcomes between intracorporeal and extracorporeal techniques in left colectomies with both laparoscopic and robotic approaches and evaluate advantages and disadvantages of intracorporeal anastomosis according to IDEAL framework (Exploration, stage 2b). Methods This is a single center, ambispective cohort study comparing total intracorporeal anastomosis (TIA) and standard surgery with extracorporeal anastomosis (EA). Patients with colon cancer treated by left colectomy, sigmoidectomy and high anterior resection by total intracorporeal anastomosis between May 2020 and January 2023 without exclusion criteria were prospectively included in a standardized database. Short-term outcomes in the group undergoing TIA were compared with a historical EA cohort. The main assessment outcomes were intraoperative complications, postoperative morbidity according to the Clavien-Dindo scale and the comparison of pathological. We conducted a preliminary comparative study within the TIA group between approaches, a primary analysis between the two anastomotic techniques, and a propensity score matched analysis including only the laparoscopic approach, between both anastomotic techniques. Results Two hundred and forty-six patients were included: 103 who underwent TIA, 35 of them with laparoscopic approach and 68 with robotic approach, and a comparison group comprising another 103 eligible consecutive patients who underwent laparoscopic EA. There were no statistically significant differences between the two groups in terms of demographic variables. No statistically significant differences were observed in anastomotic dehiscence. Intraoperative complications are fewer in the TIA group, with a higher C-Reactive Protein levels. Relevant anastomotic bleeding and the number of retrieved lymph nodes were higher in EA group. Nevertheless, no differences were observed in terms of overall morbidity. Conclusion Minimally invasive left colectomy with intracorporeal resection and anastomosis is technically feasible and safe suing either a laparoscopic or a robotic approach. Clinical data from this cohort demonstrate outcomes comparable to those achieved through the conventional EA procedure in relation to postoperative morbidity and oncological efficacy, with indications suggesting that the utilization of robotic-assisted techniques may play a contributing role in enhancing overall treatment outcomes.

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Principles of robot-assisted colorectal surgery

Bittermann,

Berlet,

Wilhelm

2024

Eur Surg

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Summary Background Robotic-assisted surgery is gaining popularity and is about to become the leading principle for less invasive procedures in colorectal diseases. Despite the great achievements made in terms of robotic technology and the high ergonomics that current systems offer, the application of these devices still places special demands on the user and requires comprehensive training and knowledge. Methods This review article combines recommendations from the current literature with personal experience in performing robotic interventions and supplements these with expert knowledge derived from scientific conferences and peer-to-peer meetings. Results The two essential aspects of robotic surgery are case-related planning and standardization of the technique, which both consider the special technical possibilities and limitations of the systems used. The article provides comprehensive recommendations in this regard and discusses the essential steps of left- and right-sided interventions. Conclusion This article is aimed at surgeons performing their first robot-assisted procedures in colorectal surgery and aims to help them to optimize their own approach, but it might also feature interesting insights for persons already trained in robotic colorectal surgery.

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Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results

Cited by 5 publications

References 16 publications

Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study — stage 2a IDEAL framework for evaluating surgical innovation

Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study — stage 2a IDEAL framework for evaluating surgical innovation

Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

Principles of robot-assisted colorectal surgery

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