Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study

Abstract

Performing the RRCIA offers significantly better perioperative recovery outcomes compared with the LRCEA, with a substantial reduction in the length of the hospital stay. The RRCIA does not offer the same advantages compared with the LRCIA.

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

“…Milone et al [16] matched the control group using a propensity score. Trastulli et al [18] reported a retrospective multicenter case series on right colectomy comparing robotic intracorporeal anastomosis to laparoscopic intracorporeal anastomosis and laparoscopic extracorporeal anastomosis. The included studies resulted in a total number of 1492 participants who underwent a laparoscopic right hemicolectomy further specified to 763 and 729 patients for intra- or extracorporeal anastomosis, respectively.…”

“…In nine studies, the intracorporeal performed anastomosis was created using a mechanical stapler with [13–15, 17–19, 33, 35, 36] or without [16] additional sutures in the IA technique. A mechanical stapler was most commonly used for the extracorporeal anastomosis as well (with [13, 14, 18, 36] or without [16, 19] additional sutures). One study made a hand-sewn anastomosis [15] or according to the preference of the individual surgeon (mechanical or hand-sewn) [17, 33].…”

“…Interestingly, Scatizzi et al [36] defined short-term outcomes as 90 days and reported an outpatient clinic visit 8 days after discharge, but subsequently failed to report on the 3 month FU besides readmission. Half of the studies changed their way of operation halfway during the score inclusion period from EA to IA, using their last EA as ‘historic’ control group [15, 18, 19, 32, 33, 35]. All studies scored low on unbiased assessment of outcomes due to lack of blinding and randomization.…”

A meta-analysis of robotic versus laparoscopic colectomy

“…Intraoperative conversion rates were statistically significantly lower among patients undergoing RC. Reasons for conversion included the presence of extensive intraabdominal adhesions, the local extension of the neoplasm [33], hemorrhage from the paraduodenal veins that could not be effectively controlled, intraoperative bleeding due to an injury in the left renal vein [25], obesity with a bulky colonic mesentery and fatty omentum [26], and technical difficulties that included stapler misfiring. In assessing the rate of conversion to laparotomy, a history of previous abdominal surgery in a patient can be a confounding factor.…”

“…Studies with a higher proportion of patients who have had prior surgery may have a higher rate of conversions because of the presence of adhesions and scarring. Transtulli et al [33] attempted to address this issue in their study. Their study showed that of the four robotic procedures converted (conversion rate: 3.9%), 47 patients had a history of previous abdominal surgery (previous abdominal surgery rate: 46.7%).…”