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

Robert K Cleary¹, Matthew Silviera², Tobi J Reidy³, James McCormick⁴, Craig S Johnson⁵, Patricia Sylla⁶, Jamie Cannon⁷, Henry Lujan⁸, Andrew Kassir⁹, Ron Landmann¹⁰, Wolfgang Gaertner¹¹, Edward Lee¹², Amir Bastawrous¹³, Ovunc Bardakcioglu¹⁴, Sushil Pandey¹⁵, Vikram Attaluri¹⁶, Mitchell Bernstein¹⁷, Vincent Obias¹⁸, Morris E Franklin Jr^#¹⁹, Alessio Pigazzi²⁰

Affiliations

¹ Department of Surgery, Saint Joseph's Mercy Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI, 48106, USA. robert.cleary@stjoeshealth.org.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Department of Surgery, Franciscan Health, Indianapolis, IN, USA.
⁴ Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
⁵ Department of Surgery, Oklahoma Surgical Hospital, Tulsa, OK, USA.
⁶ Division of Colorectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY, USA.
⁷ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Colon and Rectal Surgery, Jackson Health System, Miami, FL, USA.
⁹ Colon and Rectal Clinical, Honor Health, Scottsdale, AZ, USA.
¹⁰ Department of Colon Rectal Surgery, Baptist MD Andersen Cancer Center, Jacksonville, FL, USA.
¹¹ Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA.
¹² Department of Surgery, Albany Medical College, Albany, NY, USA.
¹³ Colon and Rectal Clinic, Swedish Medical Center, Seattle, WA, USA.
¹⁴ Department of Colorectal, Las Vegas School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA.
¹⁵ West Valley Colon and Rectal Surgery Center, Sun City, AZ, USA.
¹⁶ Colon and Rectal Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
¹⁷ Division of Colon and Rectal Surgery, NYU Langone Medical Center, New York, NY, USA.
¹⁸ Division of Colon and Rectal Surgery, The George Washington University Hospital, Washington, DC, USA.
¹⁹ Texas Endosurgery Institute, San Antonio, TX, USA.
²⁰ Division of Colon and Rectal Surgery, Weill Medical College Cornell University, New York, NY, USA.

^# Contributed equally.

PMID: 34724580
PMCID: PMC9085698
DOI: 10.1007/s00464-021-08780-9

Observational Study

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

Robert K Cleary et al. Surg Endosc. 2022 Jun.

. 2022 Jun;36(6):4349-4358.

doi: 10.1007/s00464-021-08780-9. Epub 2021 Nov 1.

Authors

Affiliations

¹ Department of Surgery, Saint Joseph's Mercy Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI, 48106, USA. robert.cleary@stjoeshealth.org.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Department of Surgery, Franciscan Health, Indianapolis, IN, USA.
⁴ Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
⁵ Department of Surgery, Oklahoma Surgical Hospital, Tulsa, OK, USA.
⁶ Division of Colorectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY, USA.
⁷ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Colon and Rectal Surgery, Jackson Health System, Miami, FL, USA.
⁹ Colon and Rectal Clinical, Honor Health, Scottsdale, AZ, USA.
¹⁰ Department of Colon Rectal Surgery, Baptist MD Andersen Cancer Center, Jacksonville, FL, USA.
¹¹ Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA.
¹² Department of Surgery, Albany Medical College, Albany, NY, USA.
¹³ Colon and Rectal Clinic, Swedish Medical Center, Seattle, WA, USA.
¹⁴ Department of Colorectal, Las Vegas School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA.
¹⁵ West Valley Colon and Rectal Surgery Center, Sun City, AZ, USA.
¹⁶ Colon and Rectal Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
¹⁷ Division of Colon and Rectal Surgery, NYU Langone Medical Center, New York, NY, USA.
¹⁸ Division of Colon and Rectal Surgery, The George Washington University Hospital, Washington, DC, USA.
¹⁹ Texas Endosurgery Institute, San Antonio, TX, USA.
²⁰ Division of Colon and Rectal Surgery, Weill Medical College Cornell University, New York, NY, USA.

^# Contributed equally.

PMID: 34724580
PMCID: PMC9085698
DOI: 10.1007/s00464-021-08780-9

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.

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

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References

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

Affiliations

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

Authors

Affiliations

Abstract

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References

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LinkOut - more resources

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