A comparative analysis of staple height used for robotic right colectomy

Abstract

The use of a closed staple height of less than 3.5 mm in right colon resections remains poorly defined, with limited comparative data against the traditionally used 3.5 mm staplers. To compare rates of anastomotic bleeding and other complications between two staple heights (2.5 mm, white cartridge versus 3.5 mm, blue cartridge) used for intracorporeal isoperistaltic ileocolic anastomosis in robotic right hemicolectomies. This is a retrospective study. The investigation is based on data from a tertiary care center. All patients who underwent a robotic right hemicolectomy or robotic extended right hemicolectomy with an intracorporeal isoperistaltic ileocolic anastomosis for dysplasia or cancer from August 2018 to February 2024. The primary outcome was the anastomotic bleeding rate. A total of 120 patients were included of which 64 patients (53.3%) were female. Group 1 comprised of 52 patients (43.3%) in whom white cartridges were used for ileocolic anastomosis, and group 2 had 68 patients (56.6%) for whom a blue cartridge was used either for the resection of the colon, creation of the anastomosis, or both. A total of 14 patients (11.6%) had anastomotic bleeding. This was managed conservatively with hemodynamic monitoring and blood transfusions in 13 patients (93%), and one patient required a lower endoscopy. The incidence of anastomotic bleeding was almost twice as high in group 2 at 14.7% compared to only 7.6% in group 1 (p = 0.23). No anastomotic leaks were observed in this study. The retrospective nature of the study and inclusion of a single specialized center. The use of staplers with reduced staple height while performing robotic right colon resections may reduce the incidence of bleeding complications without an increase in rates of other complications. Further investigation with large-scale and randomized patient populations is warranted to validate these findings.

Keywords: Anastomotic bleeding; Intracorporeal anastomosis; Robotic right colectomy; Staple height; Surgical outcomes; Surgical stapler.