Comparative Study

. 2026 Jan;40(1):502-511.

doi: 10.1007/s00464-025-12327-7. Epub 2025 Oct 27.

Extraction site hernia and short-term outcomes following intracorporeal versus extracorporeal anastomosis for robotic and laparoscopic right colectomy: 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 G Landmann¹⁰, Wolfgang Gaertner¹¹, Edward Lee¹², Amir L Bastawrous¹³, Ovunc Bardakcioglu¹⁴, Sushil Pandey¹⁵, Vikram Attaluri¹⁶, Mitchell Bernstein¹⁷, Vincent Obias¹⁸, Alessio Pigazzi¹⁹

Affiliations

¹ Department of Surgery, Trinity Health Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI, 48106, USA. clearyrk@gmail.com.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Department of Surgery, Franciscan Health Indianapolis, 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 Arkansas, Little Rock, AR, 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 Anderson 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, 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, Johns Hopkins University, Baltimore, MD, USA.
¹⁹ Division of Colon and Rectal Surgery, City of Hope Orange County, Irvine, CA, USA.

PMID: 41145697
PMCID: PMC12823757
DOI: 10.1007/s00464-025-12327-7

Comparative Study

Extraction site hernia and short-term outcomes following intracorporeal versus extracorporeal anastomosis for robotic and laparoscopic right colectomy: a multi-center prospective trial

Robert K Cleary et al. Surg Endosc. 2026 Jan.

. 2026 Jan;40(1):502-511.

doi: 10.1007/s00464-025-12327-7. Epub 2025 Oct 27.

Authors

Affiliations

¹ Department of Surgery, Trinity Health Hospital, 5325 Elliott Drive, Ste 104, Ann Arbor, MI, 48106, USA. clearyrk@gmail.com.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Department of Surgery, Franciscan Health Indianapolis, 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 Arkansas, Little Rock, AR, 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 Anderson 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, 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, Johns Hopkins University, Baltimore, MD, USA.
¹⁹ Division of Colon and Rectal Surgery, City of Hope Orange County, Irvine, CA, USA.

PMID: 41145697
PMCID: PMC12823757
DOI: 10.1007/s00464-025-12327-7

Abstract

Background: Studies have shown outcomes advantages of intracorporeal compared to extracorporeal anastomosis during minimally invasive right colectomy that include less conversion to open, faster return of bowel function, and shorter hospital length of stay. The extracorporeal anastomosis and specimen extraction incision are often midline and may be associated with incisional hernias. The study aim was to determine if intracorporeal right colectomy is associated with fewer incisional hernias.

Methods: This is the final data analysis for the ANastomotic COmparison in Right Colectomy (ANCOR) prospective multi-center study designed to compare laparoscopic- or robotic-assisted intracorporeal versus extracorporeal anastomoses in patients undergoing minimally invasive right colectomy for benign or malignant neoplasia. The primary outcome was the extraction site incisional hernia rate at 2 years. Secondary outcomes included hospital length of stay and short-term complications. Descriptive statistics [mean with standard deviation and median with interquartile range (IQR)] were applied using SAS 9.4.

Results: 150 patients (30 laparoscopic and 120 robotic assisted) underwent intracorporeal anastomosis, and 150 patients (120 laparoscopic and 30 robotic assisted) underwent extracorporeal anastomosis. All extracorporeal specimen extraction sites were midline. Intracorporeal extraction sites were off-midline in 98.7%. At 2 years, extraction site hernias were significantly more common in the extracorporeal group (10.1% vs. 1.9%, p = 0.013), with only one hernia repaired in the intracorporeal group. The intracorporeal group had significantly fewer conversions to open (0% vs. 4.7%, p < 0.0001), shorter extraction site incisions (4.9 cm vs. 6.0 cm, p < 0.0001), shorter time to gastrointestinal recovery, shorter time to tolerating diet, shorter hospital length of stay (3.0 vs. 4.0 days, p < 0.0001), and longer operative times (207.5 min vs. 173.1 min, p < 0.0001). There were no significant differences between groups in postoperative complications and short-term oncologic outcomes.

Conclusion: Intracorporeal anastomosis during minimally invasive right colectomy is associated with a lower rate of incisional hernias and other benefits compared to the extracorporeal approach. These data support continued training in and implementation of intracorporeal anastomotic techniques.

Trial registration: Clinicaltrials.gov identifier: NCT03312569.

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

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Conflict of interest statement

Declarations. Disclosures: Robert K. Cleary has received honoraria from Intuitive Surgical, Inc. for educational speaking. James McCormick reports personal fees from Intuitive Surgical, outside the submitted work. Patricia Sylla reports personal fees from Ethicon, Medtronic, Stryker, Activ Surgical, Safeheal, and Boehringer, outside the submitted work. Jamie Cannon is on the speaker’s bureau for Intuitive Surgical, Inc. Wolfgang Gaertner reports personal fees from Intuitive Surgical and personal fees from Coloplast, outside the submitted work. Amir L. Bastawrous reports personal fees from Intuitive Surgical outside the submitted work. Vincent Obias is a consultant for Intuitive Surgical, Medrobotic, and Noah Medical. Alessio Pigazzi reports royalties from Xodus and consulting fees from Medtronic and Ethicon outside the submitted work. Authors Robert K. Cleary, Matthew Silviera, Tobi J. Reidy, James McCormick, Craig S. Johnson, Patricia Sylla, Jamie Cannon, Henry Lujan, Andrew Kassir, Ron G. Landmann, Wolfgang Gaertner, Edward Lee, Amir L. Bastawrous, Ovunc Bardakcioglu, Sushil Pandey, Vikram Attaluri, Mitchell Bernstein, Vincent Obias, and Alessio Pigazzi have no conflicts of interest or financial ties to disclose.

Figures

**Fig. 2**
Extraction site incisional hernias at 1 and 2 years

See this image and copyright information in PMC

References

1. Cleary RK, Silviera M, Reidy T et al (2022) Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy; short-term outcomes of a multi-center prospective trial. Surg Endosc 36:4349–4358 - DOI - PMC - PubMed
1. Morpurgo E, Contardo T, Molaro R, Zerbinati A, Orsini C, D’Annibale A (2013) Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv Surg Technol 23(5):414–417 - DOI - PubMed
1. Samia H, Lawrence J, Nobel T, Stein S, Champagne BJ, Delaney CP (2013) Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the mid- line? Am J Surg 205(3):264–267 - DOI - PubMed
1. Harr JN, Juo Y-Y, Luka S, Agarwal S, Brody F, Obias V (2013) Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 30(8):3505–3510 - DOI - PubMed
1. Widmar M, Keskin M, Beltran P et al (2016) Incisional hernias after laparoscopic and robotic right colectomy. Hernia 20(5):723–728 - DOI - PMC - PubMed

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Extraction site hernia and short-term outcomes following intracorporeal versus extracorporeal anastomosis for robotic and laparoscopic right colectomy: a multi-center prospective trial

Affiliations

Extraction site hernia and short-term outcomes following intracorporeal versus extracorporeal anastomosis for robotic and laparoscopic right colectomy: a multi-center prospective trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical