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From Laparoscopic Right Colectomy with Extracorporeal Anastomosis to Robot-Assisted Intracorporeal Anastomosis to Totally Robotic Right Colectomy for Cancer: The Evolution of Robotic Multiquadrant Abdominal Surgery.
- Source :
-
Journal of laparoendoscopic & advanced surgical techniques. Part A [J Laparoendosc Adv Surg Tech A] 2018 Oct; Vol. 28 (10), pp. 1216-1222. Date of Electronic Publication: 2018 Aug 17. - Publication Year :
- 2018
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Abstract
- Background: Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic procedures. In the literature, few works have been published comparing laparoscopic, hybrid, and totally robotic right colectomies. The aim of this study is to retrospectively analyze the improvements brought on by the evolution of robotic surgery at our specialized center.<br />Materials and Methods: Two hundred six (hybrid and totally) robotic right colectomies (RRCs) with IA were compared with 160 laparoscopic right colectomies (LRCs) with EA. A separate analysis carried out by the robotic group compared 30 totally robotic right colectomies (TRRCs) with 176 hybrid robot-assisted right colectomies (HRRCs). Demographics, pathological features, operative details, and postoperative outcomes were retrospectively analyzed from a prospectively maintained database.<br />Results: The groups were comparable with respect to demographics and tumor staging. When compared with LRC, RRC showed shorter time to first flatus (P < .001), stools (P < .001), solid diet (P < .001), and discharge (P < .001). The number of lymph nodes harvested was 23.13 ± 11.2 in RRC versus 20.5 ± 11.2 in LRC (P = .031). Operative time was longer in RRC (253.0 ± 47 minutes versus 209.9 ± 64 minutes; P < .001), but conversion to open (2.4% versus 18.1%; P < .001), anastomotic leaks (0.5% versus 5%; P = .012), and bleeding (0.3% versus 4.4%; P = .024) were significantly less frequent. Subsequent analysis shows no significant increase in operative time in TRRC versus HRRC (261.0 ± 41 minutes versus 251.6 ± 47.6 minutes; P = .310). Even if not statistically significant, TRRC showed faster bowel function recovery and tolerance to solid diet.<br />Conclusions: We confirmed the clinical advantages of RRC with IA over LRC with EA in postoperative recovery outcomes and complication rate. Furthermore, our preliminary analysis in a cohort of 30 TRRC shows promising results.
- Subjects :
- Aged
Anastomosis, Surgical adverse effects
Colectomy adverse effects
Conversion to Open Surgery statistics & numerical data
Female
Humans
Laparoscopy adverse effects
Male
Middle Aged
Operative Time
Postoperative Complications epidemiology
Postoperative Complications etiology
Retrospective Studies
Robotic Surgical Procedures adverse effects
Anastomosis, Surgical methods
Colectomy methods
Colonic Neoplasms surgery
Laparoscopy methods
Robotic Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9034
- Volume :
- 28
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of laparoendoscopic & advanced surgical techniques. Part A
- Publication Type :
- Academic Journal
- Accession number :
- 30117748
- Full Text :
- https://doi.org/10.1089/lap.2017.0693