Ileo-colic intra-corporeal anastomosis during robotic right colectomy: a systematic literature review and meta-analysis of different techniques

Abstract

Purpose Robotic assistance could increase the rate of ileo-colic intra-corporeal anastomosis (ICA) during robotic right colectomy (RRC). However, although robotic ICA can be accomplished with several different technical variants, it is not clear whether some of these technical details should be preferred. An evaluation of the possible advantage of one respect to another would be useful. Methods We conducted a systematic review of literature on technical details of robotic ileo-colic ICA, from which we performed a meta-analysis of clinical outcomes. The extracted data allowed a comparative analysis regarding the outcome of overall complication (OC), bleeding rate (BR) and leakage rate (LR), between (1) mechanical anastomosis with robotic stapler, versus laparoscopic stapler, versus totally hand-sewn anastomosis and (2) closure of enterocolotomy with manual double layer, versus single layer, versus stapled. Results A total of 30 studies including 2066 patients were selected. Globally, the side-to-side, isoperistaltic anastomosis, realized with laparoscopic staplers, and double-layer closure for enterocolotomy, is the most common technique used. According to the meta-analysis, the use of robotic stapler was significantly associated with a reduction of the BR with respect to mechanical anastomosis with laparoscopic stapler or totally hand-sewn anastomosis. None of the other technical aspects significantly influenced the outcomes. Conclusions ICA fashioning during RRC can be accomplished with several technical variants without evidence of a clear superiority of anyone of these techniques. Although the use of robotic staplers could be associated with some benefits, further studies are necessary to draw conclusions.

A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy

“…The ICA approach, irrespective of technique, is associated with low rates of postoperative gastrointestinal dysfunction and earlier postoperative recovery. Our work demonstrates largely equivalent clinical outcomes between the two approaches, echoing previous works in this area [13], and supports broader works supporting superior clinical outcomes observed with ICA overall [14].…”

“…This is supported by previous works, with Johnston et al reporting an anastomotic leak rate of 0.9% following stapled robotic ICA [21] and Guadagni et al reporting an anastomotic leak rate of 1.5% in handsewn robotic anastomosis [13]. The overall reported rates of anastomotic leak following robotic hemicolectomy are low, ranging from 0.9% to 3.1% [13,21–23]. In comparison, the reported anastomotic leak rates for open and laparoscopic right hemicolectomy are much higher, with the European Society of Coloproctology right hemicolectomy audit reporting anastomotic leak rates of 11.4% and 5.4%, respectively [2].…”

“…The robotic platform has revolutionized minimally invasive right hemicolectomy and primary anastomosis by enabling the transition from ECA to ICA [18–20]; with a stapled ICA, robotic anastomosis is now considered to be the gold standard [13]. The ongoing development of robotic stapling technology enhances the utility and application of stapled ICA.…”

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

“…Recent studies have reported uniformly low rates of anastomotic leakage. The overall reported rates of anastomotic leak following robotic right colectomy are low, ranging between 0.9% and 3.8% [24][25][26]. Regarding SSI, theoretically, the intraperitoneal incision into the bowel lumen in IA may cause fecal spillage, which can lead to SSI.…”

“…Recent studies have reported uniformly low rates of anastomotic leakage. The overall reported rates of anastomotic leak following robotic right colectomy are low, ranging between 0.9% and 3.8% [ 24 - 26 ].…”