Right colectomy from open to robotic — a single-center experience with functional outcomes in a learning-curve setting

Abstract

Purpose Right colectomy (RC) is a frequently performed procedure. Beneath standard conventional open surgery (COS), various minimally invasive techniques had been introduced. Several advantages had recently been described for robotic approaches over COS or conventional laparoscopy. Nevertheless, novel minimally invasive techniques require continuous benchmarking against standard COS to gain maximum patient safety. Bowel dysfunction is a frequent problem after RC. Together with general complication rates postoperative bowel recovery are used as surrogate parameters for postoperative patient outcome in this study. Methods Retrospective, 10-year single-center analysis of consecutive patients who underwent sequentially either COS (n = 22), robotic-assisted (ECA: n = 39), or total robotic surgery (ICA: n = 56) for oncologic RC was performed. Results The conversion from robotic to open surgery rate was low (overall: 3.2%). Slightly longer duration of surgery had been observed during the early phase after introduction of the robotic program to RC (ECA versus COS, p = 0.044), but not anymore thereafter (versus ICA). No differences were observed in oncologic parameters including rates of tumor-negative margins, lymph node-positive patients, and lymph node yield during mesocolic excision. Both robotic approaches are beneficial regarding postoperative complication rates, especially wound infections, and shorter length of in-hospital stay compared with COS. The duration until first postoperative stool is the shortest after ICA (COS: 4 [2–8] days, ECA: 3 [1–6] days, ICA: 3 [1–5] days, p = 0.0004). Regression analyses reveal neither a longer duration of surgery nor the extent of mesocolic excision, but the degree of minimally invasiveness and postoperative systemic inflammation contribute to postoperative bowel dysfunction, which prolongs postoperative in-hospital stay significantly. Conclusion The current study reflects the institutional learning curve of oncologic RC during implementation of robotic surgery from robotic-assisted to total robotic approach without compromises in oncologic results and patient safety. However, the total robotic approach is beneficial regarding postoperative bowel recovery and general patient outcome.

Comparison of Postoperative and Oncological Outcomes in Robotic and Open Right Colectomy for Colon Cancer

“…Although the results of this study may cause surgeons to approach with caution, centers around the world have shown lower levels of morbidity in their studies than initially reported (13,14). In their study comparing robotic and convention- (16). In our series, no conversions were reported, and although the operation time was longer in the robot group, it did not affect the postoperative period.…”

“…The technique should also allow for adequate lymph node uptake for staging and therapeutic purposes, with more than 12 lymph nodes for every anatomical segment (17,18). The current literature suggests that there is a higher lymph node harvesting efficiency in minimally invasive robotic surgery for CME performed in RRC cases, but there is insufficient evidence on this topic (16,19). There are also studies reporting a lower number of lymph nodes in robotic surgery despite having an adequate number (15).…”

Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery – systematic review and meta-analysis

“…Beyond the transient physiological gastrointestinal paralysis that occurs shortly after major abdominal surgery, the development of prolonged postoperative gastrointestinal dysmotility is influenced by multiple factors 3 – 5 . Perioperative neurogenic dysregulation and inflammatory processes play pivotal roles in the pathogenesis of POI 2 , 6 .…”