Right colectomy with intracorporeal anastomosis for cancer: a prospective comparison between robotics and laparoscopy

Sorgato, Nadia; Mammano, Enzo; Contardo, Tania; Vittadello, Fabrizio; Sarzo, Giacomo; Morpurgo, Emilio

doi:10.1007/s11701-021-01290-9

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…Procedure times seem to be an aspect of economic disadvantages of robotic surgery. Although the literature proofs shorter time for intracorporal suturing of the anastomosis during robotic surgery [ 12 , 38 ], the duration of the total robotic procedure is — in contrast to the data of the present ICA group — supposed being longer compared with conventional laparoscopy and COS [ 11 , 39 , 40 ]. But, there is currently no standardized definition available which data should be recorded for the operation time of robotic surgery and most publications on robotics do not discriminate between port setup time, time-consuming docking, robot time, or assisted time, which includes creation and closure of the minilaparotomy, extraction of the specimen, or different steps of surgery, for example, the time for extracorporal anastomosis as well [ 8 , 41 ].…”

Section: Discussionmentioning

confidence: 82%

“…This reflects the situation in many surgical departments, as ours: the decision is made between COS or robotic surgery, but conventional laparoscopy is not considered for oncologic RC. Thereby, the literature reveals for patients after robotic surgery some impactful advantages with respect to relevant clinical outcome parameters moreover laparoscopy [ 11 , 16 , 24 , 31 ], including higher lymph node yield during CME and shorter intracorporal hand-sewn anastomosis time due to improvements in ergonomics, handling, and visualization through the robot [ 8 , 12 , 31 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

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

Hirschburger

Schneider

Kraenzlein

et al. 2022

Langenbecks Arch Surg

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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.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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

Hirschburger

Schneider

Kraenzlein

et al. 2022

Langenbecks Arch Surg

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“…A total of 81 studies were eliminated due to the lack of right colon resection trial, of which 16 studies met the criteria. After reading the full text according to criteria and filtering for data integrity, 15 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] with a total of 5142 patients (RRC group, 1116 patients; LRC group, 4036 patients) were eventually included in this meta-analysis.…”

Section: Selected Studiesmentioning

confidence: 99%

Robotic versus laparoscopic right colectomy for colon cancer: a systematic review and meta-analysis

Zheng¹,

Zhao²,

Chen³

et al. 2023

wiitm

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The aim of the study was to compare the short-term surgical outcomes of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC) for colon cancer, to evaluate the safety and feasibility of the robotic surgery system. Material and methods: A systematic literature review was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases regarding the comparison of RRC vs. LRC for colon cancer in the last 5 years. Studies were included as per the PICOS criteria, and relevant event data were extracted. Results: Fifteen studies (RRC: 1116 patients; LRC: 4036 patients) were evaluated. RRC demonstrated lower conversion to laparotomy (p = 0.03) and shorter length of hospital stay (p = 0.01), compared with LRC. However, operation times were longer in RRC than in LRC (p < 0.001). The estimated blood loss, retrieved lymph nodes, and overall postoperative complications were similar between RRC and LRC (p > 0.05). Conclusions: RRC can be regarded as a feasible and safe technique for colon cancer.

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“…IA is performed more often with the robotic approach, whereas EA is performed more often with the laparoscopic approach [ 12 ]. Sorgato et al [ 17 ] reported that operative time was not statistically different between robotic IA and laparoscopic IA (robotic group, 265.9 minutes vs. laparoscopic group, 254.2 minutes; p = 0.29). Robotic surgery allowed for a shorter suture time during IA in right colectomy.…”

Section: Operative Outcomesmentioning

confidence: 99%

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

Baek

2022

J Minim Invasive Surg

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Laparoscopic right colectomy is currently considered the standard treatment for right colon cancer. After excision of the right colon, minimally invasive options for ileocolonic anastomosis include extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). However, the choice of anastomotic technique remains debated. As the entire IA is performed in the abdominal cavity, it is known for its advantages of a faster intestinal recovery and small incision. However, IA is time-consuming and technically difficult, limiting its widespread use. Recently, the robotic approach has increased the adoption of intracorporeal anastomotic techniques owing to the benefits of endowrist-articulated instruments and staplers. Except for a small incision and faster bowel recovery, the outcomes of the two anastomoses methods are inconsistent. To date, there has been no clear conclusion regarding whether IA or EA should be used to treat right colon cancer. This review aimed to investigate the current evidence relating to intraoperative outcomes and shortterm postoperative results between both anastomotic approaches.

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Right colectomy with intracorporeal anastomosis for cancer: a prospective comparison between robotics and laparoscopy

Cited by 9 publications

References 32 publications

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

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

Robotic versus laparoscopic right colectomy for colon cancer: a systematic review and meta-analysis

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

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