Robotic versus laparoscopic right hemicolectomy: a case-matched study

Abstract

The current gold standard surgical treatment for right colonic malignancy is the laparoscopic right hemicolectomy (LRH). However, laparoscopic surgery has limitations which can be overcome by robotic surgery. The benefits of robotics for rectal cancer are widely accepted but its use for right hemicolectomy remains controversial. The aim of this study was to compare outcomes in patients undergoing robotic right hemicolectomy (RRH) and LRH in a university teaching hospital. Demographic, perioperative and postoperative data along with early oncological outcomes of patients who underwent RRH and LRH with extracorporeal anastomosis (ECA) were identified from a prospectively maintained database. A total of 70 patients (35 RRH, 35 LRH) were identified over a 4-year period. No statistically significant differences in estimated blood loss, conversion to open surgery, postoperative complications, anastomotic leak, 30-day reoperation, 30-day mortality, surgical site infection or lengths of stay were demonstrated. Surgical specimen quality in both groups was favourable. The mean duration of surgery was longer in RRH (p < < 0.00001). A statistically significant proportion of RRH patients had a higher BMI and ASA grade. The results demonstrate that RRH is safe and feasible when compared to LRH, with no statistical difference in postoperative morbidity, mortality and early oncological outcomes. A difference was noted in operating time, however was influenced by training residents in docking the robot and a technically challenging cohort of patients. Operative time has shortened with further experience. Incorporating an intracorporeal anastomosis technique in RRH offers the potential to improve outcomes compared to LRH.

New era of robotic surgery: first case in Spain of right hemicolectomy on Hugo RAS surgical platform

“…In the last year more robot-assisted right colectomy (RAC) has been described highlighting the advantages of the robotic approach due to a three-dimensional and magnified image with a stable camera, the eldest dexterity of instruments and the possibility for the surgeon to independently control the camera 1–8. These advantages improve postoperative outcomes, but the cost still remains a controversial issue that may restrict its application 9. In the previous years several studies have been published comparing RAC with the laparoscopic approach (LA) performing a cost-effectiveness analysis 3 10.…”

“…In the previous years several studies have been published comparing RAC with the laparoscopic approach (LA) performing a cost-effectiveness analysis 3 10. The results from the experience published in the literature showed that the robotic approach for the RAC is a feasible and safe procedure compared with LA 9. Furthermore these studies concluded that RAC is well accepted in terms of cost-effectiveness in a healthcare panorama 10.…”

“…This is the real challenge in the first part of the learning curve. However, this process should become more straightforward in line with the learning curve for such systems 9. During the last procedures Hugo RAS appears to offer more flexibility compared with other systems 12 13.…”

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

“…Some of the advantages provided include a stable three-dimensional view directly controlled by the operating surgeon, elimination of tremors, improved ergonomics, and 180° articulation with a 540° rotation for a wider range of motion. However, there has been widespread criticism of robotic right hemicolectomy (RRH), including increased cost and longer operation time, as well as the inartificial advantages of robotic platforms being less remarkable in the larger intra-abdominal cavity compared to the pelvis, and impaired ergonomics and range of motion due to instrument collision (7,8).…”

The Dukes' Club fundamentals of colorectal surgery video series: A stepwise approach to laparoscopic right hemicolectomy– A video vignette

“…We have previously published a video demonstrating a sutured end-to-end anasto- Laparoscopic right hemicolectomy has become the gold standard approach to right colonic cancers due to benefits including faster recovery and shorter in hospital stay [4]. Further techniques have been reported for the surgical treatment of right colonic cancer including complete mesocolic excision (CME) described by Hoenberger et al [5] and robotic right hemicolectomies [6]. Robotic-assisted surgery has grown in popularity over the years due to the ergonomic advantages over laparoscopic surgery; however, the benefits of right colon cancer surgery remain limited with only a few studies demonstrating improved outcomes [7].…”