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Completely intracorporeal anastomosis in robotic left colonic and rectal surgery: technique and 30-day outcomes

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Abstract

As robotic surgery continues to disseminate into the field of colon and rectal surgery, there is a growing interest in the utilization of intracorporeal anastomosis to potentially improve surgical outcomes. The purpoe of this study was to compare feasibility, safety, and short-term outcomes of robotic sigmoid and low anterior resections performed with completely intracorporeal anastomosis (CICA) technique to the traditional extracorporeal assisted anastomosis (ECAA) technique. Consecutive series of patients who underwent elective robotic sigmoid or low anterior resections for benign or malignant disease utilizes either CICA or ECAA between August 2017 and November 2019. Surgical complications were assessed until 30 postoperative days and compared between the two groups. A total of 160 patients were identified; 73 (45.6%) in the CICA group and 87 (54.4%) in the ECAA group. Most of the procedures were performed for malignancy (76%). Estimated blood loss was lower in the CICA group (80.7 mL vs. 110.2 mL; p = 0.048), while operative times were longer (5.9 ± SD hours vs. 4.9 ± SD hours; p =  < 0.001). Overall conversion rate was 1.9%, with no conversions in the CICA group. Overall complications occurred in 54 patients (33.8%) with 13 (8.3%) representing major complications. There were no significant differences in 30 day outcomes between the two groups. This study demonstrates the feasibility and safety of robotic sigmoid and low anterior resections with CICA. Outcomes for robotic sigmoid and low anterior resections are encouraging regardless of anastomotic technique (CICA vs ECAA).

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Because of the sensitive nature of the data collected for this study, requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to the corresponding author.

References

  1. Nguyen NT, Neuhaus AM, Ho HS et al (2001) A prospective evaluation of intracorporeal laparoscopic small bowel anastomosis during gastric bypass. Obes Surg. https://doi.org/10.1381/096089201321577875

    Article  PubMed  Google Scholar 

  2. Hanna MH, Hwang GS, Phelan MJ et al (2016) Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc 30:3933–3942. https://doi.org/10.1007/s00464-015-4704-x

    Article  PubMed  Google Scholar 

  3. van Oostendorp S, Elfrink A, Borstlap W et al (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-016-4982-y

    Article  PubMed  Google Scholar 

  4. Akamatsu H, Omori T, Oyama T et al (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609. https://doi.org/10.1007/s00464-009-0406-6

    Article  PubMed  Google Scholar 

  5. Park JS, Choi GS, Kim HJ et al (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg. https://doi.org/10.1002/bjs.7419

    Article  PubMed  Google Scholar 

  6. Kelley SR, Duchalais E, Larson DW (2018) Robotic right colectomy with intracorporeal anastomosis for malignancy. J Robot Surg. https://doi.org/10.1007/s11701-017-0759-0

    Article  PubMed  Google Scholar 

  7. Larson DW, Lovely JK, Cima RR, et al (2014) Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. BJS 101:1023–1030. https://doi.org/10.1002/bjs.9534

  8. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bhem KT, Larson DW (2019) Robotic surgery: clinical perceptions. Approaches and Challenges. nova science publishers, Washington, DC

    Google Scholar 

  10. Feroci F, Lenzi E, Garzi A et al (2013) Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis. https://doi.org/10.1007/s00384-013-1651-7

    Article  PubMed  Google Scholar 

  11. Emile SH, Elfeki H, Shalaby M et al (2019) Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis. Tech Coloproctol. https://doi.org/10.1007/s10151-019-02079-7

    Article  PubMed  Google Scholar 

  12. Genova P, Pantuso G, Cipolla C et al (2020) Laparoscopic versus robotic right colectomy with extra-corporeal or intra-corporeal anastomosis: a systematic review and meta-analysis. Langenbeck’s Arch Surg. https://doi.org/10.1007/s00423-020-01985-x

    Article  Google Scholar 

  13. Bollo J, Turrado V, Rabal A et al (2020) Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg. https://doi.org/10.1002/bjs.11389

    Article  PubMed  Google Scholar 

  14. Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891. https://doi.org/10.1007/s00464-009-0865-9

    Article  PubMed  Google Scholar 

  15. Kim JY, Kim NK, Lee KY et al (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: Laparoscopic versus robotic surgery. Ann Surg Oncol. https://doi.org/10.1245/s10434-012-2262-1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Allaix ME, Degiuli M, Bonino MA et al (2019) Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: a double-blinded randomized controlled trial. Ann Surg. https://doi.org/10.1097/SLA.0000000000003519

    Article  PubMed  Google Scholar 

  17. Scatizzi M, Kröning KC, Borrelli A et al (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case-control study. World J Surg. https://doi.org/10.1007/s00268-010-0743-6

    Article  PubMed  Google Scholar 

  18. Iorio T, Blumberg D (2014) A case-control study examining the benefits of laparoscopic colectomy using a totally intracorporeal technique for left-sided colon tumors. Surg Laparosc Endosc Percutaneous Tech. https://doi.org/10.1097/SLE.0b013e318290155b

    Article  Google Scholar 

  19. Bucher P, Wutrich P, Pugin F et al (2008) Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler. Surg Endosc Other Interv Tech 22:1278–1282. https://doi.org/10.1007/s00464-007-9607-z

    Article  Google Scholar 

  20. Nishimura A, Kawahara M, Suda K et al (2011) Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc. https://doi.org/10.1007/s00464-011-1716-z

    Article  PubMed  Google Scholar 

  21. Di Saverio S, Birindelli A, Mandrioli M et al (2017) Intracorporeal anastomoses in emergency laparoscopic colorectal surgery from a series of 59 cases: where and how to do it—a technical note and video. Color Dis. https://doi.org/10.1111/codi.13642

    Article  Google Scholar 

  22. Di Saverio S, Birindelli A, Segalini E et al (2018) “To stent or not to stent?”: immediate emergency surgery with laparoscopic radical colectomy with CME and primary anastomosis is feasible for obstructing left colon carcinoma. Surg Endosc. https://doi.org/10.1007/s00464-017-5763-y

    Article  PubMed  Google Scholar 

  23. Di Saverio S, Vennix S, Birindelli A et al (2016) Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis. Surg Endosc. https://doi.org/10.1007/s00464-016-4869-y

    Article  PubMed  Google Scholar 

  24. Jiang JK, Yang SH, Lin JK (2005) Transabdominal anastomosis after low anterior resection: a prospective, randomized, controlled trial comparing long-term results between side-to-end anastomosis and colonic J-pouch. Dis Colon Rectum. https://doi.org/10.1007/s10350-005-0139-0

    Article  PubMed  Google Scholar 

  25. Mäkelä JT, Kiviniemi H, Laitinen S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46:653–660. https://doi.org/10.1007/s10350-004-6627-9

    Article  PubMed  Google Scholar 

  26. Brisinda G, Vanella S, Cadeddu F et al (2009) End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer. J Surg Oncol. https://doi.org/10.1002/jso.21182

    Article  PubMed  Google Scholar 

  27. Rybakov EG, Pikunov DY, Fomenko OY, et al (2016) Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial. Int J Colorectal Dis. https://doi.org/10.1007/s00384-016-2608-4

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Pietro Achilli, William Perry, Fabian Grass, Mohamed A. Abd El Aziz, Scott R. Kelley, David W. Larson & Kevin T. Behm

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  1. Pietro Achilli
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  2. William Perry
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  3. Fabian Grass
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  4. Mohamed A. Abd El Aziz
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  5. Scott R. Kelley
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  6. David W. Larson
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  7. Kevin T. Behm
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by PA, MAAEA, and KTB. The first draft of the manuscript was written by FG, PA, and MAAEA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kevin T. Behm.

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This study was approved by the Institutional review board.

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Informed consent to participate in the study was obtained from all the participants.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Achilli, P., Perry, W., Grass, F. et al. Completely intracorporeal anastomosis in robotic left colonic and rectal surgery: technique and 30-day outcomes. Updates Surg 73, 2137–2143 (2021). https://doi.org/10.1007/s13304-021-01061-z

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  • DOI: https://doi.org/10.1007/s13304-021-01061-z

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