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Intracorporeal or extracorporeal anastomosis after minimally invasive right colectomy: a systematic review and meta-analysis

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Abstract

Purpose

As part of the wide adoption of minimally invasive surgery, intracorporeal anastomosis is becoming increasingly common. The benefits of minimally invasive versus open right colectomy are well known although the additional benefits of an intracorporeal anastomosis, performed laparoscopically or robotically, are unclear. The aim of this study was to assess the current literature comparing intracorporeal and extracorporeal anastomosis in the setting of laparoscopic and robotic-assisted right colectomy.

Methods

A systematic review and meta-analysis was conducted according to PRISMA and AMSTAR methods. Studies included were randomized controlled trials and prospective or retrospective cohort studies, between January 1 2010 and July 1 2021, comparing intracorporeal and extracorporeal anastomosis with laparoscopic and robotic approaches. Four groups were identified: laparoscopic extracorporeal anastomosis (L-ECA), laparoscopic intracorporeal anastomosis (L-ICA), robotic extracorporeal anastomosis (R-ECA), and robotic intracorporeal anastomosis (R-ICA). Operative time, rate of conversion to an open procedure, surgical site infection, reoperation within 30 days, postoperative complications within 30 days, and length of hospital stay were assessed.

Results

Twenty-one retrospective cohort studies were included in the final analysis. R-ICA and R-ECA had comparable operative times, but a robotic approach required more time than laparoscopic (68 min longer, p < 0.00001). Conversion to open surgery was 55% less likely in the R-ICA group vs. L-ICA, and up to 94% less likely in the R-ICA group in comparison to the R-ECA group. Length of hospital stay was shorter for R-ICA by a half day vs. R-ECA, and up to 1 day less vs. L-ECA. There were no differences in postoperative complications, reoperations, or surgical site infections, regardless of approach. However, the included studies all had high risks of bias due to confounding variables and patient selection.

Conclusion

Robotic-assisted right colectomy with intracorporeal anastomosis was associated with shorter length of hospitalization and decreased rate of conversion to open surgery, compared to either laparoscopic or extracorporeal robotic approaches. Prospective studies are needed to better understand the true impact of robotic approach and intracorporeal anastomosis in right colectomy.

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Data availability

All data generated or analyzed came from previous studies and analyzed as a meta-analysis. References to these articles and data generated for the results are included in this manuscript and its supplementary information files.

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Authors and Affiliations

  1. Department of Surgery, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN, 55455, USA

    A. I. Squillaro, J. Kohn, L. Weaver & W. B. Gaertner

  2. Division of Colon and Rectal Surgery, University of Minnesota, Mayo Mail Code 450, 420 Delaware St. S.E., Minneapolis, MN, 55455-0341, USA

    A. I. Squillaro & W. B. Gaertner

  3. Global Access, Value and Economics, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086, USA

    A. Yankovsky, G. Milky, N. Patel & U. S. Kreaden

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  1. A. I. Squillaro
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Contributions

AIS: Assisted in the clinical concept of the study, organized, analyzed, and interpreted the data, and primarily drafted the manuscript. JK: Assisted in the clinical concept of the study, analyzed and interpreted the data, drafted the manuscript, and reviewed the manuscript for important intellectual content. LW: Assisted in the clinical concept of the study, analyzed and interpreted the data, drafted the manuscript, and reviewed the manuscript for important intellectual content. AY: Collected, analyzed, and interpreted the data and contributed to methods and results of manuscript. GM: Collected, analyzed, and interpreted the data and contributed to methods and results of manuscript. NP: Collected, analyzed, and interpreted the data and contributed to methods and results of manuscript. USK: collected, analyzed, and interpreted the data, contributed to methods and results, and critically reviewed and revised the manuscript. WBG: Led the study as principal investigator, conceptualized, and designed the study, analyzed, and interpreted the data, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to A. I. Squillaro.

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Conflict of interest

Dr. Wolfgang B. Gaertner: Intuitive Surgical (proctor, speaker, consultant); Coloplast (advisory board, consultant); Applied Medical (consultant); BD (consultant, speaker). Ana Yankovsky, Gediwon Milky, Neera Patel, and Usha Seshadri Kreaden are all employees of Intuitive Surgical and own stock in the company. The remaining authors have no conflicts of interest relevant to this article to disclose.

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Squillaro, A.I., Kohn, J., Weaver, L. et al. Intracorporeal or extracorporeal anastomosis after minimally invasive right colectomy: a systematic review and meta-analysis. Tech Coloproctol 27, 1007–1016 (2023). https://doi.org/10.1007/s10151-023-02850-x

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