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A single surgeon’s experience transitioning to robotic-assisted right colectomy with intracorporeal anastomosis

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Abstract

Background

Despite substantial evidence demonstrating benefits of minimally invasive surgery, a large percentage of right colectomies are still performed via an open technique. Most laparoscopic right colectomies are completed as a hybrid procedure with extracorporeal anastomosis. As part of a pure minimally invasive procedure, intracorporeal anastomosis (ICA) may confer additional benefits for patients. The robotic platform may shorten the learning curve for minimally invasive right colectomy with ICA.

Methods

From January 2014 to May 2016, 49 patients underwent robotic-assisted right colectomy by a board-certified colorectal surgeon (S.R). Extracorporeal anastomosis (ECA) was used in the first 20 procedures, whereas ICA was used in all subsequent procedures. Outcomes recorded in a database for retrospective review included operating time (OT), estimated blood loss (EBL), length of stay (LOS), conversion rate, complications, readmissions, and mortality rate.

Results

Comparison of average OT, EBL, and LOS between extracorporeal and intracorporeal groups demonstrated no significant differences. For all patients, average OT was 141.6 ± 25.8 (range 86–192) min, average EBL was 59.5 ± 83.3 (range 0–500) mL, and average LOS was 3.4 ± 1.19 (range 1.5–8) days. Four patients required conversion, all of which occurred in the extracorporeal group. There were no conversions after the 18th procedure. The 60-day mortality rate was 0%. There were no anastomotic leaks, ostomies created, or readmissions. As the surgeon gained experience, a statistically significant increase in lymph node sampling was observed in oncologic cases (p = .02).

Conclusions

The robotic platform may help more surgeons safely and efficiently transition to a purely minimally invasive procedure, enabling more patients to reap the benefits of less invasive surgery. Transitioning from ECA to ICA during robotic right colectomy resulted in no significant change in OT or LOS. A lower rate of conversion to open surgery was noted with increased experience.

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Acknowledgements

All tables and figures were finalized by Satyen Tripathi, Senior Multimedia Developer, Department of Surgery, Emory University School of Medicine.

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Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    Alexandra C. W. Reitz

  2. Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Ed Lin

  3. Division of Colorectal Surgery, Emory University School of Medicine, 6335 Hospital Parkway, Suite 110, Johns Creek, GA, 30097, USA

    Seth A. Rosen

Authors
  1. Alexandra C. W. Reitz
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  2. Ed Lin
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Correspondence to Seth A. Rosen.

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Disclosures

Dr. Seth Rosen has been paid by Intuitive Surgical for teaching courses in robotic-assisted colectomy. Dr. Ed Lin and Ms. Alexandra Reitz have no conflicts of interest or financial ties to disclose.

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Reitz, A.C.W., Lin, E. & Rosen, S.A. A single surgeon’s experience transitioning to robotic-assisted right colectomy with intracorporeal anastomosis. Surg Endosc 32, 3525–3532 (2018). https://doi.org/10.1007/s00464-018-6074-7

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  • DOI: https://doi.org/10.1007/s00464-018-6074-7

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