eP193 - Robotic-assisted versus Laparoscopic Approach in Performing the Intra-corporeal Ileocolic Anastomosis After Radical Right Hemicolectomy… a Prospectively Observational Cohort Study

Purpose/Background:

Background: Recently, more and more colorectal surgeons advocated the intracorporeal anastomosis (IA) for the reconstruction of bowel continuity after the radical right hemicolectomy for cancer. A major advantage when performing IA is that it allows for specimen extraction through a suprapubic incision associated with reduced pain and fewer short - and long-term wound complications, and reduces manipulation of the bowel. These combined effects of ICA are thought to improve postoperative bowel functional recovery and reduce surgical stress. However, current IA techniques include hand-sewn anastomosis and mechanical anastomosis. Manual anastomosis is time-consuming and requires relatively high levels of surgical skill and operator experience. The available mechanical IA techniques tend to be cumbersome and susceptible to operator status, resulting in unreliable quality of the anastomosis. Such scenario can explain why most colorectal surgeons still adopt the EA after radical excision of the right-sided colon cancer. Remarkably, some colorectal surgeons promote the robotic approach for the surgery of right-sided colon cancer because the robotic approach, with the increased surgical maneuverability and 3D vision, can facilitate an IA through overcoming the technical difficulty of laparoscopic IA, yet unproven.

Objective: To determine if the robotic IA can reproduce the clinical benefits of laparoscopic IA with better technical efficiency.Methods/Interventions:

Design: Since June 2019, we have routinely adopted the IA for the patients requiring an ileocolic anastomosis after the standard radical right hemicolectomy for the treatment of right-sided colon cancer. We have developed a quadruple stapling surgical technique for performing the ileocolic IA. Consecutive patients who underwent either robotic right colectomy with IA or laparoscopic right colectomy with IA were prospectively collected from June 2019 to August 2023. The primary outcome was patient-reported postoperative bowel functional recovery. Secondary endpoints were intraoperative technical events and postoperative clinical outcomes.
SETTINGS: Conducted in a high-volume tertiary referral center in Taiwan.
PATIENTS: 64 patients undergoing laparoscopic IA and 44 patients undergoing robotic IA were recruited during the study period.Results/Outcomes:

Results: The duration of IA was significantly shorter in robotic IA group of patients than that in laparoscopic IA group of patients [median 24 (range 14-34) versus 44 (30-84) min; P < 0.0001]. There was no significant difference between the two patient groups in wound length for specimen retrieval, digestive functional recovery such as initial flatus passage, the incidence of paralytic ileus, postoperative pain and weighted analgesia requirement and the pain score (p>0.05). There was no significance difference (p>0.05) between two patient groups in the grade I and II complications and the hospital stay.Conclusion/

Discussion: LIMITATIONS: A non-randomized study performed at a single institution.

Conclusion: In this prospectively observational cohort study of intracorporeal ileocolic anastomosis, we have found the robotic IA can be performed with better technical efficiency and can reproduce the improvements of short-term outcomes, quick return of bowel function, and short length of hospital stay of laparoscopic IA. These outcome advantages support current and future training programs preparing surgeons in the adoption of robotic intracorporeal IA surgery techniques.