A propensity score-matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted right colectomy in an Enhanced Recovery Pathway

Am J Surg. 2018 Dec;216(6):1095-1100. doi: 10.1016/j.amjsurg.2018.06.010. Epub 2018 Jun 19.

Abstract

Introduction: There may be short-term outcomes advantages for the intracorporeal approach to minimally invasive right colectomy.

Methods: This is a retrospective propensity score-matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted right colectomy in an Enhanced Recovery colorectal surgery service.

Results: 55 intracorporeal and 55 extracorporeal cases were compared. Operative time was significantly longer (p < 0.001) and incision length shorter in the intracorporeal group (p = 0.007). Outcomes significantly favorable for the intracorporeal group included conversion-to-open (p = 0.013), time to first flatus (p < 0.001), time to first bowel movement (p = 0.006), and dehydration (p = 0.03). There were more extraction site hernias in the midline compared to off-midline locations, though this difference did not reach statistical significance (p = 0.06).

Conclusion: There are outcomes advantages for the intracorporeal technique for robotic-assisted right colectomy when compared to the extracorporeal approach for patients in an Enhanced Recovery Pathway. Training efforts should continue to advocate the intracorporeal option.

Keywords: Colorectal; Intracorporeal anastomosis; Minimally invasive surgery; Right colectomy; Robotic.

MeSH terms

  • Aged
  • Colectomy / methods*
  • Colonic Diseases / pathology
  • Colonic Diseases / surgery*
  • Critical Pathways
  • Female
  • Humans
  • Male
  • Middle Aged
  • Operative Time
  • Propensity Score
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Treatment Outcome