Cargando…
Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial
BACKGROUND: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9085698/ https://www.ncbi.nlm.nih.gov/pubmed/34724580 http://dx.doi.org/10.1007/s00464-021-08780-9 |
_version_ | 1784703875132948480 |
---|---|
author | Cleary, Robert K. Silviera, Matthew Reidy, Tobi J. McCormick, James Johnson, Craig S. Sylla, Patricia Cannon, Jamie Lujan, Henry Kassir, Andrew Landmann, Ron Gaertner, Wolfgang Lee, Edward Bastawrous, Amir Bardakcioglu, Ovunc Pandey, Sushil Attaluri, Vikram Bernstein, Mitchell Obias, Vincent Franklin, Morris E. Pigazzi, Alessio |
author_facet | Cleary, Robert K. Silviera, Matthew Reidy, Tobi J. McCormick, James Johnson, Craig S. Sylla, Patricia Cannon, Jamie Lujan, Henry Kassir, Andrew Landmann, Ron Gaertner, Wolfgang Lee, Edward Bastawrous, Amir Bardakcioglu, Ovunc Pandey, Sushil Attaluri, Vikram Bernstein, Mitchell Obias, Vincent Franklin, Morris E. Pigazzi, Alessio |
author_sort | Cleary, Robert K. |
collection | PubMed |
description | BACKGROUND: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. METHODS: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. RESULTS: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. CONCLUSION: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy. |
format | Online Article Text |
id | pubmed-9085698 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-90856982022-05-11 Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial Cleary, Robert K. Silviera, Matthew Reidy, Tobi J. McCormick, James Johnson, Craig S. Sylla, Patricia Cannon, Jamie Lujan, Henry Kassir, Andrew Landmann, Ron Gaertner, Wolfgang Lee, Edward Bastawrous, Amir Bardakcioglu, Ovunc Pandey, Sushil Attaluri, Vikram Bernstein, Mitchell Obias, Vincent Franklin, Morris E. Pigazzi, Alessio Surg Endosc Article BACKGROUND: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. METHODS: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. RESULTS: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. CONCLUSION: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy. Springer US 2021-11-01 2022 /pmc/articles/PMC9085698/ /pubmed/34724580 http://dx.doi.org/10.1007/s00464-021-08780-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Cleary, Robert K. Silviera, Matthew Reidy, Tobi J. McCormick, James Johnson, Craig S. Sylla, Patricia Cannon, Jamie Lujan, Henry Kassir, Andrew Landmann, Ron Gaertner, Wolfgang Lee, Edward Bastawrous, Amir Bardakcioglu, Ovunc Pandey, Sushil Attaluri, Vikram Bernstein, Mitchell Obias, Vincent Franklin, Morris E. Pigazzi, Alessio Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title | Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title_full | Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title_fullStr | Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title_full_unstemmed | Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title_short | Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
title_sort | intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9085698/ https://www.ncbi.nlm.nih.gov/pubmed/34724580 http://dx.doi.org/10.1007/s00464-021-08780-9 |
work_keys_str_mv | AT clearyrobertk intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT silvieramatthew intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT reidytobij intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT mccormickjames intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT johnsoncraigs intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT syllapatricia intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT cannonjamie intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT lujanhenry intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT kassirandrew intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT landmannron intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT gaertnerwolfgang intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT leeedward intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT bastawrousamir intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT bardakciogluovunc intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT pandeysushil intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT attalurivikram intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT bernsteinmitchell intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT obiasvincent intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT franklinmorrise intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial AT pigazzialessio intracorporealandextracorporealanastomosisforroboticassistedandlaparoscopicrightcolectomyshorttermoutcomesofamulticenterprospectivetrial |