Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

Robert K. Cleary; Matthew Silviera; Tobi J. Reidy; James McCormick; Craig S. Johnson; Patricia Sylla; Jamie Cannon; Henry Lujan; Andrew Kassir; Ron Landmann; Wolfgang Gaertner; Edward Lee; Amir Bastawrous; Ovunc Bardakcioglu; Sushil Pandey; Vikram Attaluri; Mitchell Bernstein; Vincent Obias; Morris E. Franklin; Alessio Pigazzi

doi:10.1007/s00464-021-08780-9

Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

Robert K. Cleary, Matthew Silviera, Tobi J. Reidy, James McCormick, Craig S. Johnson, Patricia Sylla, Jamie Cannon, Henry Lujan, Andrew Kassir, Ron Landmann, Wolfgang Gaertner, Edward Lee, Amir Bastawrous, Ovunc Bardakcioglu, Sushil Pandey, Vikram Attaluri, Mitchell Bernstein, Vincent Obias, Morris E. Franklin, Alessio Pigazzi

Surgery

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	4349-4358
Number of pages	10
Journal	Surgical endoscopy
Volume	36
Issue number	6
DOIs	https://doi.org/10.1007/s00464-021-08780-9
State	Published - Jun 2022

Bibliographical note

Funding Information:
This study was sponsored and funded by Intuitive Surgical, Inc., Sunnyvale, CA in association with the identified study investigators under a cooperative clinical trial agreement.

Funding Information:
Morris E Franklin Jr. MD passed away on August 2, 2020. He was instrumental in the conception and design of this study. He was an innovator and early adopter of laparoscopic techniques in colon and rectal surgery and his contributions to education and clinical research were countless. He was loved by many. We are grateful to Dr Franklin and his group at Texas Endosurgery Institute, San Antonio, TX. We would also like to thank the following surgeons for contributing cases to this study: Dr. Amanda McClure and Dr. Beth-Ann Shanker of Saint Joseph Mercy Health System, Dr. Matthew Mutch, Dr. Paul Wise, Dr. Sean Glasgow, and Dr. Steven Hunt of Washington University School of Medicine, Dr. Ben Tsai, Dr. Dipen Maun, and Dr. Frederick Lane from Franciscan Health Indianapolis, Dr. Matthew Voth and Dr. Patrick Recio from Allegheny Health Network, Dr. Bryce Murray from Oklahoma Surgical Hospital, Dr. Daniel Popowich, Dr. David Chessin, and Dr. Sergey Khaitov from the Icahn School of Medicine at Mount Sinai, Dr. Gregory Kennedy from the University of Alabama at Birmingham, Dr. Gustavo Plasencia from Jackson Health System, Dr. Mehraneh Jafari and Dr. Joseph Carmichael from the University of California, Irvine School of Medicine, and Dr. Melinda Hawkins from Swedish Medical Center. The authors thank Intuitive Surgical, Inc. (Sunnyvale, CA, USA) for sponsoring and funding this study, and we especially thank the project managers, Madhu Gorrepati, MD, and Auben Debus. We also acknowledge Dongjing Guo and Tami Crabtree, MS, respectively, for statistical analysis oversight and independent third-party statistical analysis.

Publisher Copyright:
© 2021, The Author(s).

Keywords

Extracorporeal anastomosis
Intracorporeal anastomosis
Laparoscopic right colectomy
Minimally invasive colorectal surgery
Robotic-assisted right colectomy

PubMed: MeSH publication types

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

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Cleary, R. K., Silviera, M., Reidy, T. J., McCormick, J., Johnson, C. S., Sylla, P., Cannon, J., Lujan, H., Kassir, A., Landmann, R., Gaertner, W., Lee, E., Bastawrous, A., Bardakcioglu, O., Pandey, S., Attaluri, V., Bernstein, M., Obias, V., Franklin, M. E., & Pigazzi, A. (2022). Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial. Surgical endoscopy, 36(6), 4349-4358. https://doi.org/10.1007/s00464-021-08780-9

Cleary, RK, Silviera, M, Reidy, TJ, McCormick, J, Johnson, CS, Sylla, P, Cannon, J, Lujan, H, Kassir, A, Landmann, R, Gaertner, W, Lee, E, Bastawrous, A, Bardakcioglu, O, Pandey, S, Attaluri, V, Bernstein, M, Obias, V, Franklin, ME & Pigazzi, A 2022, 'Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial', Surgical endoscopy, vol. 36, no. 6, pp. 4349-4358. https://doi.org/10.1007/s00464-021-08780-9

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title = "Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial",

abstract = "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.",

keywords = "Extracorporeal anastomosis, Intracorporeal anastomosis, Laparoscopic right colectomy, Minimally invasive colorectal surgery, Robotic-assisted right colectomy",

author = "Cleary, {Robert K.} and Matthew Silviera and Reidy, {Tobi J.} and James McCormick and Johnson, {Craig S.} and Patricia Sylla and Jamie Cannon and Henry Lujan and Andrew Kassir and Ron Landmann and Wolfgang Gaertner and Edward Lee and Amir Bastawrous and Ovunc Bardakcioglu and Sushil Pandey and Vikram Attaluri and Mitchell Bernstein and Vincent Obias and Franklin, {Morris E.} and Alessio Pigazzi",

note = "Funding Information: This study was sponsored and funded by Intuitive Surgical, Inc., Sunnyvale, CA in association with the identified study investigators under a cooperative clinical trial agreement. Funding Information: Morris E Franklin Jr. MD passed away on August 2, 2020. He was instrumental in the conception and design of this study. He was an innovator and early adopter of laparoscopic techniques in colon and rectal surgery and his contributions to education and clinical research were countless. He was loved by many. We are grateful to Dr Franklin and his group at Texas Endosurgery Institute, San Antonio, TX. We would also like to thank the following surgeons for contributing cases to this study: Dr. Amanda McClure and Dr. Beth-Ann Shanker of Saint Joseph Mercy Health System, Dr. Matthew Mutch, Dr. Paul Wise, Dr. Sean Glasgow, and Dr. Steven Hunt of Washington University School of Medicine, Dr. Ben Tsai, Dr. Dipen Maun, and Dr. Frederick Lane from Franciscan Health Indianapolis, Dr. Matthew Voth and Dr. Patrick Recio from Allegheny Health Network, Dr. Bryce Murray from Oklahoma Surgical Hospital, Dr. Daniel Popowich, Dr. David Chessin, and Dr. Sergey Khaitov from the Icahn School of Medicine at Mount Sinai, Dr. Gregory Kennedy from the University of Alabama at Birmingham, Dr. Gustavo Plasencia from Jackson Health System, Dr. Mehraneh Jafari and Dr. Joseph Carmichael from the University of California, Irvine School of Medicine, and Dr. Melinda Hawkins from Swedish Medical Center. The authors thank Intuitive Surgical, Inc. (Sunnyvale, CA, USA) for sponsoring and funding this study, and we especially thank the project managers, Madhu Gorrepati, MD, and Auben Debus. We also acknowledge Dongjing Guo and Tami Crabtree, MS, respectively, for statistical analysis oversight and independent third-party statistical analysis. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2022",

month = jun,

doi = "10.1007/s00464-021-08780-9",

language = "English (US)",

volume = "36",

pages = "4349--4358",

journal = "Surgical endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "6",

}

TY - JOUR

T1 - Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy

T2 - short-term outcomes of a multi-center prospective trial

AU - Cleary, Robert K.

AU - Silviera, Matthew

AU - Reidy, Tobi J.

AU - McCormick, James

AU - Johnson, Craig S.

AU - Sylla, Patricia

AU - Cannon, Jamie

AU - Lujan, Henry

AU - Kassir, Andrew

AU - Landmann, Ron

AU - Gaertner, Wolfgang

AU - Lee, Edward

AU - Bastawrous, Amir

AU - Bardakcioglu, Ovunc

AU - Pandey, Sushil

AU - Attaluri, Vikram

AU - Bernstein, Mitchell

AU - Obias, Vincent

AU - Franklin, Morris E.

AU - Pigazzi, Alessio

N1 - Funding Information: This study was sponsored and funded by Intuitive Surgical, Inc., Sunnyvale, CA in association with the identified study investigators under a cooperative clinical trial agreement. Funding Information: Morris E Franklin Jr. MD passed away on August 2, 2020. He was instrumental in the conception and design of this study. He was an innovator and early adopter of laparoscopic techniques in colon and rectal surgery and his contributions to education and clinical research were countless. He was loved by many. We are grateful to Dr Franklin and his group at Texas Endosurgery Institute, San Antonio, TX. We would also like to thank the following surgeons for contributing cases to this study: Dr. Amanda McClure and Dr. Beth-Ann Shanker of Saint Joseph Mercy Health System, Dr. Matthew Mutch, Dr. Paul Wise, Dr. Sean Glasgow, and Dr. Steven Hunt of Washington University School of Medicine, Dr. Ben Tsai, Dr. Dipen Maun, and Dr. Frederick Lane from Franciscan Health Indianapolis, Dr. Matthew Voth and Dr. Patrick Recio from Allegheny Health Network, Dr. Bryce Murray from Oklahoma Surgical Hospital, Dr. Daniel Popowich, Dr. David Chessin, and Dr. Sergey Khaitov from the Icahn School of Medicine at Mount Sinai, Dr. Gregory Kennedy from the University of Alabama at Birmingham, Dr. Gustavo Plasencia from Jackson Health System, Dr. Mehraneh Jafari and Dr. Joseph Carmichael from the University of California, Irvine School of Medicine, and Dr. Melinda Hawkins from Swedish Medical Center. The authors thank Intuitive Surgical, Inc. (Sunnyvale, CA, USA) for sponsoring and funding this study, and we especially thank the project managers, Madhu Gorrepati, MD, and Auben Debus. We also acknowledge Dongjing Guo and Tami Crabtree, MS, respectively, for statistical analysis oversight and independent third-party statistical analysis. Publisher Copyright: © 2021, The Author(s).

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

KW - Extracorporeal anastomosis

KW - Intracorporeal anastomosis

KW - Laparoscopic right colectomy

KW - Minimally invasive colorectal surgery

KW - Robotic-assisted right colectomy

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Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

Abstract

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