Warqaa M Akram1, Riad H Al-Natour2, Jeremy Albright3, Juan Wu4, Jane Ferraro5, Beth-Ann Shanker6, Amanda M McClure7, Robert K Cleary8. 1. Colon and Rectal Surgery Fellow, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: warqaa.akram@stjoeshealth.org. 2. General Surgery Resident, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: Riad.AlNatour@stjoeshealth.org. 3. Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA. Electronic address: Jeremy@methodsconsultants.com. 4. Academic Research, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: Juan.Wu@stjoeshealth.org. 5. Academic Research, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: Jane.Ferraro@stjoeshealth.org. 6. Division of Colon and Rectal Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: BethAnn_Shanker@ihacares.com. 7. Division of Colon and Rectal Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: Amanda_McClure@ihacares.com. 8. Division of Colon and Rectal Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA. Electronic address: Robert.Cleary@stjoeshealth.org.
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.
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.
Authors: Morris E Franklin; 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; Alessio Pigazzi Journal: Surg Endosc Date: 2021-11-01 Impact factor: 3.453
Authors: Amir L Bastawrous; Kara K Brockhaus; Melissa I Chang; Gediwon Milky; I-Fan Shih; Yanli Li; Robert K Cleary Journal: Surg Endosc Date: 2021-02-10 Impact factor: 4.584