Alexandra C Reitz, BA, Edward Lin, MD, Seth A Rosen, MD. Emory University
Introduction: When performed laparoscopically, right colectomy is most commonly a hybrid procedure with hand-assistance and/or extracorporeal anastomosis (ECA) because of the technical complexity of laparoscopic anastomosis. Robotic-assisted right colectomy (RRC) may offer technical advantages over laparoscopic-assisted right colectomy enabling more surgeons to perform a completely minimally invasive procedure.
Methods and Procedures: We conducted a retrospective review of 49 consecutive RRCs performed by a single surgeon during a 17 month period. Data analysis was conducted using independent-samples t-test, linear regression, Fisher’s exact test, and Spearman’s rank test. Statistical significance was defined as a p-value <0.05
Results: Patients were an average age of 61.8 ± 14.7 years, 28 (57%) were female, average body mass index (BMI) was 29.7 ± 7.4 kg/m2, and 28 patients (57%) had undergone prior abdominal surgery. The most common indications for surgery were cancer (23 patients) and polyp (21 patients). Conversion to open surgery was required in 4 (8.2%) patients and post-operative complications occurred in 5 (10.2%) patients. There were no anastomotic leaks, mortalities or readmissions within 30 days. Comparing the first 20 cases (ECA) with the next 29 cases (ICA) showed no statistical differences for average operating room time (ORT) (139.1 ± 28.0 minutes for ECA , 143.5 ± 24.5 minutes for ICA), mean estimated blood loss (EBL) (70.8 ± 120.1 ml for ECA, 47.6 ± 46.7 ml for ICA), lymph nodes sampled (LNS) (15.1 ± 5.4 for ECA, 18.5 ± 6.4 for ICA), or hospital length of stay (3.7 ± 1.5 days for ECA, 3.2 ± 0.9 days for ICA). Comparing procedures performed for malignancy with those performed for non-oncologic indications demonstrated no statistically significant difference in ORT, EBL, post-operative complications or LOS. Earlier cases were significantly associated with conversion compared to later cases (p=0.01). Later case number correlated with a significant increase in LNS (p=0.02) and a trend toward longer ORT (p=0.08). Patients with higher BMI trended toward longer ORT, though this was not statistically significant. Patient characteristics such as BMI, age, comorbidities and prior abdominal surgeries were not significantly associated with LOS. Similarly, conversion, EBL, ORT and anastomosis technique were not associated with LOS. Post-operative complications were significantly associated with LOS and accounted for 16% of the variation in estimated LOS (R2=0.16, p=0.01).
Conclusions: During transition from ECA to ICA with RRC, we noted no significant change in ORT, EBL, LNS or LOS. The robotic platform enabled transition to a completely minimally invasive procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77352
Program Number: P269
Presentation Session: Poster (Non CME)
Presentation Type: Poster