Ramon O Minjares-Granillo, MD1,2, Bertha A Dimas, MD1,2, Samuel W Carson, MD1,3, Bobby L Johnson, MD1,3, Jean-Paul J Lefave, MD1,2,3, Eric M Haas, MD1,2,3. 1Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas, 2Southeast Clinical Research Associates, Inc., Houston, Texas, 3Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, Texas
Introduction: We present the first known comparative analysis of robotic left-sided colorectal resection using natural orifice-assisted intracorporeal anastomosis (ICA) and removal of specimen. Although there has been a surge of enthusiasm and reports of outcome benefits following robotic ICA for right-sided colectomy, there are few reports investigating the feasibility, utility, benefits and limitations of robotic left-sided colectomy in the worldwide literature. We recently developed a stepwise approach designed for reproducibility and widespread adoption of this technique which we refer to as the Robotic NICE procedure: Natural orifice IntraCorporeal anastomosis with Extraction.
Methods: Thirty-five consecutive patients who underwent the NICE procedure over a four-month period were matched to a cohort of patients undergoing conventional robotic left-sided colectomy based on 4 matching criteria: surgeon, institution, disease, and procedure. Patients who underwent neoadjuvant therapy were excluded. Demographic data, intraoperative parameters, costs, and short-term outcomes were analyzed in an IRB database.
Results: There was no significant difference in demographics between the groups including age, gender, BMI, and ASA. Diverticulitis was the most common diagnosis (63%) followed by colorectal cancer (29%). Overall mean operative time was similar between the NICE and conventional group (212 vs. 228 min, p = 0.298). When comparing the NICE vs. conventional group, there was a significant difference in return of bowel function (1 vs. 2 days, p = 0.001), length of stay (50 vs. 75 hours, p = 0.001) and direct costs ($19,497 vs. $22,336, p = 0.026). Significantly greater number of patients were discharged by POD 2 in the NICE group (74%) compared to the conventional group (46%) and alll but 2 patients in the NICE group were discharged by POD 3 (p = 0.025). Overall opioid use was lower in the NICE group but did not reach statistical significance (14 vs. 22 mg morphine equivalent, p = 0.13). No significant difference was found in complication, readmission or reoperation rates. There was one surgical site infection in each group. No anastomotic leaks or mortalities were encountered.
Conclusion: The robotic NICE procedure is a promising approach that utilizes the rectum as a natural orifice for ICA and specimen extraction. It thereby eliminates the need for an abdominal incision other than the port sites. In this initial analysis there was a significant reduction in length of stay, earlier return of bowel function and decreased costs. Additional outcomes including reduced opioid requirements will be addressed in larger multicenter studies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95866
Program Number: P708
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster