Robotic Right Colectomy: Pathological and Early Clinical Results

M Zuccaro, MD, R Biffi, MD, M. Valvo, MD, T. Leal Ghezzi, MD, S. Cenciarelli, MD, F. Luca, MD. Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

Introduction: In the era of mini-invasive techniques there is still no agreement on the best surgical approach to right-sided colon cancer, albeit several reports showed some clinical advantages in terms of hospital stay and pain control after “non laparotomic” treatment. There are still few reports in the literature on the use of da Vinci Surgical System for this type of colonic resection. Aim of our study was to evaluate if the technical advantages demonstrated for rectal cancer surgery could offer benefits also for right colon resection performed for oncological intent.

Material and methods: Between February 2008 and June 2010 37 consecutive patients underwent robotic right colectomy (RRC) for malignant disease. All operations were performed with a medial to lateral approach using a full robotic technique with the da Vinci System. Vessel control was gained by endoclips with section of ileocolic, right colic and right branch of middle colic vessels. Specimen extraction and stapled extracorporeal anastomosis were completed through a minilaparotomy. Data regarding outcome and pathology reports were prospectively collected in a dedicated database

Results: Eighteen women and 19 men, with a mean age 65 years (SD ? 11), underwent RRC; mean BMI was 25.5 (SD ? 2,7). Tumor localization is reported in table 1.

Table1
Cecum Ascending hepatic Flexure Transverse
18 15 3 1

In all cases an extracorporeal anastomoses was performed: 24 termino-lateral and 13 latero-lateral. A mean of 27 lymph nodes were harvested (SD ? 8.6), and all patients reached a R0 resection. Mean operation time was 190 minutes (SD ? 35.0 range: 127-250 min). Estimated median blood loss was 10 ml (0 – 250 ml), and intraoperative blood transfusion was nil. Median postoperative hospital stay was 5 days (4 – 11). No conversion occurred in this series. Four minor complications occurred (all wound infection) and one patient with wound infection and fever was re-hospitalized. No major complication was observed. Most common pathological stage was pT3pN0. No recurrence or death were observed after a mean follow-up of 16 months.

Discussion Almost every kind of operations have been reported to be safe and feasible with robotic technique . Some authors claimed 6that right hemicolectomy represents the ideal procedure to start a robotic colorectal surgery program. We believe that the features of the da Vinci Surgical System: stable camera platform and magnified tridimensional view help also experienced surgeons thus reducing stress and fatigue. In addition, wristed instruments with motion scaling and tremor elimination could reduce the risk of iatrogenic injuries and allow for a wide and secure lymphadenectomy.
Conclusion: Our experience confirms the feasibility and safety of RRC. Quality of surgery measured in terms of number of lymph nodes harvested, postoperative recovery and estimated blood loss, was high in all patients of our series.