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Robotic versus laparoscopic right colectomy within a systematic ERAS protocol: a propensity-weighted analysis.

Marco Migliore1, Maria Carmela Giuffrida1, Alessandra Marano1

  • 1Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy.

Updates in Surgery
|February 23, 2020
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Summary

Robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) show similar outcomes in an enhanced recovery after surgery (ERAS) program. RRC, however, requires a longer operative time than LRC.

Keywords:
Enhanced recovery after surgeryLaparoscopicRight colectomyRobotic

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Area of Science:

  • Minimally Invasive Surgery
  • Colorectal Surgery
  • Surgical Oncology

Background:

  • Enhanced recovery after surgery (ERAS) programs standardize perioperative care.
  • Robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) are minimally invasive techniques for colectomies.
  • Intracorporeal anastomosis (IA) is a common reconstruction method in both RRC and LRC.

Purpose of the Study:

  • To compare early postoperative and pathological outcomes of RRC versus LRC with IA.
  • To evaluate outcomes within a systematic ERAS program.
  • To identify differences in operative time, length of stay, and complication rates.

Main Methods:

  • Retrospective review of a single-institution prospective database.
  • Inclusion of patients undergoing elective RRC or LRC with IA for neoplastic lesions (April 2010 - June 2018).
  • Propensity-weighted analysis to control for selection bias.

Main Results:

  • RRC had a significantly longer operative time (242.43 min) compared to LRC (187.60 min) (p=0.001).
  • Conversion rates, median length of hospital stay (4 days), 30-day readmission rates (2.2% vs 2.4%), and 30-day morbidity/mortality were comparable between groups.
  • No significant difference was observed in the number of harvested lymph nodes.

Conclusions:

  • In an ERAS setting, RRC and LRC with IA demonstrate similar early postoperative and pathological outcomes.
  • Robotic right colectomy is associated with a longer operative time compared to the laparoscopic approach.
  • Both techniques are viable options for right colectomy within ERAS protocols, with comparable safety and efficacy profiles.