Bottom-up suprapubic approach for robotic right colectomy: technical aspects and preliminary outcomes

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Robotic Surgery

Background:

• Laparoscopic complete mesocolic excision (CME) for right colectomy is technically demanding, particularly with intracorporeal anastomosis (IA).
• Robotic platforms offer potential advantages to overcome laparoscopic limitations in complex procedures.
• The bottom-up technique for robotic right colectomy (RRC) with CME and IA aims to simplify the procedure.

Purpose of the Study:

• To describe the robotic bottom-up technique for right colectomy with CME and IA.
• To evaluate the short-term outcomes of this robotic approach.

Main Methods:

• Prospective data collection and retrospective analysis of 109 patients undergoing RRC with bottom-up suprapubic approach for cancer.
• Assessment of intraoperative and postoperative outcomes, including complications, conversion rates, and pathological data.
• Variables analyzed: operative time, complications, conversion rate, postoperative stay, incisional hernia rate, and anastomotic leak.

Main Results:

• A total of 109 patients underwent the procedure with a low conversion rate (3.6%) and no intraoperative complications.
• Mean operative time was 179 minutes; mean postoperative stay was 4.6 days.
• Low 30-day complication rates: overall 15.6% (12% minor, 3.6% major), anastomotic leak 0.9%, and incisional hernia 0.9%.

Conclusions:

• The bottom-up approach for robotic right colectomy with CME and IA demonstrates feasibility.
• This technique is associated with low rates of conversions and short-term postoperative complications.
• Robotic surgery facilitates complex procedures like RRC with CME and IA, offering favorable patient outcomes.