Multiple robotic stapler firings to transect the rectum are not associated with anastomotic leakage

The relationship between the number of stapler firings (SFs) during robotic rectal transection and the risk of colorectal/coloanal anastomotic leakage (AL) is controversial. This study investigates whether the number of robotic SFs is associated with an increased risk of AL.

Retrospective review of adult patients who underwent robotic total mesorectal excision (TME) and partial mesorectal excision (PME) with double-stapled colorectal or coloanal anastomosis for both benign and malignant colorectal diseases between 2015 and 2023 across three enterprise-wide hospitals.

the effect of multiple SFs on postoperative AL rate among patients who underwent one, two, or three or more SFs.

the effects of other potential risk factors on postoperative AL.

Of 503 patients who underwent robotic colorectal resection with a double-stapled anastomosis, 56 (11%) developed a postoperative AL. The number of SFs was not associated with the AL rate (p = 0.51): the univariable and multivariate analyses found no correlation between the AL rate and the increasing number of SFs required, compared with one SF as the reference (adjusted two SFs, OR = 1.1, 95% CI: 0.6-2.2, p = 0.77 vs. adjusted three or more SFs, OR = 0.98, 95% CI: 0.4-2.3, p = 0.96). On multivariate analysis, AL was strongly associated with male gender (OR = 2.5, 95% CI: 1.3-4.9, p = 0.005) and with TME versus PME (OR = 2.8, 95% CI: 1.5-5.5, p = 0.002).

The number of robotic SFs for rectal transection is not correlated with postoperative AL.