Minimally Invasive Right Hemicolectomy With Intracorporeal Anastomosis-Eliminating the Painful 12 mm Port Paradox

BackgroundMinimally invasive right hemicolectomy with intracorporeal anastomosis (ICA) with relocation of the 12 mm port to the Pfannenstiel specimen incision is associated with reduced length of stay and postoperative ileus while preserving surgical and oncologic outcomes when compared to extracorporeal anastomosis (ECA).MethodsAn institutional review board (IRB)-approved retrospective review was conducted at a single center for all patients who underwent elective laparoscopic or robotic right hemicolectomy from 2015 to 2023. The 12 mm port for anastomosis stapler was placed in the planned Pfannenstiel specimen extraction site in all patients undergoing ICA.Results112 patients underwent minimally invasive right hemicolectomy (33 laparoscopic ECA, 1 robotic ECA, 51 laparoscopic ICA, 27 robotic ICA). Median operative times for ECA vs ICA were 149.8 and 183.1 minutes, respectively (P < .01). The median length of stay was shorter for ICA (2 vs 3 days, P < .01). Postoperative ileus was greater in the ECA group (8.8% vs 2.6%, P = .140). Hospital readmissions were higher in the ECA group (3 vs 1, P = .048). The rate of no evidence of disease at time of last oncology follow-up was in the ECA group (93.6%) vs in the ICA group (98.5%), P = .092. Recurrence rate was not significantly different when comparing the ECA group vs the ICA group (6.45% vs 4.55%, P = .708).DiscussionMinimally invasive right hemicolectomy with ICA is associated with a lower rate of postoperative ileus and shorter length of stay. Relocating the 12-mm port for the bowel stapler to the Pfannenstiel extraction site eliminates the painful 12-mm port paradox.