ABSTRACT
Numerous studies have confirmed significant benefits of intracorporeal anastomosis (ICA) following colorectal procedures; however technical challenges have limited this approach following conventional laparoscopic surgery. The robotic Xi platform serves as an enabling technology and has resulted in a surge of reports for right-sided ICA, however, there are no reports involving more complex left-sided procedures such as diverticulitis. Furthermore, there are no reports of natural orifice-assisted techniques using robotic Xi in which the specimen can be removed and the anvil can be placed transrectally, thereby completely eliminating the need for an abdominal wall incision other than for port sites. We present a pilot study to investigate the safety, feasibility and short-term outcomes of robotic Natural orifice-assisted IntraCorporeal anastomosis with transrectal Extraction of specimen, called the robotic NICE procedure. Consecutive patients presenting for elective resection for diverticulitis with formation of a colorectal anastomosis were entered into an IRB database. All patients underwent the robotic NICE procedure. Demographic data, intraoperative data and outcomes data were assessed and analyzed. Ten patients (five males and five females) underwent resection. The mean age and BMI were 56 years (43-66) and 29 kg/m2 (21-35). All procedures were successfully completed including transrectal extraction of the specimen and formation of an ICA. The mean operative time was 198 min (146-338) and mean EBL was 35 ml (15-50). Mean time to first flatus was 16 h (10-22) and mean length of stay was 1.9 days (1.6-2.6). There were no intraoperative or postoperative complications. There was no unexpected ICU stay, reoperation or readmission. Colorectal left-sided resections such as for diverticulitis were safely accomplished using natural orifice-assisted extraction of the specimen as well as complete intracorporeal anastomosis in this pilot study. The NICE procedure resulted in early return of bowel function, short length of stay and low complication. The complete elimination of abdominal wall incision likely accounts for these findings and larger cohorts of patients are to be investigated to explore this promising approach afforded by robotic technology.
Subject(s)
Anastomosis, Surgical/methods , Colectomy/methods , Diverticulitis, Colonic/surgery , Endoscopy, Gastrointestinal/methods , Laparoscopy/methods , Rectum/surgery , Robotic Surgical Procedures/methods , Specimen Handling/methods , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Robotic Surgical Procedures/instrumentation , Safety , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Despite numerous benefits, only a small fraction of laparoscopic left-sided colectomy is accomplished without the need for an abdominal incision to retrieve the specimen and prepare for anastomosis. We report our early experience with a robotic approach using Natural orifice IntraCorporeal anastomosis with Extraction of specimen (NICE) to help overcome the technical limitations and challenges of this approach. METHODS: Twenty consecutive patients presented for elective sigmoid or rectosigmoid resection for benign and malignant disease and underwent the NICE procedure. Safety, feasibility and post-operative outcomes were analyzed. RESULTS: Intracorporeal anastomosis was accomplished in all patients. One patient required an abdominal incision to extract a bulky tumor. Mean operative time was 222â¯min (146-344). Mean time to first flatus and length of stay was 23 and 49â¯h, respectively. All but 4 patients were discharged home on post-operative day 2. One patient was readmitted with a pelvic fluid collection. CONCLUSION: Robotic left-sided colorectal resection with NICE procedure is a safe and feasible minimally invasive approach and may facilitate greater adoption rates of this technique.