title: Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study.
abstract: BACKGROUND
  Growing evidence suggests that the intracorporeal fashioning of an anastomosis after a laparoscopic right colectomy may offer several advantages. However, due to the difficulty of the intracorporeal technique, laparoscopic extracorporeal confectioning of the anastomosis remains the most widely adopted technique. Although the purpose of the robotic approach was to overcome the limitations of the laparoscopic technique and to simplify the most demanding surgical procedures, such as performing an intracorporeal anastomosis, evidence is lacking that compares the robotic right colectomy with intracorporeal anastomosis (RRCIA) technique with both the conventional laparoscopic right colectomy with extracorporeal anastomosis (LRCEA) and the laparoscopic right colectomy with intracorporeal anastomosis confectioning (LRCIA) techniques. This study aims to compare the intraoperative and postoperative outcomes of the RRCIA to those of both the LRCEA and the LRCIA.
  
  
  METHODS
  A retrospective review of a prospectively maintained database of two Italian centres was performed on the data on patients undergoing an RRCIA, LRCEA or LRCIA for cancer or adenomas.
  
  
  RESULTS
  Two hundred and thirty-six patients (RRCIA = 102, LRCEA = 94, LRCIA = 40) met the criteria for inclusion in the study. The three groups were comparable in their demographic and baseline characteristics. No significant differences were found in the conversion to open rates, intraoperative blood loss, 30-day morbidity and mortality, number of lymphnodes harvested and other pathological characteristics. Compared with the LRCEA, the RRCIA required a longer operative time (P < 0.0001) but had better recovery outcomes, such as a shorter length of hospital stay (P < 0.0001). Compared with the LRCIA, the RRCIA had a shorter time to first flatus (P < 0.0001) but offered no advantages in terms of the length of the hospital stay.
  
  
  CONCLUSIONS
  Performing the RRCIA offers significantly better perioperative recovery outcomes compared with the LRCEA, with a substantial reduction in the length of the hospital stay. The RRCIA does not offer the same advantages compared with the LRCIA.
authors.affiliation: Department of Digestive Surgery and Liver Unit, Santa Maria Hospital, Terni, Italy, stefano.trastulli@hotmail.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Guarino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Piagnerelli
authors.forename: Mario
authors.initials: M
authors.lastname: Annecchiarico
authors.forename: Francesco
authors.initials: F
authors.lastname: Coratti
authors.forename: Michele
authors.initials: M
authors.lastname: Di Marino
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricci
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics