title: Robotic right colectomy with intracorporeal anastomosis: experience with 52 consecutive cases.
abstract: BACKGROUND
  In laparoscopic right hemicolectomy (LRC), extracorporeal or intracorporeal (ICA) anastomosis can be performed. Several authors have suggested advantages to ICA. This study reports our transition to and our experience with robotic right colectomy (RRC) with ICA.
  
  
  METHODS
  From June 2009 to September 2012 we performed 58 consecutive RRCs, of which 52 were with ICA. Data were prospectively stored and retrospectively reviewed.
  
  
  RESULTS
  Twenty-eight female and 30 male patients with a mean age of 71.6 ± 8.3 years (range, 52-89 years) were studied. Indications for surgery included adenocarcinoma (n=30), adenoma (n=20), diverticulitis (n=1), and Crohn's disease (n=1). For RRC with ICA (n=52), mean operative time (OT) was 193.2 ± 42.2 minutes (range, 123-239 minutes). Mean estimated blood loss (EBL) was 47.8 ± 59.5 mL (range, 5-300 mL). Mean length of hospital stay (LOS) was 3.7 ± 3.2 days (range, 1-21 days). Mean extraction-site incision size was 4.61 ± 0.78 cm (range, 2.5-6.5 cm). Mean lymph node harvest was 20.7 ± 8.2 (range, 6-40). Mean specimen length was 18.9 ± 7.2 cm (range 10-37). No intraoperative complications, conversions, or 30-day mortality occurred. Nine postoperative complications (19.1%) occurred, with one anastomotic leak (1.7%). For LRC with ICA as reported in the literature, OT ranges from 136 to 190 minutes, EBL ranges from 0 to 500 mL, median LOS ranges from 3 to 5 days, complication rates range from 6% to 15%, with ileus <22%, and conversion rates are <5%.
  
  
  CONCLUSIONS
  RRC with ICA is safe and feasible. OTs and outcomes compare favorably with those published in the literature for LRC with ICA. The robot may facilitate transition to ICA, and if future studies confirm advantages of ICA, the role of RRC may gain importance.
authors.affiliation: 1 Jackson Medical Group Specialty Physicians, Jackson South Community Hospital , Miami, Florida.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Lujan
authors.forename: Andres
authors.initials: A
authors.lastname: Molano
authors.forename: Alfredo
authors.initials: A
authors.lastname: Burgos
authors.forename: Brian
authors.initials: B
authors.lastname: Rivera
authors.forename: Gustavo
authors.initials: G
authors.lastname: Plasencia
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003092:Colitis / Q000601:surgery; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome