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Liang Y, Li L, Su Q, Liu Y, Yin H, Wu D. Short-term outcomes of intracorporeal and extracorporeal anastomosis in robotic right colectomy: a systematic review and meta-analysis. Tech Coloproctol 2022; 26:529-535. [PMID: 35347491 DOI: 10.1007/s10151-022-02599-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/10/2022] [Indexed: 12/01/2022]
Abstract
Ileocolic anastomosis is performed via extracorporeal or intracorporeal techniques in robotic right hemicolectomy. The aim of this meta-analysis was to compare the short-term outcomes of intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) for robotic right colectomy. The EMBASE, PubMed, and Cochrane Library databases were searched systematically (from inception until March 1, 2020) for randomized and non-randomized control trials reporting the short-term outcomes of IA and EA for robotic right colectomy. Five observational cohort studies involving 585 participants were included in our meta-analysis. Compared to the EA group, the IA group showed significantly longer operation time [weighted mean difference (WMD): 28.88, 95% confidence interval (CI) 13.88-43.89, p = 0.0002], lower rate of anastomotic leak (odds ratio: 0.26, 95% CI 0.08-0.85, p = 0.03), and shorter time to first flatus (WMD: - 0.57, 95% CI - 0.95 to 0.19, p = 0.003). However, pooled results revealed no difference in blood loss, complications, wound infection, incisional hernia, length of incision, and hospital stay between the IA and EA groups (p < 0.05). This meta-analysis indicated that IA was superior to EA in terms of anastomotic leak and time to first flatus, but inferior in terms of operation time. Large-scale, multicenter, randomized studies are needed to confirm our findings.
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Affiliation(s)
- Y Liang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - L Li
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Q Su
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Y Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - H Yin
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - D Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Shi H, Chen SY, Xie ZF, Huang R, Jiang JL, Lin J, Dong FF, Xu JX, Fang ZL, Bai JJ, Luo B. Peroral traction-assisted natural orifice trans-anal flexible endoscopic rectosigmoidectomy followed by intracorporeal colorectal anastomosis in a live porcine model. World J Gastrointest Endosc 2020; 12:451-458. [PMID: 33269054 PMCID: PMC7677887 DOI: 10.4253/wjge.v12.i11.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Compared to traditional open surgery, laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain, a shorter hospital stay, and better quality of life. In 2007, Whiteford et al reported the first natural orifice trans-anal endoscopic surgery (NOTES) sigmoidectomy using transanal endoscopic microsurgery. To date, all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid platforms.
AIM To introduce a novel technique of peroral external traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live porcine model.
METHODS Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid resection. After preoperative work-up and bowel preparation, general anesthesia combined with endotracheal intubation was achieved. One dual-channel therapeutic endoscope was used. Carbon dioxide insufflation was performed during the operation. The procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps: (1) The rectosigmoid colon was tattooed with India ink by submucosal injection; (2) Creation of gastrostomy by directed submucosal tunneling; (3) Peroral external traction using endoloop ligation; (4) Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling; (5) Peroral external traction-assisted dissection of the left side of the colon; (6) Trans-anal rectosigmoid specimen transection, where an anvil was inserted into the proximal segment after purse-string suturing; (7) Intracorporeal colorectal end-to-end anastomosis using a circular stapler by a single stapling technique; and (8) Closure of gastrostomy using endoscopic clips. All animals were euthanized immediately after the procedure, abdominal exploration was performed, and the air-under-water leak test was carried out.
RESULTS The procedure was completed in all three animals, with the operation time ranging from 193 min to 259 min. Neither major intraoperative complications nor hemodynamic instability occurred during the operation. The length of the resected specimen ranged from 7 cm to 13 cm. With the assistance of a trans-umbilical rigid grasper, intracorporeal colorectal, tension-free, end-to-end anastomosis was achieved in the three animals.
CONCLUSION Peroral traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis is technically feasible and reproducible in an animal model and is worthy of further improvements.
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Affiliation(s)
- Hong Shi
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Su-Yu Chen
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zhao-Fei Xie
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Rui Huang
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Jia-Li Jiang
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Juan Lin
- Department of Digestive Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Fang-Fen Dong
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Jia-Xiang Xu
- School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Zhi-Li Fang
- School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Jun-Jie Bai
- School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Ben Luo
- School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China
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Intra-versus extracorporeal anastomosis in laparoscopic right colectomy: a meta-analysis of 3699 patients. Int J Colorectal Dis 2020; 35:1673-1680. [PMID: 32691134 DOI: 10.1007/s00384-020-03675-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Laparoscopic right colectomy (LRC) has become a gold standard. However, a major current concern is still whether anastomosis should be performed extracorporeally or entirely laparoscopically. This meta-analysis assesses and compares peri- and postoperative outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in LRC. METHODS The research used the PubMed, Embase and Cochrane databases for studies comparing IA with EA during LRC. Our main endpoint was parietal abscess. Secondary endpoints were 30-day morbidity, mortality, time to onset of gas and stools, length of stay, number of lymph nodes removed and postoperative incisional hernia rates. The MINORS criteria were used to evaluate the quality of the studies examined. RESULTS Twenty-four articles comprising 3699 patients, published between 2004 and 2020, were included in this meta-analysis. After sensitivity analysis, IA was associated with a decrease in parietal abscesses (OR 0.526, IC 0.333-0.832, p = 0.006). CONCLUSION This meta-analysis finds that IA allows a decrease in parietal abscesses and time to first gas and stools, surgical repair and length of stay, with similar overall complications.
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Anania G, Tamburini N, Sanzi M, Schimera A, Bombardini C, Resta G, Marino S, Valpiani G, Valentini A, Cavallesco G. Extracorporeal versus intracorporeal anastomosis in laparoscopic right hemicolectomy for cancer. MINIM INVASIV THER 2020; 31:112-118. [PMID: 32393093 DOI: 10.1080/13645706.2020.1757464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: This study aimed at assessing the long-term oncological outcomes of intracorporeal ileocolic anastomosis (ICA) for laparoscopic right hemicolectomy for colon cancer compared with extracorporeal anastomosis (ECA).Material and methods: We performed a retrospective analysis of 149 consecutive patients who underwent laparoscopic right hemicolectomy for colon cancer between January 2006 and December 2012.Results: Eighty and 69 patients underwent intracorporeal and ECA, respectively. The two groups were demographically comparable. ICA exhibited a significantly shorter operative time (p < .0001), while local relapse and length of hospital stay did not significantly differ among the groups (p = .724 and .310, respectively). There was no significant difference in median number of retrieved lymph node. The overall survival and the disease-free survival at five years did not significantly differ among the groups.Conclusions: Intracorporeal ICA can reduce operative time and is associated with similar postoperative and long-term oncological outcomes compared to the ECA technique.
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Affiliation(s)
- Gabriele Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Marcello Sanzi
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Antonio Schimera
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Cristina Bombardini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Serafino Marino
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | | | - Giorgio Cavallesco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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Bollo J, Turrado V, Rabal A, Carrillo E, Gich I, Martinez MC, Hernandez P, Targarona E. Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg 2019; 107:364-372. [PMID: 31846067 DOI: 10.1002/bjs.11389] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/21/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several non-randomized and retrospective studies have suggested that intracorporeal anastomosis (IA) has advantages over extracorporeal anastomosis (EA) in laparoscopic right colectomy, but scientific evidence is lacking. The aim was to compare short-term outcomes and to define the possible benefits of IA compared with EA in elective laparoscopic right colectomy. METHODS An RCT was conducted from May 2015 to June 2018. The primary endpoint was duration of hospital stay. Secondary endpoints were intraoperative technical events and postoperative clinical outcomes. RESULTS A total of 140 patients were randomized. Duration of surgery was longer for procedures with an IA than in those with an EA (median 149 (range 95-215) versus 123 (60-240) min; P < 0·001). Wound length was shorter in the IA group (median 6·7 (4-9·5) versus 8·7 (5-13) cm; P < 0·001). Digestive function recovered earlier in patients with an IA (median 2·3 versus 3·3 days; P = 0·003) and the incidence of paralytic ileus was lower (13 versus 30 per cent; P = 0·022). Less postoperative analgesia was needed in the IA group (mean(s.d.) weighted analgesia requirement 39(24) versus 53(26); P = 0·001) and the pain score was also lower (P = 0·035). The postoperative decrease in haemoglobin level was smaller (mean(s.d.) 8·8(1·7) versus 17·1(1·7) mg/dl; P = 0·001) and there was less lower gastrointestinal bleeding (3 versus 14 per cent; P = 0·031) in the IA group. IA was associated with a significantly better rate of grade I and II complications (P = 0·016 and P = 0·037 respectively). The duration of hospital stay was slightly shorter in the IA group (median 5·7 (range 2-19) versus 6·6 (2-23) days; P = 0·194). CONCLUSION Duration of hospital stay was similar, but IA was associated with less pain and fewer complications. Registration number: NCT02667860 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- J Bollo
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Turrado
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Rabal
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Carrillo
- Department of Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - I Gich
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M C Martinez
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Hernandez
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Targarona
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, Petz WL, Bergamini C, Arezzo A, Valpiani G, Morotti C, Silecchia G. Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis. Surg Endosc 2019; 34:4788-4800. [PMID: 31741153 PMCID: PMC7572335 DOI: 10.1007/s00464-019-07255-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration Clinical trial (Identifier: NCT03934151).
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Affiliation(s)
- Gabriele Anania
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy. .,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Ferdinando Agresta
- Department of General Surgery, ULSS5 Polesana del Veneto, Adria, RO, Italy
| | - Elena Artioli
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Serena Rubino
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, BS, Italy
| | - Wanda Luisa Petz
- Division of Gastrointestinal Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Bergamini
- Department of Emergency Surgery, University Hospital of Careggi, Florence, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giorgia Valpiani
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Morotti
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Science and Biotechnologies, Faculty Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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