• Colon cancer
• Colorectal cancer
• Da Vinci
• MIS
• RHC
• Robotic surgery

• Colectomy/methods
• Humans
• Robotic Surgical Procedures/methods
• Laparoscopy/methods
• Length of Stay
• Operative Time
• Anastomosis, Surgical/methods
• Treatment Outcome
• Conversion to Open Surgery/statistics & numerical data

• University of Geneva

• Right colectomy
• handsewn anastomosis
• intracorporeal anastomosis
• mechanical anastomosis
• robotic approach

Right colectomy (RC) is a frequently performed procedure. Beneath standard conventional open surgery (COS), various minimally invasive techniques had been introduced. Several advantages had recently been described for robotic approaches over COS or conventional laparoscopy. Nevertheless, novel minimally invasive techniques require continuous benchmarking against standard COS to gain maximum patient safety. Bowel dysfunction is a frequent problem after RC. Together with general complication rates postoperative bowel recovery are used as surrogate parameters for postoperative patient outcome in this study.

Retrospective, 10-year single-center analysis of consecutive patients who underwent sequentially either COS (n = 22), robotic-assisted (ECA: n = 39), or total robotic surgery (ICA: n = 56) for oncologic RC was performed.

The conversion from robotic to open surgery rate was low (overall: 3.2%). Slightly longer duration of surgery had been observed during the early phase after introduction of the robotic program to RC (ECA versus COS, p = 0.044), but not anymore thereafter (versus ICA). No differences were observed in oncologic parameters including rates of tumor-negative margins, lymph node-positive patients, and lymph node yield during mesocolic excision. Both robotic approaches are beneficial regarding postoperative complication rates, especially wound infections, and shorter length of in-hospital stay compared with COS. The duration until first postoperative stool is the shortest after ICA (COS: 4 [2–8] days, ECA: 3 [1–6] days, ICA: 3 [1–5] days, p = 0.0004). Regression analyses reveal neither a longer duration of surgery nor the extent of mesocolic excision, but the degree of minimally invasiveness and postoperative systemic inflammation contribute to postoperative bowel dysfunction, which prolongs postoperative in-hospital stay significantly.

The current study reflects the institutional learning curve of oncologic RC during implementation of robotic surgery from robotic-assisted to total robotic approach without compromises in oncologic results and patient safety. However, the total robotic approach is beneficial regarding postoperative bowel recovery and general patient outcome.

• Bowel dysfunction
• Complete mesocolic excision
• Ileus
• Intracorporal anastomosis
• Right colectomy
• Robot

• Extracorporeal anastomosis
• Intracorporeal anastomosis
• Meta-analysis
• Right colectomy
• Robotic

As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.

To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.

In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.

Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.

Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.

• Colorectal neoplasms
• Surgery
• Robot
• Complication
• Postoperative
• Classification
• Retrospective studies

• Intra-corporeal anastomosis
• Right colectomy
• Robotic surgery
• da Vinci

• Anastomosis, Surgical
• Colectomy
• Colic
• Humans
• Laparoscopy
• Robotic Surgical Procedures/adverse effects

• Università di Pisa

• extracorporeal anastomosis
• intracorporeal anastomosis
• postoperative complication

Surgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

• Colectomy
• Colon cancer
• Da Vinci
• Laparoscopy
• Robot

• Cost analysis
• Cost-effectiveness analysis
• Oncological outcomes
• Robotic right colectomy

• Adenocarcinoma/economics
• Adenocarcinoma/surgery
• Adenoma/economics
• Adenoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Colectomy/economics
• Colectomy/methods
• Colonic Neoplasms/economics
• Colonic Neoplasms/surgery
• Cost-Benefit Analysis
• Feasibility Studies
• Female
• Humans
• Laparoscopy/economics
• Laparoscopy/methods
• Male
• Middle Aged
• Operative Time
• Propensity Score
• Prospective Studies
• Robotic Surgical Procedures/economics
• Robotic Surgical Procedures/methods
• Time Factors
• Treatment Outcome