Skip to main content

Advertisement

SpringerLink
Log in

Robotic ileocolic resection with intracorporeal anastomosis for Crohn’s disease

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

The robotic platform can overcome limitations of the laparoscopic approach, particularly in the facilitation of intracorporeal anastomosis creation. We aim to share our institutional experience with robotic ileocolic resection for Crohn’s disease (CD) and compare it to a laparoscopic cohort. We identified patients who underwent ileocolic resection for CD with a purely robotic (R) or laparoscopic (L) approach between February 2015 and 2018. Chart review was performed and preoperative, intraoperative, and postoperative data was collected. A total of 47 patients with a mean age of 35.2 years old were identified and 61% were female. Seventy percent [n = 33, (23 females, 69.6%)] of the cases were performed robotically and 30% of the cases [n = 14, (6 females, 42.8%)] were performed laparoscopically. The groups were well matched for age, gender, BMI as well as disease related factors (CD duration; clinical classification and location), perioperative immunosuppression, and surgical history. Time to bowel function was shorter by about 1 day in the robotic group (R: 1.9 ± 0.88 days vs. L: 2.7 ± 0.8 days, p = 0.003). Mean operative time was longer in the robotic group by 51 min and this difference was significant (p = 0.03), however 30.3% of patients underwent ureteral stent placement, which can account for added time in robotic cases. There were less conversions in the robotic group [R: 1(4.3%) vs. L: 1(7%)], but this was not significant. There were no intraoperative complications in either group. Complication (L: 21.4% vs. R: 15.1%, p = 0.605) and reoperation rates (L: 0% vs. R: 3.03%, p = 0.429) were similar. Robotic ileocolic resection for Crohn’s disease is as safe and feasible as the laparoscopic approach. This was accomplished with no leaks, major morbidity or mortality and comparable length of stay, with 1 day shorter return of bowel function, and with a lower overall complication rate. The robotic approach offers advantages in Crohn’s disease which should be studied further in prospective studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F et al (2005) Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 19:117–119

    Article  CAS  PubMed  Google Scholar 

  2. Ferrara F, Piagnerelli R, Scheiterle M, Di Mare G, Gnoni P, Marrelli D et al (2016) Laparoscopy versus robotic surgery for colorectal cancer: a single-center initial experience. Surg Innov 23:374–380

    Article  PubMed  Google Scholar 

  3. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202

    Article  PubMed  Google Scholar 

  4. Miller PE, Dao H, Paluvoi N, Bailey M, Margolin D, Shah N et al (2016) Comparison of 30-day postoperative outcomes after laparoscopic vs. robotic colectomy. J Am Coll Surg 223:369–373

    Article  PubMed  Google Scholar 

  5. Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IH, Gooszen HG, Janssen LW et al (2005) Robot-assisted endoscopic surgery: a four-year single-center experience. Dig Surg 22:313–320

    Article  PubMed  Google Scholar 

  6. Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51:1627–1632

    Article  PubMed  Google Scholar 

  7. Hashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R et al (2002) Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc 16:1187–1191

    Article  CAS  PubMed  Google Scholar 

  8. Morpurgo E, Contardo T, Molaro R, Zerbinati A, Orsini C, D'Annibale A (2013) Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv Surg Tech A 23:414–417

    Article  PubMed  Google Scholar 

  9. Cleary RK, Mullard AJ, Ferraro J, Regenbogen SE (2018) The cost of conversion in robotic and laparoscopic colorectal surgery. Surg Endosc 32:1515–1524

    Article  PubMed  Google Scholar 

  10. Tarta C, Bishawi M, Bergamaschi R (2013) Intracorporeal ileocolic anastomosis: a review. Tech Coloproctol 17:479–485

    Article  CAS  PubMed  Google Scholar 

  11. Lujan HJ, Plasencia G, Rivera BX, Molano A, Fagenson A, Jane LA et al (2018) Advantages of robotic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech 28:36–41

    Article  PubMed  Google Scholar 

  12. Orcutt ST, Balentine CJ, Marshall CL, Robinson CN, Anaya DA, Artinyan A et al (2012) Use of a Pfannenstiel incision in minimally invasive colorectal cancer surgery is associated with a lower risk of wound complications. Tech Coloproctol 16:127–132

    Article  CAS  PubMed  Google Scholar 

  13. Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D (2016) Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 30:3823–3829

    Article  PubMed  Google Scholar 

  14. Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891

    Article  PubMed  Google Scholar 

  15. Samia H, Lawrence J, Nobel T, Stein S, Champagne BJ, Delaney CP (2013) Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline? Am J Surg 205:264–267 (Discussion 8)

    Article  PubMed  Google Scholar 

  16. Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F et al (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29:1512–1521

    Article  PubMed  Google Scholar 

  17. Bandzar S, Gupta S, Platt MO (2013) Crohn’s disease: a review of treatment options and current research. Cell Immunol 286:45–52

    Article  CAS  PubMed  Google Scholar 

  18. Yamamoto T, Watanabe T (2014) Surgery for luminal Crohn’s disease. World J Gastroenterol 20:78–90

    Article  PubMed  PubMed Central  Google Scholar 

  19. Heimann TM, Swaminathan S, Greenstein AJ, Greenstein AJ, Khaitov S, Steinhagen RM et al (2017) Can laparoscopic surgery prevent incisional hernia in patients with Crohn’s disease: a comparison study of 750 patients undergoing open and laparoscopic bowel resection. Surg Endosc 31:5201–5208

    Article  PubMed  Google Scholar 

  20. Cirocchi R, Cesare Campanile F, Di Saverio S, Popivanov G, Carlini L, Pironi D et al (2017) Laparoscopic versus open colectomy for obstructing right colon cancer: a systematic review and meta-analysis. J Visc Surg 154:387–399

    Article  CAS  PubMed  Google Scholar 

  21. Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  CAS  PubMed  Google Scholar 

  22. Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P et al (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766 (Discussion 67)

    Article  PubMed  PubMed Central  Google Scholar 

  23. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  24. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  CAS  PubMed  Google Scholar 

  25. Gasche C, Scholmerich J, Brynskov J, D'Haens G, Hanauer SB, Irvine EJ et al (2000) A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 6:8–15

    Article  CAS  PubMed  Google Scholar 

  26. Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL (2017) Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 31:2387–2396

    Article  PubMed  Google Scholar 

  27. Reitz ACW, Lin E, Rosen SA (2018) A single surgeon’s experience transitioning to robotic-assisted right colectomy with intracorporeal anastomosis. Surg Endosc 32(8):3525–3532

    Article  PubMed  Google Scholar 

  28. Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T et al (2014) Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg 208:33–40

    Article  PubMed  Google Scholar 

  29. deSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006

    Article  PubMed  Google Scholar 

  30. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708

    Article  CAS  PubMed  Google Scholar 

  31. Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99:1219–1226

    Article  CAS  PubMed  Google Scholar 

  32. Kang J, Park YA, Baik SH, Sohn SK, Lee KY (2016) A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 26:497–502

    Article  PubMed  Google Scholar 

  33. Benlice C, Aytac E, Costedio M, Kessler H, Abbas MA, Remzi FH et al (2017) Robotic, laparoscopic, and open colectomy: a case-matched comparison from the ACS-NSQIP. Int J Med Robot 13(3):e1783

    Article  Google Scholar 

  34. Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Pigazzi A, Stamos MJ, Mills S (2016) Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surg Endosc 30:2792–2798

    Article  PubMed  Google Scholar 

  35. Parisi A, Scrucca L, Desiderio J, Gemini A, Guarino S, Ricci F et al (2017) Robotic right hemicolectomy: analysis of 108 consecutive procedures and multidimensional assessment of the learning curve. Surg Oncol 26:28–36

    Article  PubMed  Google Scholar 

  36. Liao G, Zhao Z, Lin S, Li R, Yuan Y, Du S et al (2014) Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol 12:122

    Article  PubMed  PubMed Central  Google Scholar 

  37. Solaini L, Bazzocchi F, Cavaliere D, Avanzolini A, Cucchetti A, Ercolani G (2018) Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 32:1104–1110

    Article  PubMed  Google Scholar 

  38. Rondelli F, Trastulli S, Avenia N, Schillaci G, Cirocchi R, Gulla N et al (2012) Is laparoscopic right colectomy more effective than open resection? A meta-analysis of randomized and nonrandomized studies. Colorectal Dis 14:e447–e469

    Article  CAS  PubMed  Google Scholar 

  39. Vignali A, Elmore U, Lemma M, Guarnieri G, Radaelli G, Rosati R (2017) Intracorporeal versus extracorporeal anastomoses following laparoscopic right colectomy in obese patients: a case-matched study. Dig Surg 35(3):236–242

    Article  PubMed  Google Scholar 

  40. Magistro C, Lernia SD, Ferrari G, Zullino A, Mazzola M, De Martini P et al (2013) Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc 27:2613–2618

    Article  PubMed  Google Scholar 

  41. Lee KH, Ho J, Akmal Y, Nelson R, Pigazzi A (2013) Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc 27:1986–1990

    Article  PubMed  Google Scholar 

  42. Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12:1084–1093

    Article  CAS  PubMed  Google Scholar 

  43. D'Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C et al (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168

    Article  PubMed  Google Scholar 

  44. DeNoto G, Rubach E, Ravikumar TS (2006) A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech Part A 16:551–556

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Colon and Rectal Surgery, New York University Langone Health, 530 First Ave Suite 7V, New York, NY, 10016, USA

    H. Hande Aydinli, Marissa Anderson, Amanda Hambrecht, Mitchell A. Bernstein & Alexis L. Grucela

Authors
  1. H. Hande Aydinli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marissa Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda Hambrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitchell A. Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexis L. Grucela
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexis L. Grucela.

Ethics declarations

Conflict of interest

Drs. H. Hande Aydinli, Marissa L. Anderson, Amanda Hambrecht, Mitchell A. Bernstein, and Alexis L. Grucela have no conflict of interest or financial ties to disclose. The authors have no conflict of interest including relevant financial interests, activities, relationships, and affiliations.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The safety and feasibility of robotic ileocolic resection for Crohn’s disease has not been clearly established in the literature. Our study shares our experience with robotic ileocolic resection and while comparing outcomes with laparoscopic ileocolic resection.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aydinli, H.H., Anderson, M., Hambrecht, A. et al. Robotic ileocolic resection with intracorporeal anastomosis for Crohn’s disease. J Robotic Surg 15, 465–472 (2021). https://doi.org/10.1007/s11701-020-01125-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-020-01125-z

Keywords

Search

Navigation