R. O. Minjares-Granillo1, B. Dimas1, J. P. LeFave1,2, E. M. Haas1,2 1University of Texas Medical School at Houston,Department Of Surgery, Division Of Minimally Invasive Colon And Rectal Surgery,Houston, TEXAS, USA 2Houston Methodist Hospital,Division Of Colon And Rectal Surgery,Houston, TEXAS, USA
Introduction: Numerous studies have confirmed significant benefits of intracorporeal anastomosis (ICA) following colorectal procedures however technical challenges have limited this approach following conventional laparoscopic surgery.
The robotic Xi platform serves as an enabling technology and has resulted in a surge of reports for right-sided intracorporeal anastomosis, however, there are no reports involving more complex left-sided procedures such as for diverticulitis. Furthermore, there are no reports of natural orifice assisted techniques using robotic Xi in which the specimen can be removed and the anvil can be placed thereby completely eliminating the need for an abdominal wall incision other than the port sites.
We present a pilot study to investigate the safety, feasibility and short term outcomes of robotic Natural orifice-assisted IntraCorporeal anastomosis with transrectal Extraction of specimen, called the robotic NICE procedure.
Methods: Consecutive patients presenting for elective resection for diverticulitis with formation of a colorectal anastomosis were entered into an IRB database. All patients underwent the robotic NICE procedure. Demographic data, intraoperative data and outcomes data were assessed and analyzed.
Results: Ten patients (5 male and 5 female) underwent resection. The mean age, ASA and BMI was 56 (range 43-66), II (I-III) and 29 (21-35). All procedures were successfully completed including transrectal extraction of the specimen and formation of an ICA. The mean operative time was 198 min (146–338) and mean EBL was 35 ml (15 –50). Mean time to first flatus was 16 hours (10-22) and mean length of stay was 1.9 days (1.6 – 2.6). There were no intraoperative or post-operative complications. There were no unexpected ICU stay, reoperation or readmission.
Conclusion: Colorectal left-sided resections such as for diverticulitis can be safely accomplished using natural-orifice assisted extraction of the specimen as well as complete intracorporeal anastomosis in this pilot study. The NICE procedure resulted in early return of bowel function, short length of stay and low complications. The complete elimination of abdominal wall incision likely accounts for these findings and larger cohorts of patients are to be investigated to explore this promising approach afforded by robotic technology.
