Bowel Anastomosis Research Articles

A COMPARATIVE STUDY OF STAPLERS VERSUS HAND SEWN ANASTOMOSIS IN INTESTINAL SURGERIES

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection & anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively

A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia.

The incidence of Richter's hernias has risen in part due to the increment use of laparoscopic surgery. The standard technique to manage a strangulated Richter's hernia is bowel resection with anastomosis. Alternatively, invagination of the necrotic area in the enterocele maintains a clean surgical field and allows for the use of a mesh when closing the abdominal wall. In a sterile surgical field, the use of a prosthetic reinforcement has shown advantages, including low rates of long-term complications and reduced rates of hernia recurrence. A 35-year-old male presented with a strangulated Richter's hernia in a periumbilical abdominal wall defect. In the Operating Theatre, the necrotic segment was managed laparoscopically by plication with invagination allowing for abdominal wall reconstruction with a mesh. We propose the laparoscopic repair of Richter's hernia with plication and invagination whenever feasible, therefore avoiding a bowel resection and maintaining a clean surgical field; which allows for use of prosthetic mesh. • Richter hernias are becoming more common, mostly as a result of port-site closure defects after laparoscopic surgery • Avoiding bowel resection will increase the likelihood of a successful long-term mesh implant and decrease hernia recurrences. • Likewise, avoiding a bowel anastomosis will prevent additional contamination while simplifying the procedure.

Ileostomy closure

Introduction: Faecal diversion is an effective procedure to protect bowel anastomosis at high risk for leak. Loop ileostomy is more or less acceptable method for faecal diversion. Some concerns still exist regarding the risk for a significant morbidity and complications associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing mortality. Aim of the study is to present a single institutional experience with ileostomy closures, in a high-volume training hospital, where ileostomy reversal is mainly performed by young surgeons. Methods: A retrospective study was done to evaluate data of patients who underwent loop ileostomy and ileostomy closure between June 2017 to June 2021 at Dhiraj Hospital Sumandeep Vidyapeeth , Pipariya , vadodara. Ileostomy closure was always done in hand-sewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after both methods were compared by Fisher’s exact test and Wilcoxon rank-sum test. Results: Hundred and four patients were included. Ileostomy reversal was performed by EEA in 86 patients (82.69%) and by DC in 18 patients (17.30%). Surgery was performed with a peristomal access in 93 cases (89.42%).

Do Antiseptic Coated Sutures Reduce Colo-Colonic Anastomotic Leaks?

Colorectal anastomotic leaks remain one of the most significant complications following colorectal surgery. Various interventions to reduce anastomotic leaks have been investigated, however few have resulted in a significant improvement. To date antiseptic coated monofilament sutures for sutured bowel anastomoses have not been assessed, hence this study was undertaken to investigate whether or not triclosan impregnated polydioxanone suture material (PDS) results in fewer anastomotic leaks. A rabbit colo-colonic anastomotic model was developed to compare the tensile strength and local inflammatory response between triclosan coated PDS and uncoated PDS. Of the 42 anastomoses there were 4 (9.5%) leaks. Of the remaining 38 anastomoses neither the leak pressures, degree of bowel wall inflammation or fibrosis were statistically different (P = .11; .813 and .658 respectively) when comparing the two suture materials. In an animal model, triclosan coated PDS is as safe as uncoated PDS in performing colo-colonic anastomosis.

Delayed presentation of vaginal cuff dehiscence and evisceration loop of bowel nine month after laparoscopic hysterectomy: A case report

Introduction and importanceVaginal cuff dehiscence (VCD) is an extremely rare condition and requires emergency surgery due to the possibility of developing acute small bowel ischemia, peritonitis, and sepsis. Etiology is unclear but multifactorial.Case presentationA 57-year-old nullipara postmenopausal female patient with small bowel evisceration due to vaginal cuff dehiscence while having sexual intercourse six hours earlier on arrival to the hospital. She had a history of laparoscopic hysterectomy 9 months before. For that reason, we performed an emergency laparotomy which we reduced the intestine and we closed vaginal cuff.Clinical discussionDehiscence of the vaginal cuff and evisceration involve rupture of the proximal vaginal cuff, resulting in the expulsion of intraperitoneal contents. This is unusual case can be identified clinically, and the management is surgical which can be performed transvaginal and transabdominal approach to repair the vaginal cuff. However, before repairing the vaginal defect, the bowel should be checked if there is any doubt about the need for bowel resection and anastomosis.ConclusionTransvaginal evisceration is a very rare disease that can be life-threatening. It needs to be identified quickly and treated surgically to prevent small bowel ischemia.

Perianastomotic ulceration in children with short bowel syndrome

Perianastomotic ulceration (PAU) is an uncommon but potentially devastating condition, with a wide range of presenting symptoms. However, treatment approaches differ between centres as they are well known to be difficult to treat, and recurrences are common. This is a case series with literature review on PAU. We report 2 cases under the care of a tertiary pediatric surgical centre in Hong Kong with a background of neonatal necrotizing enterocolitis who underwent massive bowel resection, followed by small bowel to large bowel anastomosis. The presentation of PAU was delayed for a median of 38 months, with varying severity of presentation from per rectal bleeding without need for transfusion to massive gastrointestinal bleeding requiring pediatric intensive care unit admission and immediate laparotomy. Recurrent bleeding was still evident in one of the patients after multiple courses of anti-inflammatory agents. PAU is a rare condition as a result of multiple factors and a consensus on management is lacking. Patients with short bowel syndrome with small to large bowel anastomoses appear to be more prone to PAU development. Due to its delayed presentation, long-term follow up and regular surveillance for PAU for patients with short bowel syndrome is recommended.

Anastomotic leakage after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer

BackgroundAnastomotic leakage (AL) after colorectal surgery is well-researched, yet the effect of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) after Cytoreductive Surgery (CRS) is unclear. Assessment of risk factors in these patients may assist surgeons during perioperative decision making. MethodsThis was a single-center, retrospective study of patients who underwent CRS-HIPEC for colorectal peritoneal metastases. Main outcome measures were anastomotic leakage and associated morbidity. ResultsAL was observed in 17 of the 234 (7.3%) anastomoses in 17 of the total of 165 (10.3%) of patients. No association was observed between the number and location of anastomoses and AL, although only one in 87 small bowel anastomoses showed leakage. The only factor associated with AL was administration of bevacizumab within 60 days prior to surgery with an odds ratio (OR) of 6.13 (1.32–28.39), P = 0.03. Deviating stomata were not statistically protective of increased morbidity, although more AL occurred in the patients with colocolic and colorectal anastomoses when no concomitant deviating stoma was created. Deviation stomata were reversed in 52.6%, and no AL was observed after stoma reversal. ConclusionThe overall AL rate of CRS-HIPEC is comparable to colorectal surgery, and there is no cumulative risk of multiple anastomoses – especially in the case of small bowel anastomoses. Deviating stomata should be considered in patients with colocolic or colorectal anastomosis, although there is a significant chance that the stoma will not be reversed in these patients. Due to increased AL-risk surgeons should be aware of previous bevacizumab treatment, and plan the CRS-HIPEC at least 60 days after the treatment-day.

V09-07 ROBOTIC PROSTATE-SPARING CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022V09-07 ROBOTIC PROSTATE-SPARING CYSTECTOMY Sharon White, Xavier Glover, and Janet Kukreja Sharon WhiteSharon White More articles by this author , Xavier GloverXavier Glover More articles by this author , and Janet KukrejaJanet Kukreja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video, we detail the steps of a robotic prostate-sparing cystectomy. We spend a significant portion of the video showing the posterior dissection, which is unique to this procedure. During this dissection, a plane is developed between the bladder and the seminal vesicles until the bladder neck is reached. METHODS: This video is an edited version of a procedure performed on a patient with muscle-invasive urothelial cancer of the bladder. A TURP and prostate MRI confirmed that there was no invasion of the prostate. He had no other contraindications to continent diversion. The steps of the procedure are as follows: identification and dissection of bilateral ureters, posterior dissection, division of the ureters, anterior dissection, bladder neck dissection, simple prostatectomy, bilateral pelvic lymph node dissection, harvesting of the neobladder and bowel anastomosis, neobladder anastomosis, neobladder sculpting, ureteral anastomosis. This video specifically highlights the posterior dissection, bladder neck dissection, and neobladder anastomosis. The posterior dissection is unique to this procedure, because we create a plane between the bladder and the seminal vesicles and preserve the pelvic floor. There is also an opportunity during this procedure to spare the vas deferens and preserve fertility. RESULTS: We have performed this procedure on five patients at this institution. All five patients are continent. Two of these patients are hyper-continent, but improving with pelvic floor physical therapy. CONCLUSIONS: Robotic prostate-sparing cystectomy with neobladder is an option for well-selected patients who desire continent diversion or continued fertility. It provides a unique plane of dissection between the seminal vesicles and bladder. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e806 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sharon White More articles by this author Xavier Glover More articles by this author Janet Kukreja More articles by this author Expand All Advertisement PDF DownloadLoading ...

Presentation and Outcomes of Jejunoileal Atresia Treatment in Neonates

Background: Intestinal atresia is a very common cause of neonatal intestinal obstruction. Jejunoileum is the commonest site of intestinal atresia. The frequencies of Jejunoileal atresia are still few in developing countries. We have not enough research-based information regarding the presentation and outcomes of jejunoileal atresia treatment. Aim of the study: The aim of this study was to assess the presentation and outcomes of neonates with jejunoileal atresia. Methods: This prospective observational study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital, and Institute, Dhaka, Bangladesh during period from July 2016 to June 2020-. In total 27 neonates with jejunoileal atresia were included as the study subjects for this study. Patients with suspected jejunoileal atresia (JA) but who died before surgery and duodenal or colonic atresia were excluded from the study. A predesigned questionnaire was used in data collection. All data were collected, processed, and analyzed by using MS Office and SPSS version 23.0 programs as per need. Results: In this study, the male-female ratio was 1:1.25. The highest number of participants were with Type I atresia which was 37%. In the majority of the participants (59%) as a primary surgical procedure, a single small bowel anastomosis was performed. As early complications ‘Clavien-Dindo ≥III’ and cholestasis were found among 26% and 37% of patients respectively which were considered the most frequent. On the other hand, as of late complications, short bowel syndrome was found in 22% of patients which was noticeable. Finally, in this intervention 4% cases of mortality were found whereas 96% were survived. Conclusion: Till now intestinal atresia (IA), as well as jejunoileal atresia, are associated with unacceptably high morbidity as well as mortality because of inadequate neonatal intensive care, late presentation, and lack of parenteral nutritional support, especially in the countries of the third world.

AVOID; a phase III, randomised controlled trial using indocyanine green for the prevention of anastomotic leakage in colorectal surgery

IntroductionAnastomotic leakage (AL) is one of the major complications after colorectal surgery. Compromised tissue perfusion at the anastomosis site increases the risk of AL. Several cohort studies have shown that...

Case report: successful treatment of a rare large jejunal gastrointestinal stromal tumour with surgery and using principle of short-term fasting

Small intestinal gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours of gastrointestinal tract comprise 0.04% of small intestinal neoplasms. We presented a case of 61 years female presenting in emergency with pain in epigastrium, multiple episodes of vomiting, raised total leucocyte counts. CECT abdomen showed a large non-enhancing jejunal lesion. The patient had emergency small bowel resection and anastomosis. Postoperative patient started on imatinib and kept on short-term fasting. This case report highlights the rare presentation of jejunal GISTs, successful surgical outcome and good enhancing effect of short-term fasting on chemotherapy.

Double-layered hand-sewn anastomosis: a valuable resource for the colorectal surgeon

Hand-sewn anastomosis is an essential and fundamental skill for surgeons dealing with any gastrointestinal anastomosis. Despite the advances in minimally invasive surgery and stapling devices, there are still complex surgical circumstances when the surgeon’s surgical know-how are necessary. Therefore, a safe hand-sewn technique for bowel anastomosis is required to establish a tension-free, well-perfused, and sealed anastomosis that allows gastrointestinal continuity with no unexpected complications. We describe a step-by-step procedure for hand-sewn double-layered anastomosis that reflects these principles and is practical for small and large bowel anastomosis.

A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program.

BackgroundWorldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents’ exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential.MethodsA low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training.ResultsStatistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations.ConclusionAn OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.

Remote ischemic postconditioning has a detrimental effect and remote ischemic preconditioning seems to have no effect on small intestinal anastomotic strength

Background The effect of remote pre- and postconditioning on anastomotic healing has been sparsely studied. The aim of our study was to investigate whether remote ischemic conditioning (RIC) applied before and after the creation of a small bowel anastomosis had an effect on anastomotic healing on postoperative day five evaluated by a tensile strength test and histological analysis. Materials and methods Twenty-two female piglets were randomized into two groups. The intervention group (n = 12) received RIC on the forelimbs consisting of 15 min of ischemia followed by 30 min of reperfusion before the first end-to-end ileal anastomosis was created. The RIC procedure was repeated and the second and more distal anastomosis was performed. The control group (n = 10) had two similar anastomoses with similar time intervals but without RIC. On postoperative day five, the anastomoses were subjected to macroscopic evaluation, tensile strength test and histological examination. Results Mean tensile strength when the first transmural rupture appeared (MATS-2) was significantly lower in the first anastomosis in the intervention group compared to the control group (11.4 N vs 14.7 N, p < .05). Similar result was found by the maximal strength (MATS-3) as defined by a drop in the load curve (12.3 N vs 15.9 N, p < .05). Histologically, a significantly higher necrosis score was found in the anastomosis in the intervention group (1.4 vs 0.8, p < .05). No other significant differences were found. Conclusions In conclusion, post-anastomotic remote ischemic conditioning had a detrimental effect and pre-anastomotic conditioning seems to have no effect on small intestinal anastomotic strength.

Evaluation of sutureless anastomosis after ileostomy takedown using the self-forming magnet anastomosis system in a porcine model.

Current standard of care for creation of small bowel anastomoses after a loop ileostomy reversal includes the use of stapler devices and sutures. Compression anastomosis devices have been used for decades, aimed toward improved outcomes with a "staple free" &amp; "suture free" anastomosis. The self-forming magnet (SFM) device is a type of compression anastomosis device used to safely and effectively create an end-to-end small bowel anastomosis without the localized inflammatory response seen with sutures or staples, as no foreign bodies are left behind. A Good Laboratory Practice preclinical study using a porcine model to evaluate creating an in vivo anastomosis via magnetic compression between two segments of small bowel (jejunum or ileum) was performed. Magnetic anastomoses were compared to stapled and handsewn anastomoses. Six animals were used for the magnetic anastomosis and eight for the two control groups for a total of 14 subjects. Mean creation times were 17.1min (SD 6.06) for the SFM group, 10.3min (SD 6.55, CI 95%) for the stapled anastomosis group, and 28.3min (SD 2.63, CI 95%) for the suture anastomosis group, with a statistically significant difference among groups (p &lt; 0.0021). All evaluated SFM anastomosis, stapled anastomosis, and handsewn anastomosis underwent a burst test with a pressure of 1.3 PSI. All six magnets used for anastomoses were naturally expelled. The range of days to expel magnets was 10-17days. Intestinal anastomoses using magnets had considerably less residual scarring and intestinal distortion than anastomoses done with either suture or staples. This preclinical study documents the safety and efficacy of creating end-to-end small bowel anastomoses after ileostomy takedown using a magnetic compression device. The result is an anastomosis free of foreign objects with less inflammation, scarring, distortion, and mural thickening than seen in sutured or stapled anastomoses.

Intraoperative uses of near-infrared fluorescence spectroscopy in pediatric surgery: A systematic review

BackgroundThe application of near infrared spectroscopy (NIRS) imaging in surgery is growing. This study aimed to systematically review the literature to summarize the intraoperative uses of NIRS in pediatric surgery. MethodsA PRISMA-compliant literature search was conducted in PubMed, Embase, Scopus, and Web of Science from inception to February 2020. Title/abstract and then full-text screening were performed. The Oxford centre for Evidence Based Medicine tool (OCEBM) was used to evaluate the level of evidence of included studies. ResultsReviewers identified 53 articles. Of which, 34 studies (64.2%) were case-series and 11 (20.8%) were case reports. Most of the studies (n = 45, 84.9%) were level 4 on the OCEBM tool. The most common uses of NIRS were to visualize the biliary tree and to identify primary and metastatic malignant tissues. Other applications include assessment of perfusion of tissues including bowel anastomoses, and lymphatic surgery. Several advantages of the introduction of NIRS in pediatric surgery exist including having the potential to reduce operative time and intra/post-operative complications. Moreover, NIRS helps in detecting malignant tissues that can be missed by conventional imaging. However, NIRS has important limitations such as difficulty in identification of the biliary tree in obese patients or inflamed gallbladder, detection of small deeply localized malignant tissues, as well as the high cost. ConclusionsNIRS is a promising modality that can be used intraoperatively to augment different pediatric surgical procedures. NIRS has important advantages and limitations compared to conventional surgery, however, more studies are required to evaluate its outcomes and cost-effectiveness.Level of evidence: IV

Standardizing HIPEC and perioperative care for patients with ovarian cancer in the Netherlands using a Delphi-based consensus

ObjectiveHyperthermic Intraperitoneal Chemotherapy (HIPEC) is standard of care in the Netherlands in patients with stage III epithelial ovarian cancer following interval cytoreductive surgery (CRS). Differences in patient selection, technical aspects, and perioperative management exist between centers performing HIPEC. Standardization aims to reduce unwanted variation in clinical practice. As part of an implementation process, we aimed to standardize perioperative care for patients treated with CRS and HIPEC using a Delphi-based consensus approach. MethodsWe performed a two-phase modified Delphi method involving a multidisciplinary panel of 40 experts who completed a survey on CRS and HIPEC. During a consensus meeting, survey outcomes and available scientific evidence was discussed. Items without consensus (<75% agreement) were adjusted and evaluated in a second survey. ResultsConsensus was reached in the first round on 51% of items. After two rounds, consensus was reached on the majority of items (82%) including patient selection, preoperative workup, technical aspects of CRS and HIPEC, and postoperative care. No consensus was reached on the role of HIPEC in rare ovarian cancer types, preoperative bowel preparation, timing to create bowel anastomoses, and manipulation of the perfusate. ConclusionsDutch experts reached consensus on most items regarding interval CRS and HIPEC for ovarian cancer. This consensus study may help to align treatment protocols and to minimize practice variation. Topics without consensus may be put on the research agenda of HIPEC for ovarian cancer.

The transferability of the minimal invasive surgeon’s skills to open surgery

Background Robot-assisted laparoscopic surgery has gained popularity, which has contributed to a decrease in the number of open procedures. Hence a growing concern regarding the ability of laparoscopically trained surgeons to perform open surgery (e.g. due to bleeding complications) has been raised. The aim of the study was to investigate the ability of conversion to open surgery following exclusively robotic or laparoscopic training. Methods Thirty-six medical students were randomized into three groups: Open surgery, laparoscopy, and robot-assisted laparoscopy. All underwent intensive simulation training in the allocated surgical modality. Subsequently, all study subjects performed an open bowel anastomosis in a pig model where anastomoses were tested for resistance to pressure and leak as a surrogate marker of surgical quality. Results The primary endpoint was the surgical quality of an open surgery model assessed as, leak pressure, which was 80.01 ± 36.16 mmHg in the laparoscopic training group, 106.57 ± 23.03 mmHg in the robotic training group, and 133.65 ± 18.32 mmHg in the open surgery training group (mean, SD). We found that there were no significant differences between the open surgery training group and the robotic training group whereas a significant difference was found when comparing laparoscopic and open surgery training groups in favor of open procedure training (p < 0.001). Conclusion In a surrogate open surgery model based on bowel anastomosis, we found that skills acquired through practice on robotic simulation platforms were not significantly worse when compared to skills acquired through training in open surgery, whereas skills acquired from laparoscopic training were significantly poorer when compared to open surgery practice.

Autonomous robotic surgery makes light work of anastomosis.

An autonomous robotic laparoscopic surgical technique is capable of tracking tissue motion and offers consistency in suturing for the anastomosis of the small bowel.

Robotic left-stapled total intracorporeal bowel anastomosis versus stapled partial extracorporeal anastomosis: operative technical description and outcomes

BackgroundAlthough there is extensive literature on robotic total intracorporeal anastomosis (TICA) for right colon resection, left total ICA using the da Vinci Xi robotic platform has only been described in short case series previously. In this study, we report on the largest cohort of robotic left total ICA, provide a description of our institution’s techniques, and compare outcomes to robotic left partial extracorporeal anastomosis (PECA).MethodsPatients who underwent robotic left colectomy for any underlying pathology from July 1, 2016 through April 30, 2020 were identified by procedure code. A technical description is provided for two unique techniques performed at our institution. Outcomes included operative time, length of stay, supply cost, post-operative ileus, post-operative morbidity and mortality and need for complete mobilization of the splenic flexure.ResultsFrom a review of our institution’s data, 83 robotic TICA cases were identified and 76 robotic PECA cases were identified. Common procedures included low anterior resection, sigmoidectomy, left hemicolectomy, and rectopexy with resection. TICA was associated with significantly shorter intraoperative time compared to PECA.ConclusionsOur series shows that TICA is a safe and feasible technique that does not increase the risk of adverse outcomes. Using either the anvil-forward or anvil-backward technique, we were able to reliably reproduce this method in a total of 83 patients undergoing left colon resection for either benign or malignant diseases.