Right Colectomy For Colon Cancer Research Articles

Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly

BackgroundDiversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited.Case presentationA 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis.ConclusionsLaparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance.

A commentary on "Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis".

A commentary on "Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis".

Simple technique of double-layer enterotomy closure using a bidirectional barbed suture material when performing intracorporeal side-to-side anastomosis in robot-assisted right colectomy for colon cancer.

Simple technique of double-layer enterotomy closure using a bidirectional barbed suture material when performing intracorporeal side-to-side anastomosis in robot-assisted right colectomy for colon cancer.

Incisional Hernia After Laparoscopic Right Colectomy for Colorectal Cancer: A Prospective Study with Retrospective Control on Intracorporeal Versus Extracorporeal Anastomosis.

Background: Incisional hernias often occur after laparoscopic colorectal surgery, but the precise risk factors are not fully understood. This study's primary aim was to compare the incidence of incisional hernias following laparoscopic right colectomy with intracorporeal anastomotic reconstruction (ICA) versus extracorporeal anastomotic reconstruction (ECA). Materials and Methods: A cohort study compared two groups of patients who underwent elective laparoscopic right colectomy for colon cancer following a standardized perioperative enhanced recovery program (ERP): a prospective group underwent ICA from January 2018 to February 2020 and a retrospective group underwent ECA from January 2013 to December 2016. The presence of incisional hernias was assessed by reviewing patients' follow-up computed tomography scans or evaluating the patients by telephone interview or outpatient office visit and diagnostic imaging. Secondary objectives included the hospital length of stay, postoperative complications, 30-day readmission rate, reoperation, and mortality. Results: The study included 89 patients who had laparoscopic right colectomy for malignant colon neoplasms. Among these, 48 underwent ECA (ECA group), and 41 had ICA (ICA group). At a median follow-up of 36 months, incisional hernia was observed in 1 patient (2.4%) in the ICA group, in contrast to 11 (22.9%) confirmed cases in the ECA group (P = .010). The length of hospital stay was similar between the two groups (5 days versus 4 days; P = .064). The two groups showed similarities in terms of postoperative complications (P = .093), hospital readmission (P = .999), and the rate of reoperation within 30 days (P = .461). Conclusions: The ICA technique was associated with a reduced risk of incisional hernias compared with the ECA technique, with similar outcomes in short-term postoperative complications and overall patient recovery.

Comparison of post-operative outcomes in laparoscopic and open right colectomy for colon cancer: A 4-year single centre experience

Background: Laparoscopic right colectomy (LRHC) is a procedure which has been getting more popular compared to traditional open right colectomy (ORHC) over the last three decades. This study compares the post-operative outcomes in laparoscopic and open right colectomy for colon cancer.
 Patients and Methods: This is a retrospective study of right colectomy at a single institution from January 2018 to December 2021. The factors that were studied included postoperative HDU admission, the incidence of post-operative ileus (POI) and the length of hospital stay.
 Results: During the study period, 161 patients underwent right hemicolectomy. Sixty-seven (42%) underwent LRHC, 73 (45%) ORHC, and 21 (13%) laparoscopic converted to open procedure. The overall incidence of POI was 56 (35%), 14 (21%) among the LRHC and 28 (38%) among the ORHC group (p=0.024). The length of hospital stay was 7.1 (±4.8) days after the laparoscopic procedure compared to 8.7 (±4.4) in the open group (p=0.048). Forty-two patients out of 161 (26%) needed post-operative HDU admissions; out of these 11 (16%) were in the laparoscopic group and 29 (40%) among the open group (p=0.023).
 Conclusion: Post-operative recovery was significantly quicker among the laparoscopic right hemicolectomy group incomparison to the open right hemicolectomy group.

The effect of mechanical bowel preparation on postoperative complications in laparoscopic right colectomy: a retrospective propensity score matching analysis.

To assess whether full bowel preparation affects 30-day surgical outcomes in laparoscopic right colectomy for colon cancer. A retrospective chart review of all elective laparoscopic right colectomies performed for colonic adenocarcinoma between Jan 2011 and Dec 2021. The cohort was divided into two groups-no bowel preparation (NP) group and patients who received full bowel preparation (FP), including oral and mechanical cathartic bowel preparation. All anastomoses were extracorporeal stapled side-to-side. The two groups were compared at baseline and then were matched using propensity score based on demographic and clinical parameters. The primary outcome was 30-day postoperative complication rate, mainly anastomotic leak (AL) and surgical site infection (SSI) rate. The original cohort included 238 patients with a median age of 68 (SD 13) and equal M:F ratio. Following propensity score matching, 93 matched patients were included in each group. Analysis of the matched cohort showed a significantly higher overall complication rate in the FP group (28 vs 11.8%, p = 0.005) which was mostly due to minor type II complications. There were no differences in major complication rates, SSI, ileus, or AL rate. Although operative time was significantly longer in the FP group (119 vs 100min, p ≤ 0.001), length of stay was significantly shorter in the FP group (5 vs 6days, p = 0.001). Aside from a shorter hospital stay, full mechanical bowel preparation for laparoscopic right colectomy does not seem to have any benefit and may be associated with a higher overall complication rate.

Health-care expenditures are less for minimally invasive than open colectomy for colon cancer: A US commercial claims database analysis

BackgroundMost studies comparing surgical platforms focus on short-term outcomes. In this study, we compare the expanding societal penetration of minimally invasive surgery (MIS) with open colectomy by assessing payer and patient expenditures up to one year for patients undergoing surgery for colon cancer.MethodsWe analyzed the IBM MarketScan Database for patients who underwent left or right colectomy for colon cancer between 2013 and 2020. Outcomes included perioperative complications and total health-care expenditures up to 1 year following colectomy. We compared results for patients who had open colectomy (OS) to those with MIS operations. Subgroup analyses were performed for adjuvant chemotherapy (AC+) versus no adjuvant chemotherapy (AC-) groups and for laparoscopic (LS) versus robotic (RS) approaches.ResultsOf 7,063 patients, 4,417 cases did not receive adjuvant chemotherapy (OS: 20.1%, LS: 67.1%, RS: 12.7%) and 2646 cases had adjuvant chemotherapy (OS: 28.4%, LS: 58.7%, RS: 12.9%) after discharge. MIS colectomy was associated with lower mean expenditure at index surgery and post-discharge periods for AC- patients (index surgery: $34,588 vs $36,975; 365-day post-discharge $20,051 vs $24,309) and for AC+ patients (index surgery: $37,884 vs $42,160; 365-day post-discharge $103,341vs $135,113; p < 0.001 for all comparisons). LS had similar index surgery expenditures but significantly higher expenditures at post-discharge 30 days (AC-: $2,834 vs $2276, p = 0.005; AC+: $9100 vs $7698, p = 0.020) than RS. The overall complication rate was significantly lower in the MIS group than the open group for AC- patients (20.5% vs 31.2%) and AC+ patients (22.6% vs 39.1%, both p < 0.001).ConclusionMIS colectomy is associated with better value at lower expenditure than open colectomy for colon cancer at the index operation and up to one year after surgery. RS expenditure is less than LS in the first 30 postoperative days regardless of chemotherapy status and may extend to 1 year for AC- patients.

Factors Associated with Early Discharge after Non-Emergent Right Colectomy for Colon Cancer: A NSQIP Analysis.

The National Surgical Quality Improvement Project (NSQIP) dataset was used to identify perioperative variables associated with the length of stay (LOS) and early discharge among cancer patients undergoing colectomy. Patients who underwent non-emergent right colectomy for colon cancer from 2012 to 2019 were identified from the NSQIP and colectomy-targeted databases. Postoperative LOS was analyzed based on postoperative day (POD) of discharge, with patients grouped into Early Discharge (POD 0-2), Standard Discharge (POD 3-5), or Late Discharge (POD ≥ 6) cohorts. Multivariable ordinal logistic regression was performed to identify risk factors associated with early discharge. The NSQIP query yielded 26,072 patients: 3684 (14%) in the Early Discharge, 13,414 (52%) in the Standard Discharge, and 8974 (34%) in the Late Discharge cohorts. The median LOS was 4.0 days (IQR: 3.0-7.0). Thirty-day readmission rates were 7% for Early Discharge, 8% for Standard Discharge, and 12% for Late Discharge. On multivariable regression analysis, risk factors significantly associated with a shorter LOS included independent functional status, minimally invasive approach, and absence of ostomy or additional bowel resection (all p < 0.001). Perioperative variables can be used to develop a model to identify patients eligible for early discharge after right colectomy for colon cancer. Efforts to decrease the overall median length of stay should focus on optimization of modifiable risk factors.

Right colon cancer: The influence of specific location on recurrence and survival

AimThis study aimed to investigate whether the site of the tumour within the right colon affects survival in patients who underwent right colectomy for colon cancer. MethodsAn observational retrospective longitudinal study was performed in patients who underwent right colectomy for non-metastatic, invasive right-sided colon cancer. Patients were categorized into two groups based on tumour location: (i) caecum and ascending colon; (ii) hepatic flexure and proximal transverse colon. Demographic and clinical features were characterized, and a survival analysis was performed. ResultsOf the 198 patients enroled in the study, 134 (67.8%) had caecal or ascending colon cancer and 64 (32.3%) had hepatic flexure or transverse colon cancer. Seventy (35.4%) were female and the mean age at the time of surgery was 71.6 (SD 11.4). The groups were comparable with respect to the number of lymph nodes sampled, the pTNM stage, the histological differentiation grade and the likelihood of patients receiving adjuvant chemotherapy. Recurrence rate was nearly twice as high in the hepatic flexure and proximal transverse colon group (12.5% vs 6.7%), but this difference was not statistically significant (p = 0.174). Kaplan-Meier analysis showed no differences in disease-free (p = 0.255) and overall survival (p = 0.258) between the groups. ConclusionIn our population, specific location of right-sided colon cancers does not appear to have an influence on survival. Further investigation is needed to determine if tumour subsite has an impact on the recurrence rate, and whether it should be considered in defining prognosis and treatment.

Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial

BackgroundRecent interest in laparoscopic right colectomy with D3 lymphadenectomy for right colon cancer, has raised renewed attention to the anatomic variations of the gastrocolic trunk of Henlé (GTH). Understanding the vascular structure of the GTH region for individual patients should improve surgical outcomes. The goal of this nationwide multicenter study (Anatomical Classification of Henlé's Trunk in Laparoscopic Right Hemi-colectomy (HeLaRC) trial) was to study the anatomic patterns of the GTH region, to clarify the implications of GTH in laparoscopic right colectomy with D3 lymphadenectomy (D3-RC) and analyze their clinical significance. MethodsWe enrolled 583 patients from 26 centers across China who underwent D3-RC. The number of tributaries, length and types of GTH constitutions and their influence on intra-operative data were investigated. A nomogram score (based on the length of GTH, body mass index (BMI), tumor location, T stage and type of GTH (type I vs. non-type I) was established to assess the potential hazard of bleeding. ResultsThe GTH was found in 567 patients (97.3%). The distribution of GTH types was 0 (14.1%, n = 80), I (53.3%, n = 302), II (27.0%, n = 153), III (5.6%, n = 32). Of note, the type I GTH, T1 stage and tumor location at ileocecal or ascending colon were correlated with shorter exposure time of the GTH region (P < 0.0001). Short length of GTH (P = 0.002) and tumor location (transverse colon vs. non transverse colon) (P = 0.003) were correlated with the amount of GTH bleeding during the surgery. Nomogram discrimination was good (C-index: 0.72 (95% CI: 0.64, 0.80)). The dissection plane was better in patients with type I GTH than with other types (P = 0.023). ConclusionGTH pattern variations may affect surgical outcomes in patients undergoing D3-RC. Better recognition of GTH anatomy might lead to a safer operation with better oncologic quality.

Robotic versus laparoscopic right colectomy for colon cancer: a systematic review and meta-analysis.

The aim of the study was to compare the short-term surgical outcomes of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC) for colon cancer, to evaluate the safety and feasibility of the robotic surgery system. A systematic literature review was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases regarding the comparison of RRC vs. LRC for colon cancer in the last 5 years. Studies were included as per the PICOS criteria, and relevant event data were extracted. Fifteen studies (RRC: 1116 patients; LRC: 4036 patients) were evaluated. RRC demonstrated lower conversion to laparotomy (p = 0.03) and shorter length of hospital stay (p = 0.01), compared with LRC. However, operation times were longer in RRC than in LRC (p < 0.001). The estimated blood loss, retrieved lymph nodes, and overall postoperative complications were similar between RRC and LRC (p > 0.05). RRC can be regarded as a feasible and safe technique for colon cancer.

Comparison of Postoperative and Oncologic Outcomes in Laparoscopic and Open Right Colectomy for Colon Cancer: A 5-year Experience.

Laparoscopic colectomy is a procedure which is being performed for three decades and is gaining popularity continuously over the traditional open colectomy. This study was conducted in order to compare postoperative and oncologic results based on several factors in laparoscopic and open right colectomy for right colon cancer. This is a retrospective study of right colectomy at a single institution from 2015 until 2020. The factors that were studied included postoperative values of C-reactive protein (CRP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), the number of excised lymph nodes, the use of postoperative analgesics and the length of hospital stay. We collected data from 21 open and 17 laparoscopic right colectomies through a 5-year period. Measurements on the second postoperative day revealed mean CRP and CPK values significantly lower in the laparoscopic group compared to the open group, while LDH levels did not affirm major differences between the two groups. The mean number of lymph nodes excised during the open procedure was superior to those harvested in the laparoscopic group. The use of analgesics throughout the entire hospital stay was a combination of pethidine and tramadol for the first three postoperative days in open procedures, while paracetamol and, occasionally, tramadol were administered upon patient request following laparoscopic procedures. The mean hospital stay was substantially shorter in the laparoscopic group compared to the open surgery group. Laparoscopic right colectomy is superior compared to open right colectomy with regards to postoperative analgesia and length of hospital stay, but also in certain postoperative laboratory values. Despite these there was no supremacy considering oncologic clearance.

A Study of the Right Colonic Vascular Anatomy: Correlations between Veins and Arteries.

Objectives: Few studies have examined the correlations between the arteries and veins of the right colon. In this study, we aimed to use high-resolution CT scans to understand the vascular anatomy of Henle's gastrocolic trunk and review the terminology describing the arteries and veins of the right colon. Methods: This retrospective study has examined patients who underwent laparoscopic colectomy for right colon cancer in a single institution in Japan. Scans from consecutive patients who underwent surgery between October 2017 and March 2020 (n = 165) were examined. Preoperative CT images were used to create multiplanar reformation images and volume rendering images. Results: Among the 139 patients with Henle's gastrocolic trunk (GCT) present, arteries accompanying the accessory right colic vein (ARCV) were most common on the right branch of the middle colic artery (MCA) (71.2%), followed by the right colic artery (RCA) (19.4%); meanwhile, 9.4% of the patients had no accompanying arteries. Of patients with no accompanying arteries to the ARCV, RCA was present in 15.4%. Among the 26 patients with no GCT, the right colic vein (RCV) existed in 15 patients, with the artery accompanying the RCV most commonly being the right branch of the MCA (66.6%), followed by the RCA (33.3%). Conclusions: Irrespective of the presence of GCT, approximately 70% of the arteries accompanying the drainage vein from the right colon were the right branch of the MCA. We suggest that vascular branch formation be considered preoperatively in surgical management for right colon cancer.

Robotic versus laparoscopic right colectomy for colon cancer: a nationwide cohort study.

On a national level, the minimally invasive approach is widely adopted in Denmark. The adoption of robotic colorectal surgery is increasing; however, the advantage of a robotic approach in right colectomy is still uncertain. The purpose of this study was to compare robotic right colectomy with laparoscopic right colectomy on a national level. This was a nationwide database study based on data from the Danish Colorectal Cancer Group database. Patients from all colorectal centers in Denmark in the period 2014-2018 treated with curative intend in an elective setting with either robotic or laparoscopic right colectomy were identified. Propensity score matching was performed to adjust for confounding, and the groups were compared on demographics, disease characteristics, operative data, and postoperative and pathology outcomes. Reporting was done in accordance with the STROBE statement. In total, 4002 patients were available for analysis. Propensity score matching in ratio 2:1 identified 718 laparoscopic and 359 robotic cases. After matching, we found a higher lymph node yield in the robotic group compared to the laparoscopic group, (32.5 vs. 28.4, P < 0.001), while radicality, plane of dissection, and pathological disease stages showed no differences. There were no statistical differences in morbidity and mortality. Intracorporeal anastomosis (23.7% vs. 4.5%, P < 0.001) was more commonly performed with a robotic approach. Robotic approach was associated with a significant higher lymph node yield and with similar postoperative morbidity compared to a laparoscopic approach for right colectomy.

Laparoscopic right colectomy for colon cancer after liver transplantation

The incidence of colorectal cancer (CRC) after liver transplantation is 0.5%–4%. Laparoscopic surgery is the standard-of-care treatment, however it is rarely performed in patients who had previously undergone liver transplantation. Few reports exist regarding minimally invasive surgery in such context and none about laparoscopic right colectomy. We present the case of a 64-year-old female with a history of liver transplantation in 2001 and who developed a right-sided CRC. A laparoscopic right colectomy was successfully performed, and the post-operative course was uneventful. Given the known benefits, we believe that laparoscopic approach should be considered in such patients.

Short-Term Outcomes of Complete Mesocolic Excision Versus D2 Dissection in Patients Undergoing Laparoscopic Colectomy for Right Colon Cancer (RELARC Trial): A Multicentre Randomised Controlled Phase III Trial

Background: Whether extended lymphadenectomy for right colon cancer leads to increased perioperative complications or improves survival is still controversial. This multicentre randomised controlled trial (RCT) aimed to compare the efficacy and safety of complete mesocolic excision (CME) versus D2 dissection in laparoscopic right hemicolectomy for patients with right colon cancer. Methods: This superiority phase III trial was undertaken at 17 hospitals in 9 provinces of China. Patients with adenocarcinoma located between the cecum and the right third of the transverse colon, without evidence of distant metastases, were randomly assigned (in a 1:1 ratio) to receive either CME or D2 dissection during laparoscopic right colectomy. Morbidity and mortality in the first 30 days after surgery were compared between the two groups using a modified intention-to-treat (mITT) analysis. Findings: A total of 1072 patients were enrolled between January 11, 2016, and December 26, 2019. Of these patients, 995 (495 CME patients, 500 D2 patients) were included in the mITT analysis. The 30-day postoperative morbidity rate was 19·6% in the CME group vs. 21·8% in the D2 group (difference, -2·2% [95%CI, -0·07, - 0·03]; P = 0·34); no deaths occurred in either group. The CME procedures harvested significantly more lymph nodes (26·0 vs 23·0, difference, 3·4 [95%CI, 2·0, 4·9]; P<0·001), and larger mesentery areas (116·4 cm2 vs 107·8 cm2; difference, 8·4 [95%CI, 3·3, 13·5]; P = 0·001), but took longer time (163·0 minutes vs 150·5 minutes, difference 11·6 [95%CI, 5·7, 17·5]; P = 0·0002), and slight more blood loss (50 mL vs 50 mL, difference 5·4 [95%CI, -2·6, 13·4]; P = 0·049) than D2 dissections. Interpretation: When performed by experienced surgeons, CME during laparoscopic right hemicolectomy does not increase risk for intra/postoperative complications. Trial Registration: This study was registered with ClinicalTrials.gov (No.NCT02619942.) Funding Statement: This trial was sponsored by the Capital Characteristic Clinical Project of Beijing Municipal Science & Technology Commission (Z161100000516014) and the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences (2019XK320003). Declaration of Interests: We declare that we have no conflicts of interest. Ethics Approval Statement: The study protocol and all amendments were approved by the Ethics Committee of Peking Union Medical College Hospital. Approval of the local ethics committee at each centre was also obtained before starting the study. All patients provided written informed consent.

Robotic Right Colectomy for Colon Cancer; Two Case Reports

Robotic Right Colectomy for Colon Cancer; Two Case Reports

Feasibility and Safety of Laparoscopic Right Colectomy in Oldest-Old Patients with Colon Cancer: Results of the CLIMHET Study Group.

Laparoscopy for colorectal cancer treatment is widely accepted. However, there is no consensus as to whether or not laparoscopy can be considered the preferred treatment strategy in octogenarian and nonagenarian patients with colon cancer. The aim of this study was to compare operative and postoperative outcomes of laparoscopic right colectomy between oldest-old (≥80 years) and younger (<80 years) patients with colon cancer. The study population was sampled from the CLIMHET Study Group cohort. Between January 2005 and December 2015, data were retrieved for all patients who had undergone elective laparoscopic right colectomy for colon cancer in five University Hospital centers in France (CHU of Clermont-Ferrand, Hôpital Civil of Strasbourg-IRCAD, Hôpital Henri-Mondor of Créteil, Hôpital Européen Georges Pompidou of Paris, and CHRU of Tours). Overall, 473 cancer patients were selected and analyzed. There were 156 oldest-old patients (median age: 84.1 years, range: 80-96) and 317 younger patients (median age: 67 years, range: 25-79). After adjusting based on propensity score on gender, obesity, American Society of Anesthesiologists score, smoking, arteriopathy, coronaropathy, comorbidity, and American Joint Committee on Cancer staging, no significant difference was found in operative and postoperative outcomes, except for time to resume a regular diet (3.6 days versus 3.0 days, P = .008) and length of hospital stay (12.1 days versus 9.1 days, P = .03), which were longer for oldest-old patients. Overall and disease-free survival rates were also equivalent between groups. These findings support that laparoscopic right colectomy can be safely performed in cancer patients aged 80 and older, and its outcomes are similar in oldest-old and younger patients.

Mesenteric Vein Thrombosis after Laparoscopic Right Colectomy - A Case Report and Literature Review

Introduction: Mesenteric vein thrombosis (MVT) is a rare but serious condition. Prompt diagnosis and early treatment are essential to avoid high mortality from this condition. Very few cases of this complication after laparoscopic colon resection have been reported in the literature. Presentation of case: We report superior mesenteric vein thrombosis in a 69-year old male after uneventful laparoscopic right colectomy for colon cancer. Incidental diagnosis of MVT was made on staging CT scan of abdomen one month after surgery. He was promptly treated with anticoagulation which avoided adverse outcomes. The patient was asymptomatic throughout the course of the disease. Discussion: There is significant lack of its awareness about this disease in medical fraternity due to very low incidence. Additionally, signs and symptoms are often confusing especially in patients who have had recent surgery. Pain abdomen, nausea, and diarrhea are most common symptoms. High degree of clinical suspicion by treating physician is the key to early diagnosis. Undiagnosed patients have high mortality due to consequent mesenteric ischemia and sepsis. CT angiography is the most important diagnostic test and prompt systemic anticoagulation is the treatment of choice. Conclusion: Awareness of this condition and a high index of suspicion are two most important attributes in fighting with this deadly and rare complication after laparoscopic colon resection.

A novel robotic right colectomy for colon cancer via the suprapubic approach using the da Vinci Xi system: initial clinical experience.

PurposeWe developed a technique of totally-robotic right colectomy with D3 lymphadenectomy and intracorporeal anastomosis via a suprapubic transverse linear port. This article aimed to introduce our novel robotic surgical technique and assess the short-term outcomes in a series of five patients.MethodsAll colectomies were performed using the da Vinci Xi system. Four robot trocars were placed transversely in the supra pubic area. Totally-robotic right colectomy was performed, including colonic mobilization, D3 lymphadenectomy, and intra corporeal stapled functional anastomosis. The 2 middle suprapubic trocar incisions were then extended to retrieve the specimen.ResultsFive robotic right colectomies via the suprapubic approach were performed between August 2015 and February 2016. The mean operation time was 183 ± 29.37 minutes, and the mean estimated blood loss was 27 ± 9.75 mL. The time to clear liquid intake was 3 days in all patients, and the mean length of stay after surgery was 6.2 ± 0.55 days. No patient required conversion to conventional laparoscopic surgery. There were no perioperative complications. According to the pathology report, the mean number of harvested lymph nodes was 36.6 ± 4.45. Four patients were stage III, and 1 patient was stage II according to the 7th edition of the American Joint Committee on Cancer system.ConclusionTotally-robotic right colectomy via the suprapubic approach can be performed successfully in selected patients. Further comparative studies are required to verify the clinical advantages of our technique over conventional robotic surgery.