Laparoscopic Hemicolectomy Research Articles

Effect of prophylactic abdominal drainage on postoperative pain in laparoscopic hemicolectomy for colon cancer: a single-center observational study in Korea.

This study aimed to evaluate the effect of prophylactic abdominal drainage (AD) in laparoscopic hemicolectomy, focusing on assessing postoperative pain outcomes. Patients were categorized into two groups: those with and without AD (AD group vs. no-AD group). A numerical rating scale (NRS) was used to assess postoperative pain on each postoperative day (POD). Further, the inverse probability of treatment weighting (IPTW) method was used to reduce intergroup bias. In total, 204 patients who underwent laparoscopic hemicolectomies by a single surgeon between June 2013 and September 2022 at a single institution were retrospectively reviewed. After adjusting for IPTW, NRS scores on POD 2 were significantly lower in the no-AD group (3.2 ± 0.8 vs. 3.4 ± 0.8, p = 0.043). Further examination of postoperative outcomes showed no statistically significant differences in complications between the AD (17.3%) and no-AD (12.4%) groups (p = 0.170). The postoperative length of hospital stay was 7.3 ± 2.8 days in the AD group and 6.9 ± 3.0 days in the no-AD group, with no significant difference (p = 0.298). Time to first flatus was 3.0 ± 0.9 days in the AD group and 2.7 ± 0.9 days in the no-AD group, with no significant difference (p = 0.078). Regarding readmission within 1 month, there were four cases each in the AD (2.3%) and no-AD (1.7%) groups, with no significant difference (p = 0.733). Laparoscopic hemicolectomy without AD resulted in no significant differences in postoperative clinical outcomes, except for postoperative pain. This finding suggests that prophylactic AD may exacerbate postoperative pain.

Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis

To compare the short-term outcomes and explore the potential economic benefits of laparoscopic-assisted colectomy with extracorporeal anastomosis (LAC/EA) vs. laparoscopic complete colectomy with intracorporeal anastomosis (LCC/IA) for patients with non-metastatic resectable colon cancer. Data of patients who underwent laparoscopic hemicolectomy from January 2017 to March 2023 were collected and analyzed. Propensity score matching (PSM) analyses was carried out to minimize the selection bias. Before PSM, a total of 113 patients met the inclusion criteria (39 in the LCC/IA vs. 74 in the LAC/EA). Clinicopathologic characteristics were comparable except for the median number of removed lymph nodes (P = 0.023). LCC/IA was associated with longer operative time, less intraoperative blood loss, and shorter incision length. The rate of 30-day postoperative complications was similar, but the time to first flatus and soft diet was shorter in the LCC/IA. No deaths were reported in either group within 30 days after surgery. Costs of surgical instruments (25,945.8 ± 1,918.0 vs. 23,551.9 ± 2,665.5 RMB; P < 0.01) were higher for the LCC/IA but overall costs were similar (LCC/IA, 43,220.0 ± 4,954.0 vs. LAC/EA, 41,269.2 ± 6,685.9 RMB; P = 0.112). After PSM, 38 patients in the LCC/IA and 63 patients in the LAC/EA were compared. LCC/IA was superior in terms of intraoperative blood loss, incision length, and postoperative functional recovery. There was an extra charge of 2385.0 RMB regarding surgical instruments in the LCC/IA but the overall cost did not reach statistical significance. LCC/IA is a feasible, safe, and cost-effective surgical treatment for patients with non-metastatic resectable colon cancer.

Appendiceal actinomycosis mimicking malignant tumor: a rare case report

Introduction: Actinomycosis is an uncommon bacterial infection caused by Actinomyces bacteria that typically progresses slowly and leads to the formation of masses. Although it commonly affects the cervicofacial area, about 20% of cases occur in the abdominopelvic region. Because the disease can be mistaken for a tumour due to its infiltrative mass-like nature on imaging, over 90% of cases are only diagnosed following surgery and histological confirmation. This report describes a case of an appendicular mass, initially suspected to be a malignant tumour, but eventually diagnosed as appendiceal actinomycosis. Presentation of case: Upon initial presentation, a 53-year-old woman with type II diabetes mellitus and no prior surgical history, displayed abnormal appendiceal uptake during a PET-computed tomography (CT) scan conducted for a suspected spinal tumour. Colonoscopy did not indicate any notable observations, and the patient chose to defer immediate action. Several months later, a CT scan revealed an increased mass-like appearance of the appendix compared to the previous PET-CT scan. After multidisciplinary discussions, a right laparoscopic hemicolectomy was recommended due to suspected malignancy. However, histological staining on microscopy confirmed actinomycosis originating from the appendix. Discussion: Chronic appendicitis with radiologic features similar to appendiceal carcinoma, or abdominal masses located in the ileocecal area, in patients with or without a previous surgical history should raise suspicion of actinomycosis. Conclusion: Appendiceal actinomycosis should be considered in the differential diagnosis in the aetiology of chronic appendicitis mimicking appendiceal carcinoma. Awareness and accurate diagnosis of appendiceal actinomycosis can prevent unnecessary extended surgery as was performed in this case.

Effect of anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial

BackgroundSurgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe...

The Role of Health Behaviors in Quality of Life: A Longitudinal Study of Patients with Colorectal Cancer.

Colorectal cancer (CRC) is the third most common malignancy and the second most common cancer-related cause of death worldwide. CRC incidence depends, in part, on the health behaviors that make up an individual's lifestyle. We aimed to assess the influence of health behaviors and quality of life (QoL) among patients with CRC receiving surgical treatment. In this single-center questionnaire study, 151 patients were surveyed 1 week before and 6 months after colorectal procedures (laparoscopic hemicolectomy, low rectal anterior resection, abdominoperineal resection, and others). This study demonstrated a significant decrease in alcohol consumption and physical activity following the execution of colorectal procedures. No statistically significant changes were observed in smoking or the consumption of healthy food. Global QoL did not change significantly; however, a decrease in physical and role-related functioning was observed. Significant improvements in emotional functioning were also observed. A detailed analysis showed that physical and social functioning were related to smoking, the consumption of healthy food, physical activity, and additional therapies. Emotional functioning was related to smoking, the consumption of healthy food, and complementary treatments. Six months following an operation, it was also dependent on alcohol intake. Physical functioning was the area that decreased the most in the six months after colorectal tumor surgery compared to the period before surgery. Health behaviors such as cessation of smoking, engagement in physical activity, and the consumption of healthy food contributed to a higher quality of life among patients prior to resecting colorectal cancer and six months after the procedure. Patients who received adjuvant/neoadjuvant therapy had a lower quality of life than patients who did not receive this type of therapy. The kind of surgery (laparoscopic hemicolectomy, lower anterior rectum resection, or abdominoperineal rectum resection) was not related to QoL six months after surgery.

Comparing the techniques and outcomes of laparoscopic transverse colectomy to laparoscopic hemicolectomy in mid-transverse colon cancer resection.

The mid-transverse colon cancer is relatively uncommon in all colon cancers and the optimal surgical approach of mid-transverse colon cancer remains debatable. Our study aimed to depict the techniques and outcomes of laparoscopic transverse colectomy in one single clinical center and compare this surgical approach to traditional laparoscopic right hemicolectomy and laparoscopic left hemicolectomy. This was a retrospective cohort study of patients with mid-transverse colon cancer in one single clinical center from February 2012 to October 2020. The enrolled patients were divided into two groups undergoing laparoscopic transverse colectomy and laparoscopic right/left hemicolectomy, respectively. The intraoperative, postoperative complications, oncological outcomes and functional outcomes were compared between the two groups. The primary endpoint was disease free survival (DFS). The study enrolled 70 patients with 40 patients undergoing laparoscopic transverse colectomy and 30 patients undergoing laparoscopic hemicolectomy. The intraoperative accidental hemorrhage and multiple organ resection occurred similarly in the two groups. In transverse colectomy, caudal-to-cephalic approach was likely to harvest more lymph nodes although require more operation time than cephalic-to-caudal approach (23.1 ± 14.3 vs. 13.4 ± 5.4 lymph nodes, P = 0.004; 184.3 ± 37.1 min vs. 146.3 ± 44.4 min, P = 0.012). The laparoscopic transverse colectomy was marginally associated with lower incidence of overall postoperative complications and shorter postoperative hospital stay although without statistical significance (8(20.0%) vs. 12(40.0%), P = 0.067; 7(5-12) vs. 7(5-18), P = 0.060). The 3-year DFS showed no significant difference (3-year DFS 89.7% in transverse colectomy vs. 89.9% in hemicolectomy, P = 0.688) between the two groups. The alternating consistency of defecation occurred significantly less after laparoscopic transverse colectomy than laparoscopic hemicolectomy (15(51.7%) vs. 20(80.0%), P = 0.030). The laparoscopic transverse colectomy is technically feasible with satisfactory oncological and functional outcomes for mid-transverse colon cancer. Performing the caudal-to-cephalic approach might be more advantageous in lymphadenectomy.

Cistadenoma mucinoso del apéndice cecal en paciente con cuadro clínico de apendicitis aguda operado de apendicetomía por laparoscopia

Mucoceles of the appendix are rare, predominate in women and usually present as a palpable mass in the right lower quadrant. Most patients are asymptomatic. The mucocele is defined as a cystic dilatation of the appendicular lumen caused by mucin accumulation. We present the case of a male patient in his seventh decade with clinical symptoms of acute abdomen with suspicion of acute appendicitis, laparoscopic hemicolectomy surgery was performed after finding findings of tumor dependent on ascending colon (blind region), indurated 80 × 100 mm approximately, performing right hemicolectomy plus ileocolonic lateroterminal anastomosis with adequate postoperative evolution. Keywords: Mucocele; appendix; appendicitis.

Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Background and aimsAn opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been...

Patient-Experienced Quality During Postoperative Pain Management - A Phenomenological-Hermeneutic Study

PurposeThe aim of this study was to describe an in-depth understanding of patients’ experiences and perspectives after use of the erector spinae plane block (ESP) in patients undergoing laparoscopic hemicolectomy due to malignant disease. Knowledge gained throughout the study aimed to ensure increased patient-experienced quality, patient safety and adequate post-surgery pain treatment. DesignA qualitative approach based on a phenomenological-hermeneutic framework inspired by Paul Ricoeur's perspectives was used. MethodsThe empirical material consisted of 11 semi-structured individual interviews with patients, who underwent laparoscopic hemicolectomy and received an ESP block as postoperative pain treatment. FindingsFour themes emerged during the analysis and represent the findings: (1)"The significance of the pain for everyday life", in which everyday life and social relations emerged as fundamental for patients' experience of pain and pain management; (2) "Joy and anxiety - two opposites" showed experiences of conflicting feelings causing uncertainty and insecurity (3); The theme "Painlessness - or not?" showed experiences of satisfaction with the ESP block and how patients considered the time perspective of having pain as an element of further insecurity; (4)"Losing control over one's own life" demonstrated how patients tried regaining control over their own lives during pain and after surgery. ConclusionsThe findings indicate that the majority of patients were happy with the ESP block because among other things, it reduced the need for rescue medicine including side-effects. Because of an acceptable pain intensity, patients paid more attention to other factors associated with their surgical intervention. Adequate pain management was described as of great importance for their experience of well-being and increased quality of life.

Diverticulitis of the appendix—case report and literature review

ABSTRACTAppendiceal diverticulitis is a rare diagnostic most often mistaken for an acute appendicitis.A 72-year-old man presented with a transfixing abdominal pain for 48 hours. Appendicitis was diagnosed on computed tomography scan, but a neoplasm could not be excluded. A laparoscopic hemicolectomy was performed after a surgical consensus considering the neoplastic appearance of the lesion and anatomical feature. Histopathology finally revealed an appendiceal diverticulitis.Appendiceal diverticulum is a rare condition. Most will lead to an appendiceal diverticulitis, which present similarly to an appendicitis. Perforation rate and mortality rate are much higher in appendiceal diverticulitis than in appendicitis. Furthermore, appendiceal diverticular disease is strongly associated with neoplasms, especially mucinous neoplasms and thus pseudomyxoma peritonei.Considering the high complication rate and malignant association, an appendicectomy in case of an appendiceal diverticulitis or of an incidental finding of appendiceal diverticulosis should be recommended to the patient.

The Educational Quality of Laparoscopic Right Hemicolectomy Videos on YouTube.

Introduction. Surgical technique videos are an important part of surgical fellows' education. YouTube has been identified as the preferred source of educational videos among trainees. The aim of this article is to objectively evaluate the quality of the 50 most viewed videos on YouTube concerning right laparoscopic hemicolectomy using LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). We hypothesized that the number of likes or views will not necessarily reciprocate with the educational content. Materials and methods. This observational study started with a YouTube search under the words "laparoscopic right hemicolectomy", "right colectomy", and "right hemicolectomy". The 50 most viewed videos with an English title were chosen. Video characteristics and LAP-VEGaS score were analyzed by four colorectal surgery fellows from a tertiary center in Mexico City. Results. Right hemicolectomy videos were reviewed; there was no correlation between the LAP-VEGaS score and the view ratio, the like ratio, or the video power index. The LAP-VEGaS score was significantly higher among videos uploaded by medical associations, journals, or commercial when compared with videos uploaded by doctors/physicians or academic associations. Conclusion. Educational quality in right laparoscopic hemicolectomy videos did not reciprocate with their educational quality, but it agrees significantly with the video uploading source. Low educational quality was identified among the videos underscoring the need to endorse peer-reviewed video channels.

Importance of the Duodenal Window and Fredet’s Fascia in Laparoscopic Right Hemicolectomy: Technical Note

Background: Laparoscopic right hemicolectomy requires a precise anatomical dissection to mobilise the right and proximal transverse mesocolon, following the avascular fusion planes of Toldt and Fredet. Fredet’s plane is crucial to the preparation of the origin of vessels. Easy access to Fredet’s and Toldt’s fasciae can be obtained through the “duodenal window”, a flimsy area of the root of the proximal transverse mesocolon, the margins of which are the right border of the superior mesenteric pedicle, the ileocolic pedicle, the right colic pedicle and the marginal artery. Method: We propose that dissection of the duodenal window should be the first step in laparoscopic right hemicolectomy, to obtain easy access to the duodenopancreatic plane and prepare the fascia. Results: This “duodenal window-first” technique has been applied in 45 laparoscopic right hemicolectomies and 14 laparoscopic extended right hemicolectomies, with only two conversions to open surgery. The duodenal window was easily identified in all but 3 cases with significant visceral obesity. No significant intra- or postoperative morbidity was recorded in these cases and the median postoperative length of stay was 4 days. All resections were R0 and an adequate number of retrieved lymph nodes were obtained in almost all cases. Conclusion: The duodenal window-first approach is a feasible and safe technique to standardise the first steps of radical laparoscopic right hemicolectomy, allowing prompt and complete anatomical identification and dissection.

Quantification of residual pneumoperitoneum after robotic-assisted laparoscopic surgery

Abstract Objective Laparoscopic surgery improves the postoperative recovery process and relies on CO2 insufflation to establish the operative field. Most residual CO2 is expelled prior to port and incision closure. Computed tomography (CT) is often used to assess an acute abdomen and is highly sensitive in detecting free intra-abdominal air – the hallmark sign of a bowel injury. Yet, the clinical significance of free air in the early postoperative period is confounded by residual CO2 and is not usually due to a visceral injury. The aim of this prospective study was to systematically quantify the residual pneumoperitoneum (RPP) at varying timepoints after robotic-assisted laparoscopic surgery. Methods Patients undergoing robot-assisted laparoscopic intervention, both radical prostatectomies and left hemicolectomies, were prospectively enrolled in the study. At the conclusion of each operation, manual abdominal pressure was applied to aid in exsufflation of residual CO2. Very-low-dose CT scans were performed on postoperative days (POD) 3, 5, and 7, with subsequent volumetric quantification of RPP. To investigate potential factors influencing the quantity of RPP, correlation plots were made against BMI, age, operative time, total insufflation volume, intra-abdominal pressure, time to flatus and first bowel movement, pain score, and postoperative analgesic requirement. Results Thirty-one patients undergoing robotic assisted laparoscopic prostatectomy were untill now enrolled in the study, of which only one experienced a Clavien-Dindo 2 complication; all others were free of any complications during post-operative assessment period. On POD3, 5, and 7, 97%, 94%, and 68% of patients, respectively, demonstrated RPP. The RPP volumes were noted to be 9.6 mL (IQR = 3.9-31.8; maximum = 247 mL) on POD3, 1.0 mL (0.1-5.1; maximum = 221 mL) on POD5, and 0.08 mL (1-1.2; maximum = 112 mL) on POD7. A significant correlation was only appreciated between RPP volume and BMI; those with higher BMIs had lower initial volumes of RPP on POD3 and exhibited a more rapid decrease in RPP over one week. Conclusion One week after robot-assisted laparoscopic operations, a majority of patients will exhibit clinically insignificant RPP, even with volumes as high as 250 mL. Larger patients tend to have smaller residuals of CO2. Our data provide new basic knowledge regarding RPP and may help to interpret postoperative CT-scans.

A critical view of safety in left colectomy surgery: A case of renal artery injury.

IntroductionThe standardization of the laparoscopic approach in left hemicolectomy was facilitated by the vascular anatomy of the left colon, which has few anatomical variants. The current technique for left hemicolectomy consists in approaching the inferior mesenteric artery (IMA), after identification of the inferior mesenteric vein (IMV), from above (craniocaudal) or from below (caudocranial). The type of approach is decided on the basis of the vascular window between the IMV and IMA. However, vascular abnormalities of adjacent organs can call into question the steps of the standardized technique.Case presentationWe describe a case of iatrogenic left renal artery injury caused during left laparoscopic hemicolectomy due to an abnormality of the renal vessels. The artery originated from the aorta more caudally than usual with respect to the normal population.DiscussionWhat happened made us question the security of the standardized approach in practice, especially in patients with vascular anomalies. The use of advanced imaging programs, such as 3D reconstruction, can help to prevent iatrogenic damages, but not all hospitals have such technology, especially in rural areas.ConclusionWe propose, to further decrease the risk of iatrogenic injuries, a “critical view of safety” for left colic surgery, in which, before any potential arterial resection, a careful craniocaudal and caudocranial dissection of the Toldt-Gerota plane could be useful in identifying the IMA at the center of this plane. Moreover, a preoperative imaging study is of paramount importance in all surgical procedures.

Efficiency in image-guided robotic and conventional camera steering: a prospective randomized controlled trial

Robotic camera steering systems have been developed to facilitate endoscopic surgery. In this study, a randomized controlled trial was conducted to compare conventional human camera control with the AutoLap™ robotic camera holder in terms of efficiency and user experience when performing routine laparoscopic procedures. Novelty of this system relates to the steering method, which is image based. Patients undergoing an elective laparoscopic hemicolectomy, sigmoid resection, fundoplication and cholecystectomy between September 2016 and January 2018 were included. Stratified block randomization was used for group allocation. The primary aim of this study was to compare the efficiency of robotic and human camera control, measured with surgical team size and total operating time. Secondary outcome parameters were number of cleaning moments of the laparoscope and the post-study system usability questionnaire. A total of 100 patients were randomized to have robotic (50) versus human (50) camera control. Baseline characteristics did not differ significantly between groups. In the robotic group, 49/50 (98%) of procedures were carried out without human camera control, reducing the surgical team size from four to three individuals. The median total operative time (60.0 versus 53.0min, robotic vs. control) was not significantly different, p = 0.122. The questionnaire showed a positive user satisfaction and easy control of the robotic camera holder. Image-based robotic camera control can reduce surgical team size and does not result in significant difference in operative time compared to human camera control. Moreover, robotic image-guided camera control was associated with positive user experience.

Laparoscopic versus Open Transverse-Incision Approach for Right Hemicolectomy: A Systematic Review and Meta-Analysis.

Background and Objectives: There is general agreement on the benefits of laparoscopy for treatment of rectal and left colon cancers, whereas findings regarding the comparison of laparoscopic and open right colonic resections are discordant. The aim of this systematic review and meta-analysis was to assess the outcomes and advantages of laparoscopic versus transverse-incision open surgery for management of right colon cancer. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating the results of laparoscopic and transverse-incision open right hemicolectomies were analyzed. The measured outcomes were mean operative time, time to feeding, duration of hospital stay, and number of lymph nodes harvested. Results: A total of 5 studies including 318 patients met the inclusion criteria. Meta-analysis revealed no differences in time to resume oral feeding, hospital stay, and number of lymph nodes harvested in between groups, but mean length of surgery was significantly longer in the laparoscopic group. Conclusion: These data confirm that the preferred approach to right hemicolectomy is yet unclear. Laparoscopy has a longer operative time than transverse-incision open surgery, and no significant short-term benefits were observed for the studied parameters. Well-designed randomized control trials (RCTs) might help to identify the differences between these two techniques for the surgical treatment of right colon cancer.

New way of laparascopic intracorporeal term-terminal invagination ileotransverse anastomosis

Background.Laparoscopic surgery becomes a standard treatment for many surgical diseases. Defects of a stapler laparoscopic mechanical suture during the formation of an anastomosis after hemicolectomy are detected in 18% of observed cases.Objective.Development, substantiate reproducibility and safety of a manual intracorporeal term-terminal invagination ileotransverse anastomosis method after performing the right laparoscopic hemicolectomy.Material and Methods.Authors presented a description of the technique and their own experience of performing laparoscopic hemicolectomy on the right with the formation of a manual original anastomosis in 10 patients with pathology of the right half of the colon. Eight patients (80.0%) had a malignant tumor of the right half of the colon, 1 patient (10.0%) showed multiple polyps of the cecum and the ascending part of the colon, 1 patient (10.0%) developed a cystic-solid submucosa tumor of the ileocecal angle. One patient had metastatic lung disease at the time of establishing diagnosis. The postoperative follow-up period was 7-18 months.Result.There were no conversions to open surgery. All operations (n = 10) were ended completely laparoscopically - right hemicolectomy with standard D2 lymph node dissection. In one patient, we revealed intraoperatively the spread of the tumor to the gallbladder, which required additional cholecystectomy. The duration of the operation was 122.5±10.7 min.; median blood loss was 107±5.2 ml. At the time of follow-up all patients are alive.Conclusion.The technique is universal in the surgical treatment of patients with various pathologies of the right half of the colon.

Comparing standard laparoscopic hemicolectomy to CME radical right colectomy for patients with right sided colon cancer: a randomized controlled feasibility trial

Background: TME (Total Mesorectal Excision) surgery has improved the prognosis for rectal cancer patients immensely. TME uses the embryological avascular mesorectal fascial planes for resection. Colon cancer treatment does not reach the rectal survival numbers yet, but the embryological planes that underpin TME surgery extend proximally to the entire colon, making a resection of the colon according to those principles a Complete Mesocolic Excision (CME). Some authors claim that with the use of CME they could achieve 10% better survival numbers. But randomised controlled trials on the subject are lacking but clearly required.

PSU11 ROBOTIC VS LAPAROSCOPIC RIGHT HEMICOLECTOMY: A COMPARATIVE STUDY OF CLINICAL OUTCOMES AND COSTS-EFFECTIVENESS

The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aim of this study is to compare the clinical outcomes and cost-effective outcomes of robotic versus laparoscopic surgery for right-sided colon cancer. This is an observational, comparative study whereby data were abstracted from a database of patients who underwent laparoscopic (LAP) and robotic (ROB) right hemicolectomy from October 2010 to March 2017, at Sanchinarro University Hospital. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). A sensitivity analysis was carried out in order to propagate the uncertainty of the estimations to the results of the model. We use a multivariate and stochastic sensitivity analysis performed by 5000 Monte Carlo simulations. The cost-effectiveness plane was used to represent all pairs of solutions of the model. A total of 20 robotic and 200 laparoscopic hemicolectomies were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min;p= 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups. The mean operative costs were higher for robotic surgery (€6423.77 vs €4415.20; p= 0.006) and the mean overall costs were higher too (€ 9455.1 for for robotic and € 8227.5 for the laparoscopic approach; p= 0.835). Mean QALYs at 1 year for robotic group (0.5624) was higher than that associated with OL (0.5066) (p=0.018). At a willingness-to-pay threshold of 20000 € and 30000 €, there was a 64.68% and 71.09% probability that robotic group was cost-effective relative to LAP approach. Robotic right hemicolectomy approach appears to be cost-effective compared with laparoscopic approach.

3159 A Case of Takayasu's Arteritis in a Patient With Crohn's Disease

INTRODUCTION: Takayasu's Arteritis is a rare, chronic inflammation of the large vessels, particularly the aorta and its primary branches. Though etiology is largely unknown, the pathogenesis is thought to be due in part to inflammation in vascular tissue. The vast majority of cases worldwide have been in females from 10-40 years of age. Cases of Takayatsu's Arteritis have been reported in patients with Inflammatory Bowel Disease. CASE DESCRIPTION/METHODS: We present the case of a 41 y/o Caucasian female, with long standing Crohn's Disease (2006) who reports to our clinic for evaluation in 2010. At the time of presentation, Crohn's symptoms were mild. Over the next four years the patient had multiple flares and was treated with multiple agents. In 2017 she underwent a laparoscopic hemicolectomy after colonoscopy revealed a marked stricture proximal to her terminal ileum. DISCUSSION: Pathology from the surgery revealed a neuroendocrine tumor. Subsequent Osteoscan was negative but a CT revealed circumferential thickening of the proximal thoracic aorta at the origin of the left subclavian artery, indicative of aortitis. The findings were consistent with a diagnosis of Takayatsu's Arteritis.