Abstract
Background: Robotic three-dimensional magnified visual effects and field of view stabilization have enabled precise surgical operations. Intracorporeal anastomosis in colorectal cancer surgery is expected to shorten operation times, avoid paralytic ileus, and shorten wound lengths; however, few studies have reported on intracorporeal anastomosis in left-sided colorectal cancer surgery. Herein, we introduce a simple, novel procedure for using robotic purse-string suture (RPSS) in intracorporeal anastomosis with the double-stapling technique in rectal and sigmoid cancer surgery and report short-term outcomes.
Methods: From September 2022 to April 2024, 105 consecutive patients underwent robotic surgery with double-stapling technique anastomosis for rectal or sigmoid colon cancer at our institution. Their data were retrospectively analyzed. Intracorporeal anastomosis with the double-stapling technique using RPSS was performed in 26 patients (the RPSS group), while the double-stapling technique anastomosis with extracorporeal anvil fixation was performed in 79 patients (the EC group).
In the RPSS group, after tumor-specific or total mesorectal excision, specimens were extracted from the umbilical wound with simultaneous anvil placement in the body cavity. The oral colonic stump was robotically excised and robotically circumferentially stitched with 3-0 Prolene in all layers. After anvil insertion into the stump, the bowel wall of the colon was completely sewn onto the central rod of the anvil. Reconstructions were anastomosed using the double-stapling technique.
Results: Twenty-six patients successfully completed surgery using RPSS. The RPSS group had significantly less bleeding and shorter umbilical wound lengths than the EC group. Super-low anterior resection in the RPSS group had shorter total operative times than those in the EC group (p=0.06). The RPSS group experienced no perioperative complications greater than Clavien–Dindo grade III or any anastomosis-related complications.
Conclusions: The RPSS technique can be performed safely without any anastomosis-related complications and tends to reduce the total operative time in super-low anterior resection through total robotic surgery. This may be a useful, less-invasive modality for robotic colorectal surgery.