Total Robotic Left Hemicolectomy: An Efficacy And Safety Study

Objective:Robotic surgery has been widely used in colorectal surgery,but there is little evidence to perform all-robotic left colon cancer surgery.This study was conducted to evaluate the feasibility and safety of all-robotic lower left colon resection.Methods:(1)Clinical data of 22 patients who received full robotic left hemicolectomy,24 patients who received robot-assisted left hemicolectomy,and 27 patients who received laparoscopic-assisted left hemicolectomy in The Second Xiangya Hospital of Central South University from July 2016 to March 2022 were collected.Clinical features,surgical status,postoperative recovery,complications,and specimen pathology were retrospectively analyzed.(2)A systematic review was conducted on all robotic left hemicolectomy,robot-assisted and laparoscopic-assisted left hemicolectomy published in Embase,Pubmed,Cochrane,and Web of Science databases before January 2022,with the following keywords:Robotic[Mesh],Colectomy [Mesh],Anastomosis [Mesh].We further investigated the references of obtained papers for possible related studies as supplements.Results:(1)Surgical time length(P=0.024)of the robot-assisted group was longer than the laparoscopic assisted group,and the incision length of the total-robot group was shorter than that of both the robot-assisted group and the laparoscopic assisted group(P=0.000;P=0.000),and the first postoperative exhaust time of the robot(P=0.017;P=0.000),the time of first postoperative liquid diet(P=0.000;P=0.000)and the postoperative hospital stay(P=0.001;P=0.013)were shorter than the robot-assisted group and the laparoscopic-assisted group.There were no significant differences among the three groups in the VAS score on the postoperative day 1,the conversion rate to open surgery,the total incidence of postoperative complications,intraoperative blood loss,the harvested lymph node number,tumor length,and TNM stage(P > 0.05).(2)A total of 664 patients were included from 5 literature and analyzed.Compared with the laparoscopic-assisted left hemicolectomy group,the total robotic left hemicolectomy group had a lower postoperative incision infection rate with a confidence interval of4.48(1.03,22.80)and a shorter hospital stay with a confidence interval of1.24(0.07,2.40).The analysis of the operative time showed that the operative time of left hemicolectomy in the robot-assisted group and the robot-assisted group was longer than that in the laparoscopic-assisted group,and the difference was statistically significant.The confidence interval was-25.87(-44.83,-6.92),and 57.17(75.77,38.58)respectively.Meanwhile,compared with the robot-assisted group,the operative time of the all-robot group was statistically significant,and the confidence interval was 31.30(8.67,53.94).There were no significant differences among the three groups in intraoperative blood loss,conversion rate to laparotomy,first postoperative exhaust time,the incidence of postoperative anastomotic leakage,incidence of postoperative intestinal obstruction,and incidence of postoperative total complications.Conclusion:Compared with laparoscopic-assisted and robot-assisted left hemicolectomy,total-robotic left hemicolectomy is safe and feasible,with better postoperative recovery and no increased risk of adverse outcomes.