Amid a growing volume and quality of clinical research around robotic-assisted surgery, recent colectomy studies support positive patient outcomes for patients.
A colectomy is the operation that removes a portion of a patient’s colon. It is among the well accepted types of general surgery procedures using robotic-assisted surgery. To help provide surgeons with a minimally invasive method that features enhanced vision and more precision compared to open surgery, Intuitive’s da Vinci robotic system may be used in colectomies instead of traditional laparoscopy that uses straight-stick instruments.
A recent multi-center, prospective, comparative study across four institutions , the ANCOR (ANastomotic COmparison in Right Colectomy), included 306 patients and evaluated the impact of anastomosis techniques (the part of the procedure joining of colon tissues after a portion is removed) on patient outcomes. The benefits to patients in terms of quality-of-life outcomes -- recovery of body functions such as bowel movement and return to soft, regular diet – had statistical significance.
There are two ways to perform an anastomosis: 1) intracorporeal anastomosis, or ICA (connection done inside the body) and 2) extracorporeal anastomosis, or ECA (connection done outside of the body). In the study, the majority of ICAs were done robotically and the majority of extracorporeal anastomoses were done laparoscopically. The study of 306 patients concluded that the ICA resulted in faster return of bowel function for patients and a shorter overall hospital stay, compared to ECA. There were also significantly fewer conversions to open or hand-assisted laparoscopic surgery in the intracorporeal anastomosis group than the extracorporeal anastomosis group.
“This is another significant clinical finding around minimally invasive intracorporeal anastomosis, enabled by robotics, that suggests a set of improved patient outcomes over other modalities,” said Shilpa Mehendale, vice president of Clinical Affairs at Intuitive. “Colectomy is a vibrant area of general surgery where robotics is playing a larger role, and that will bring these benefits to a broader set of patients needing this type of procedure.”
Robotic-assisted colectomies continue to be the choice of more general surgeons, according to a recent study of national procedure databases. In 2010, right-side colectomies were done robotically about 1.6% of the time, a percentage that has risen by 2019 to 26.8%, according to a paper from Dr. Sherry Wren of the Stanford University School of Medicine. For left-side colectomies, the percentage increase has been even higher: 32.6% in 2019 are now done robotically compared to 2.1% in 2010.
As with the ANCOR study, this analysis by Dr. Wren – who has operating privileges at the Veterans Administration in Palo Alto, California – and her partners pointed toward some significantly improved outcomes for patients who underwent robotic-assisted colectomies out of a broad group of more than 206,000 patients across 20 facilities. “Robotic surgery compared to open and laparoscopic was associated with a significantly lower conversion rate, development of ileus [restricted bowel function], overall complications, and 30-day hospital encounters,” Dr. Wren’s study concluded. “Robotic surgery further demonstrated lower mortality, reoperations, post-operative bleeding, and readmission rates for left and right colectomies than open surgery.”
It’s important to note that in this study, robotic-assisted colectomies had longer average operative times and in some cases higher costs than other approaches.
The ANCOR study and the research from Dr. Wren add to the more than 30,000 studies around the effective use of robotics on more than 70 cleared procedures globally.
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In order to provide benefit and risk information, Intuitive Surgical reviews the highest available level of evidence on representative procedures. Intuitive Surgical strives to provide a complete, fair and balanced view of the clinical literature. However, our materials should not be seen as a substitute for a comprehensive literature review for inclusion of all potential outcomes. We encourage patients and physicians to review the original publications and all available literature in order to make an informed decision. Clinical studies are typically available at pubmed.gov.
Important safety information
Specific risks associated with colectomies include but are not limited to leaking and/or narrowing at the spot where two sections of bowel were reconnected, colorectal or anal dysfunction (cannot empty bowel, frequent bowel movements, leakage or constipation).
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