Table 2.
Perioperative results and outcome
| Variable | Conventional open surgery (n = 22) | Robotic surgery | p-Value | |
|---|---|---|---|---|
| ECA (n = 39) | ICA (n = 56) | |||
| Final diagnosis* | ||||
| Divertikulitis | 0 | 2 | 1 | 0.055 |
| Large adenoma | 4 | 13 | 7 | |
| Carcinoma | 18 | 22 | 47 | |
| pT 1 | 3 | 4 | 13 | 0.785 |
| pT 2 | 2 | 6 | 9 | |
| pT 3 | 11 | 10 | 21 | |
| pT 4 | 2 | 2 | 4 | |
| pN + | 5 | 4 | 9 | 0.704 |
| Local pR0 | All patients | All patients | All patients | 1 |
| Adhesiolysis | 10 | 15 | 18 | 0.528 |
| Intraoperative complications | 1µ | 1µ | 0 | 0.333 |
| Intraoperative conversion# | - | 2 | 1 | 0.566 |
| Intraoperative transfusion | 1 | 1 | 1 | 0.786 |
| Intraoperative drainage | 5 | 2 | 0 | 0.0007 |
| Postoperative complications (n patients)¶ | 13 | 6 | 5 | < 0.0001 |
| Surgical site infections | 6 | 2§ | 0 | < 0.0001 |
| Pneumonia | 2 | 0 | 1 | |
| Intraluminal bleeding | 1 | 0 | 3 | |
| Intraabdominal bleeding | 1 | 1£ | 0 | |
| Anastomotic leakage | 2& | 1 | 1£ | 0.262 |
| Internal hernia | 1¥ | 0 | 0 | |
| Abdominal re-do surgery | 2 | 2 | 1 | |
| Other | 1 | 1 | 0 | |
| CCI | 8.7 (0–34.8) | 0 (0–42.4) | 0 (0–100) | < 0.0001 |
| Grade I (n complications)€ | 6 | 2 | 0 | |
| Grade II (n complications)€ | 6 | 2 | 1 | |
| Grade IIIa (n complications)€ | 0 | 0 | 3 | |
| Grade IIIb (n complications)€ | 2 | 2 | 1 | |
| Grade IVa (n complications)€ | 0 | 1 | 0 | |
| Grade IVb (n complications)€ | 0 | 0 | 0 | |
| Mortality | 0 | 0 | 2 | p = 0.336 |
| Postoperative return to ICU (n patients) | 2Ω | 1ΩΩ | 3ΩΩΩ | 0.537 |
| Postoperative bowl stimulation (n patients) | 7 | 12 | 21 | 0.553 |
| Neostigmin | 0 | 1 | 0 | |
| Laxantives | 4 | 5 | 2 | |
| Movicol | 1 | 7 | 16 | |
| Klysma | 6 | 2 | 2 | |
Patients who underwent conversion from an initially intended minimally invasive approach to conventional open surgery (n = 3) were excluded from perioperative outcome analysis. All procedures were performed due to preoperative concerns or histologically proven malignancy
*The “final” histopathologically confirmed diagnosis; patients who underwent intraoperative conversion to open surgery were excluded
#Overall conversion rate was 3.2%
µBleeding in both cases; in the ECA group leading to conversion to open surgery. Reasons for conversion to open surgery from an initially intended minimally invasive approach were dense adhesions and bleeding in the ECA group and unclear definition of the tumor site in the ICA group
¶Postoperative complications during the postoperative day 30 were included
§One deep organ space surgical site urging re-do surgery
&One anastomotic insufficiency urging re-do surgery. The other anastomotic insufficiency in the COS group as well was the anastomotic insufficiency from the ECA group were covered and did not require re-interventional therapy
£Urging re-do surgery
¥Internal hernia causing ileus and urging re-do surgery
€Regarding the Clavien-Dindo classification of surgical complications [60]. Ω Due to re-do surgery in both cases, Ω Ω due to acute kidney injury and Ω Ω Ω due to pneumonia (n = 1), intraluminal bleeding (n = 1), and intraluminal bleeding at postoperative day 6 and severe prolonged sepsis after re-do surgery for anastomotic leakage (n = 1). CCI comprehensive complication index [61], ICU intensive care unit, ECA hybrid minimally invasive, robotic-assisted right colectomy with extracorporal hand-sewn anastomosis, ICA total minimally invasive, robotic right colectomy with intracorporal hand-sewn anastomosis