Safe transition from laparoscopic right colectomy with extracorporeal anastomosis to robotic suprapubic right complete mesocolic excision with intracorporeal anastomosis for colon cancer

Aim: The robotic platform can reduce technical difficulties asso-ciated with laparoscopic surgery for colon cancer. The aim of this study was firstly to determine the learning curve associated with transitioning from laparoscopic right colectomy with extracorporeal anastomosis (ECA) to robotic right colectomy with intracorporeal anastomosis (ICA), secondly to evaluate the safety of this transition, | 283ABSTRACTand thirdly to perform a safety analysis of a stepwise implementa-tion of robotic complete mesocolic excision (CME). Method: A retrospective analysis of all laparoscopic (n = 38) and robotic (n = 133) right colectomies for (pre)malignant lesions per-formed between January 2014 and December 2020 was conducted. Cases were categorized into four groups: laparoscopic standard right colectomy with ECA, robotic standard right colectomy with ECA or ICA, robotic CME-D2 and robotic CME-D3. CUSUM-plot analysis of total procedure time was used for learning curve determination of standard robotic colectomies. Non-parametric tests were used for statistical analysis with statistical significance assumed at p < 0.05. Results: Learning curve for robotic right colectomy was 43 cases. Compared to laparoscopy, learning phase robotic right colecto-mies had longer procedure times (p < 0.001) without any difference in anastomotic leakage rate, length of stay or 30-day morbid-ity. Conversion rate was significantly lower in the robotic group (p = 0.047). Procedure time of robotic CME (D2/D3) was longer than robotic standard right colectomy in the experienced phase (p < 0.001), without any difference in 30-day morbidity, 90-day mor-tality, conversion rate or anastomotic leakage rate. Lymph node yield was significantly higher in the CME-D3 group (p = 0.004). Conclusion: Robotic right colectomy with ICA can be safely imple-mented without increasing patient morbidity. The robotic platform can be of aid to implement CME in a safe and more standardized manner, resulting in higher lymph node yields.