Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score-matched analysis.

Abstract

Purpose: Laparoscopic low anterior resection for rectal cancer is technically challenging due to the precision required for mesorectal excision. Articulated instruments were developed to improve precision and oncological safety over conventional instruments. This study compares their perioperative outcomes.

Methods: A retrospective cohort study of 432 patients with colorectal cancer who underwent low anterior resection between August 2022 and February 2024 applied propensity score matching to minimize selection bias. Primary endpoints were circumferential resection margin (CRM), distal resection margin (DRM), and harvested lymph nodes count. Secondary outcomes included postoperative complications.

Results: Following propensity score matching, 84 matched pairs were analyzed. Most patients achieved CRM negativity (>1 mm), with CRM ≥10 mm in 67.9% of the articulated group and 59.5% of the conventional group (P=0.613). Median (interquartile range, IQR) lymph nodes harvests were comparable (20 [14-26] vs. 18 [14-22], P=0.147). The articulated group had a significantly longer DRM (30.0 mm [IQR, 18.0-40.0 mm] vs. 24.0 mm [IQR, 12.0-34.2 mm], P=0.008) and the median operation time (111.0 minutes [IQR, 95.8-125.2 minutes] vs. 99.5 minutes [IQR, 72.0-119.8 minutes], P=0.009). Estimated blood loss, open conversion rates, and postoperative complications, including leakage (7.1% vs. 8.3%, P>0.999) and surgical site infections, (15.5% vs. 9.5%, P=0.383), showed no significant differences.

Conclusion: Articulated laparoscopic instruments demonstrated comparable safety and feasibility to conventional instruments but offered no significant clinical or oncological benefits beyond a longer DRM. Larger studies are needed to evaluate their value in laparoscopic rectal surgery.