Robotic versus laparoscopic right hemicolectomy: Does the approach matter?

Abstract

Introduction: Minimally invasive surgery has been widely recognised as the standard approach for the treatment of colon cancer. At present, right hemicolectomy for colonic malignancy has been widely done using a laparoscopic approach, in high-volume centres, and that has been proven to be both safe and feasible. However, laparoscopic surgery has several limitations, which can be minimised with robotic platforms. Our study aimed to compare the short-term outcomes of robotic right hemicolectomy (RRH) and laparoscopic right hemicolectomy (LRH).

Patients and methods: This was a prospective observational study with two comparative arms. All patients who underwent right hemicolectomy for malignant indications were included and who underwent emergency surgeries for perforation or obstruction were excluded. They were followed up for a minimum of 30 days postoperatively. Statistical analysis was performed using SPSS software (IBM Corp., version 28.0). Continuous variables were expressed as mean ± standard deviation. Comparison between two groups were done using Student's t -test or Mann-Whitney U -test for continuous variables. Chi-square test or Fisher's exact test for categorical variables, as appropriate.

Results: A total of 70 patients were recruited in the study, with equal numbers in each arm, and they were well matched. The RRH group had significantly longer operative time than the laparoscopic group (177.1 min vs. 144.7 min, P < 0.001). The length of hospital stay and time to passage of first flatus were shorter in the RRH arm, but it was not statistically significant. Post-operative complications were comparable between the two groups. No reoperation and mortality were noted in both groups. The RRH group had a slightly higher mean lymph node harvest than the LRH group (22.1 vs. 21.2), though not statistically significant.

Conclusion: RRH offers comparable short-term perioperative and oncological adequacy to LRH, with similar length of hospital stay, post-operative complications, return of bowel function and lymph node yield. RRH appears to be a safe and feasible alternative to LRH. The longer operative time and higher cost of the robotic platform still remain as important limitations for wider application. However, a well-designed, multi-centre RCT with a larger sample size is necessary to validate these findings and to recommend a suitable approach.