Robotic Right Hemicolectomy with Intracorporeal Anastomosis
Advances in minimally invasive techniques have led to a critical analysis of potential advantages of the intracorporeal anastomosis when compared to the extracorporeal approach. Recent studies suggest that these advantages may be the result of significant
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Robotic Right Hemicolectomy with Intracorporeal Anastomosis Robert K. Cleary and Craig S. Johnson
Background There are potential outcome advantages associated with the intracorporeal anastomosis when compared to the extracorporeal approach for minimally invasive right colectomy for benign and malignant disease [1–4]. It is not only the anastomosis that distinguishes intracorporeal and extracorporeal approaches as there are distinct differences in the degree of colonic and mesenteric mobilization and differences in specimen extraction. Intra- and extracorporeal anastomoses may be more accurately described as intra- and extracorporeal approaches or techniques that include the anastomosis. The extracorporeal technique for minimally invasive right colectomy is characterized by an extraction site incision that is typically in the midline where the anastomosis is constructed by standard open techniques and where the hernia rate is 8–12% [5–7]. In some patients, the transverse colon may not easily reach the midline extraction incision, and this may cause stretching and bleeding of the mesentery with the possible need to extend the extraction site incision. This may potentially cause delay in gastrointestinal recovery time. In contrast, the intracorporeal technique does not require an anastomosis through a small incision with poor visualization. The anastomosis is performed within the abdominal cavity after the specimen is completely freed from surrounding structures. There is less mobilization of the transverse colon because it does not have to be stretched to an extraction site incision. The extraction site incision may be anywhere off-midline Electronic Supplementary Material The online version of this chapter (https://doi.org/10.1007/978-3-030-15273-4_6) contains supplementary material, which is available to authorized users. R. K. Cleary (*) Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA e-mail: [email protected] C. S. Johnson Department of Surgery, Oklahoma Surgical Hospital, Tulsa, OK, USA
where hernia rates are
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