Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach

Background: Because of its less evident advantages regarding patient recovery, the laparoscopic approach for right colectomy initially gained less popularity than for left colectomy. The improvement in intracorporeal anastomotic techniques and the consequent switch from a laparo-assisted (LA) to a totally laparoscopic (TL) intervention seems to have overcome the initial concerns, giving rise to widespread use of such a procedure. By comparing the LA and the TL approach, our study was aimed at verifying the possible advantages of the more recent technique, also focussing on some technical implications for the surgeon. Methods: We prospectively collected and matched data from 27 consecutive laparo -assisted right colectomies (LARC) and 28 consecutive totally laparoscopic procedures (TLRC). Clinical, biochemical, pathological and cosmetic parameters were examined. Operating times were recorded and fractioned, in order to evaluate the learning curve for the different phases of the procedure. Results: LA and TL groups were homogeneous for demographic and pathological features. We had no mortality, and surgical complication rates were similar (3.6% vs. 3.7%). The TLRC group presented a significantly shorter laparotomy (4.8 cm vs. 7.2 cm, p=0.002), while no significant difference was recorded for outcome parameters. Operating time for carrying out anastomosis (TA) was significantly longer for the TL group (55.6 min vs. 20.6 min, p<0.0001). A rapid decrease in TA throughout the series attests to a short learning curve for intracorporeal ileo-transverse anastomosis. Conclusions: Further studies are needed to demonstrate the possible clinical advantages of TLRC over the LA approach. The cosmetic benefit for patients along with the safety and the prospective usefulness for surgeons (practice in intracorporeal suturing techniques) would seem to justify an inclination towards this technical development .