The robotic NICE procedure outperforms conventional laparoscopic extracorporeal-assisted colorectal resection: results of a matched cohort analysis

Introduction We introduced the robotic NICE procedure for left-sided colorectal resection in 2018 in which the entire procedure is performed without loss of pneumoperitoneum and without an abdominal wall incision by performing natural orifice-assisted transrectal extraction of the specimen and intra...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 38; no. 1; pp. 390 - 399
Main Authors:	Haas, Eric M., Secchi del Rio, Roberto, Reif de Paula, Thais, Margain Trevino, Daniel, Presacco, Stefano, Hinojosa-Gonzalez, David E., Weaver, Matthew, LeFave, Jean-Paul
Format:	Journal Article
Language:	English
Published:	New York Springer US 2024 Springer Nature B.V
Subjects:	2023 SAGES Oral Abdomen Abdominal Surgery Analgesics, Opioid Anastomosis, Surgical - methods Body mass index Case-Control Studies Cohort analysis Cohort Studies Colectomy - methods Colon Colorectal Neoplasms Colorectal surgery Endoscopy Female Gastroenterology Gynecology Hepatology Hospitals Humans Laparoscopy Laparoscopy - methods Medicine Medicine & Public Health Middle Aged Morphine Narcotics Ostomy Patients Postoperative period Proctology Retrospective Studies Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods Robotics Surgeons Surgery Surgical techniques Treatment Outcome NICE procedure Natural orifice extraction Intracorporeal anastomosis (ICA) Robotic colorectal surgery Total intracorporeal surgery NOSE
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Summary:	Introduction We introduced the robotic NICE procedure for left-sided colorectal resection in 2018 in which the entire procedure is performed without loss of pneumoperitoneum and without an abdominal wall incision by performing natural orifice-assisted transrectal extraction of the specimen and intracorporeal anastomosis. We compare the results of the NICE procedure versus conventional laparoscopic resection, which was our standard approach prior to 2018. Methods A matched pair case–control study compared patients following the NICE procedure versus those who underwent laparoscopic left-sided colorectal resection with conventional extracorporeal-assisted technique. Cases were performed at an Academic Medical Center and recorded in a prospective database to analyze perioperative outcomes. Results From a total cohort of 352 patients, 83 were matched in each group. When comparing the NICE procedure vs. the Extracorporeal-Assisted laparoscopic group, there were no significant differences in age (58.5 vs. 59.3 years old), sex (47 vs. 42 Female), body mass index (27.4 vs. 27.5 kg/m 2 ), ASA, diagnosis, or type of surgery. Operative time (198.8 vs. 197.7 min), blood loss (56.0 vs. 53.3 ml), intraoperative complications (0.0% vs. 0.0%), and conversion rates (0.0% vs. 0.0%) were similar in both groups. The NICE procedure was associated with significantly earlier return of bowel function (40.7 vs. 23.6 h), shorter length of stay (3.1 vs. 2.2 days), and lower total opioid use (94.6 vs. 70.5 morphine milligram equivalents). Overall, there were no differences in postoperative abscess formation, complications, readmission, or reoperation rates. Conclusion When compared to conventional laparoscopic resection, the NICE procedure is associated with short-term benefits including earlier recovery and less opioid use without increased operative time or increased risk of complications. Multicenter studies are recommended to validate benefits and limitations of this technique.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-023-10452-9