Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison

Background: We describe our preliminary experience in complete mesocolic excision (CME) with central vascular ligation (CVL) and intracorporeal anastomosis for right colon cancer, comparing the robotic and the three-dimensional (3D) laparoscopic approach. Methods: We performed a retrospective observational clinical cohort study on patients who underwent radical curative surgical resection of right colon cancer with CME from January 2014 to June 2019. Propensity scores were calculated by bivariate logistic regression, including the following variables: age, BMI, and size of tumor. Results: Fifty-five patients underwent CME with CVL: 26 by means of robot-assisted surgery and 29 by means of 3D laparoscopic procedure. There were not statistically significant differences about all the intra- and postoperative outcomes (operative time, length of the specimen, time to bowel canalization, time to soft oral intake, length of hospital stay, postoperative complication, number of retrieved lymph nodes, number of positive lymph nodes and lymph node ratio) between the robotic and the 3D laparoscopic approach. After the matching procedure, 20 patients of the robotic group and 20 patients of the 3D laparoscopic group were selected for the analysis. There were no differences in any of the analyzed variables between the two groups except for longer operative time in the robotic group (p = 0.002). Conclusion: The 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures)