Robotic Intracorporeal Single-Stapled Anastomosis (RISS) is Associated with Lower Anastomotic Leakage Rates than the Double-Stapled Technique After Minimally Invasive Total Mesorectal Excision for Rectal Cancer.

Abstract

Alternatives to the double-stapled (DS) technique for creating anastomoses after minimally invasive total mesorectal excision (TME) have been proposed to reduce complications and costs. Robotic intracorporeal single-stapled anastomosis (RISS) was developed as a technically intuitive approach. Standardizing such an intracorporeal robotic technique-which achieves adequate pelvic exposure, precise rectal transection, and secure anastomosis construction-may optimize outcomes, particularly anastomotic leakage (AL). A cohort study was conducted using our prospective institutional database and included patients < 80 years who underwent minimally invasive elective TME for extraperitoneal rectal cancer. Patients were allocated to the DS (abdominal stapled transection with double-stapled anastomosis) or RISS (robotic intracorporeal rectal transection with single-stapled anastomosis) groups. The exclusion criteria were nonrestorative procedures, intersphincteric resection, open surgery, and no indocyanine green perfusion assessments. The primary endpoint was 90-day clinical or radiological AL. Among 380 TMEs, 167 met the inclusion criteria (71 RISS; 96 DS). The 90-day AL rate was significantly lower in the RISS group (5.6% vs. 16.7%; p = 0.032). Reintervention (1.4% vs. 10.4%; p = 0.025), overall morbidity (33.3% vs. 52.5%; p = 0.014), and length of stay (p < 0.0001) were lower following RISS. Multivariable analysis revealed that DS technique (odds ratio [OR] 3.3; p = 0.038) and comorbidities (OR 3.1; p = 0.028) independently predicted AL. Each additional stapler firing increased the risk of AL (OR 1.62; p = 0.016), and ≥3 firings predicted AL (OR 4.92; p = 0.011). Compared with DS, RISS was associated with lower anastomotic leakage, morbidity, and reintervention and shorter hospitalization. This standardized robotic approach is safe, reproducible, and potentially cost effective.