Robot assisted end-to-end hand-sewn anastomosis after segmental colectomy for transverse and splenic flexure tumors: A preliminary cohort study

Tumors of the transverse colon and splenic flexure represent a technically demanding subset of colorectal cancer, characterized by complex anatomy. Robotic approach, with complete mesocolic excision (CME) and the use of indocyanine green (ICG) fluorescence may confer advantages for these complex resections. Furthermore, end to end hand-sewn anastomosis can potentially overcome troubles of mechanical side to side anastomosis. This retrospective single-center observational study reports 19 consecutive patients undergoing robotic segmental resection: 10 for transverse colon cancer and 9 for splenic flexure cancer. All procedures were performed with CME and ICG-guided hand-sewn intracorporeal end-to-end anastomosis. Postoperative complication rate was 10.6% ( n = 2: one small bowel perforation, one wound haematoma). Median hospital stay was 5 days. Median lymph node harvest was 25. All surgical margins were free (>7 cm). Robotic segmental colonic resection with CME and ICG fluorescence angiography seems to be technically adequate. Hand-sewn end-to-end anastomotis may be considered as a possible alternative to mechanical anastomosis.