Right Colectomy with Complete Mesocolic Excision and Intracorporeal Anastomosis: A Monocentric, Single-Surgeon Comparison of Dexter, DaVinci and Laparoscopic Approaches

TL;DR

This study compares Dexter, DaVinci, and laparoscopic techniques for right colectomy, finding Dexter offers flexibility without compromising safety or outcomes.

Contribution

The study introduces Dexter as a flexible robotic alternative with comparable safety and outcomes to DaVinci and laparoscopy.

Findings

Dexter had shorter operative times compared to DaVinci and laparoscopy.

Dexter allowed conversion to laparoscopy during complex steps, aiding the learning curve.

No significant differences in lymph node yield, CME quality, or postoperative outcomes were observed across groups.

Abstract

(1) Minimally invasive techniques are standard in colorectal surgery, though complete mesocolic excision (CME) with central lymphadenectomy remains technically demanding. Robotic systems may address these challenges. While the DaVinci system is well established, the modular Dexter system allows rapid switching between laparoscopy and robotics. (2) This prospective single-surgeon study compared right hemicolectomy with CME and intracorporeal anastomosis using Dexter, DaVinci, and conventional laparoscopy in 75 patients (25 per group) at a German high-volume center. Outcomes assessed included operative time, complications, lymph node yield, and CME quality. (3) Mean operative time was longest with DaVinci (190.5 min) versus Dexter (164.8 min) and laparoscopy (152.6 min). Intracorporeal anastomosis was more frequent in robotic groups. No significant differences were found in lymph node yield, CME quality, postoperative complications, length of stay, or survival. (4) The ability to convert briefly to laparoscopy during Dexter procedures helped manage challenging steps, especially during the learning curve. The results suggest that Dexter is a safe, feasible alternative to established robotic and laparoscopic techniques, with the added benefits of flexibility and integration into existing workflows.

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