Evaluating Anastomotic Technique in Robotic Left-Sided and Rectal Colectomy: A Single-Center Outcomes Comparison

Authors

• Karim Mhanna, Michigan State University College of Human Medicine Medical Student
• Zeinab Mhanna, Michigan State University College of Human Medicine Medical Student
• Hannah Liefeld, General Surgery Resident - Corewell Health West
• Jason Aubrey, General Surgery Resident - Corewell Health West
• Gan Tong, Colorectal Surgery - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Robotic intracorporeal anastomosis has been more commonly studied in right-sided anastomosis, whereas the data on left-sided anastomosis is scarce. We present the largest cohort of comparison in clinical outcomes between left-sided robotic total intracorporeal anastomosis (TICA) and robotic extracorporeal (ECA) anastomosis.

A single-institution retrospective review was conducted for patients > 18 years old who underwent robotic left colectomy, sigmoidectomy, or low anterior resection from September 2022 to February 2025. Patients were stratified into those who had TICA or ECA. Outcome measures include length of stay (LOS), 30-day morbidity, blood loss, creation of stoma, morphine milligram equivalent (MME) use.

390 patients had met the inclusion criteria, 297 underwent ECA and 93 underwent TICA by six surgeons. After propensity scoring, 88 patients were included per group with no differences in age, sex, race, BMI, Charlson Comorbidity Index, or Area Deprivation Index. Intraoperatively, TICA was associated with a lower estimated blood loss (30 vs 50 mL, p< 0.0001) and fewer ostomies created (9.1% vs 19.5%, p=0.05). TICA patients most commonly used a Pfannenstiel extraction (81.6%) whereas ECA patients mostly had midline retrievals (85.2%, p< 0.0001). There were no differences in indication, operative time, intra-abdominal infection, or feculent contamination. Postoperatively, TICA patients had a shorter median LOS (75.5 vs 93.5 hours, p=0.02), showing a 19.2% reduction after adjustment and a lower daily opioid use (98.8 vs 167.5 MME, p=0.02), a 31.5% adjusted reduction. No differences were observed in ICU admission, surgical site infection, anastomotic leak, ileus, reintubation, or 30-day readmissions.

Robotic left sided TICA compared to ECA is associated with shorter LOS, decreased use of narcotic pain medications, and lower rates of ostomy creation, further supporting the benefits of TICA in left sided colectomies and proctectomies without significant difference in 30 day post operative outcomes. Randomized control trials are needed to better delineate outcomes between the procedures.

Recommended Citation

Mhanna K, Mhanna Z, Liefeld H, Aubrey J, Tong G. Evaluating anastomotic technique in robotic left-sided and rectal colectomy: A single-center outcomes comparison. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2123