A propensity score matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted sigmoidectomy in an enhanced recovery pathway.

Intracorporeal options for sigmoid resection have been recently developed but not extensively evaluated. This study was designed to assess outcomes comparing intracorporeal and extracorporeal techniques for robotic-assisted sigmoid resection in an established enhanced recovery pathway. This is a retrospective comparison of intracorporeal and extracorporeal techniques for robotic-assisted sigmoid resection for benign and malignant disease. Operative technique for the newer intracorporeal innovation is described in detail. Propensity score matching was performed using patient characteristics as predictors in the propensity score model. 169 cases met inclusion criteria. After propensity score matching, 114 cases were available for analysis (intracorporeal 57, extracorporeal 57). Almost 90% were for diverticulitis in each group. There were significantly fewer conversions in the intracorporeal group when compared to the extracorporeal group (5.26% vs. 19.3%, P = 0.029). Operative time was significantly longer in the intracorporeal group (193.33 vs. 159.89 min, P < 0.001). There was no significant difference between groups for time to flatus and bowel movements, hospital length of stay, postoperative 30-day complications, and readmission rates. There were significantly fewer extraction site hernias in the intracorporeal group (0 vs. 6 (10.53%), P = 0.027) likely because there were fewer midline extraction sites (8.77% vs. 38.6%, P < 0.001). When compared to extracorporeal techniques for robotic sigmoid resection in an enhanced recovery pathway, the intracorporeal approach is safe and associated with fewer conversions, fewer extraction site hernias, and longer operating times. As adoption of the intracorporeal approach continues to increase, further analysis of this technique in larger studies may be warranted.