Feasibility of robot-assisted laparoscopic intestinal anastomosis; an experimental study in pigs

Robotic telemanipulation systems have been introduced recently to enhance the surgeon’s dexterity and visualisation in videoscopic surgery, facilitating microscopic suturing and knot tying. The aim of this study was to demonstrate technical feasibility of performing a safe and efficient robot assisted handsewn laparoscopic intestinal anastomosis in a pig model. Thirty intestinal anastomoses were performed. Twenty anastomoses were performed laparoscopically with the da Vinci robotic system, the remaining 10 anastomoses by laparotomy. OR-time, anastomosis-time and complications were recorded. Effectiveness of the laparoscopic anastomoses was evaluated by postoperative observation of 10/20 pigs for 14 days and by testing mechanical integrity in all pigs by measuring passage, circumference, number of stitches and bursting-pressure. These parameters and anastomosis time were compared to the anastomoses performed by laparotomy. In all cases the procedure was completed laparoscopically. The only peroperative complication was an intestinal perforation, caused by an assisting instrument. The median procedure time was 77 minutes. Anastomosis time was longer in the laparoscopic cases than in the controls (25 vs 10 minutes; p<0,001). Postoperatively, one pig developed an ileus, based on a herniation of spiral colon through a trocar-port. For this reason it was terminated on the sixth postoperative day. All anastomoses were mechanical intact and all parameters were comparable to those of the open procedures. Technical feasibility of performing a safe and efficient robot assisted laparoscopic intestinal anastomosis in a pig model was repeatedly demonstrated in this study, with a reasonable time required for the anastomosis.