Robotic left-sided colorectal resection with natural orifice IntraCorporeal anastomosis with extraction of specimen: The NICE procedure. A pilot study of consecutive cases

Am J Surg. 2019 Apr;217(4):670-676. doi: 10.1016/j.amjsurg.2018.11.048. Epub 2018 Dec 14.


Background: Despite numerous benefits, only a small fraction of laparoscopic left-sided colectomy is accomplished without the need for an abdominal incision to retrieve the specimen and prepare for anastomosis. We report our early experience with a robotic approach using Natural orifice IntraCorporeal anastomosis with Extraction of specimen (NICE) to help overcome the technical limitations and challenges of this approach.

Methods: Twenty consecutive patients presented for elective sigmoid or rectosigmoid resection for benign and malignant disease and underwent the NICE procedure. Safety, feasibility and post-operative outcomes were analyzed.

Results: Intracorporeal anastomosis was accomplished in all patients. One patient required an abdominal incision to extract a bulky tumor. Mean operative time was 222 min (146-344). Mean time to first flatus and length of stay was 23 and 49 h, respectively. All but 4 patients were discharged home on post-operative day 2. One patient was readmitted with a pelvic fluid collection.

Conclusion: Robotic left-sided colorectal resection with NICE procedure is a safe and feasible minimally invasive approach and may facilitate greater adoption rates of this technique.

Keywords: Intracorporeal anastomosis; Left colonic resection; Natural orifice specimen extraction; Robotic resection.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / methods*
  • Colectomy / methods*
  • Colonic Diseases / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*