Exploring the Learning Curve of Intracorporeal Anastomosis in Minimally Invasive Right and Extended Right Colectomy: A Systematic Review
Kai Siang Chan, Shen Leong Oh, Brian Wing Kin Ip, Jason Wei Ji On, Surendra Kumar Mantoo, Yao Zong LeeABSTRACT
Background
Intracorporeal anastomosis (ICA), compared with extracorporeal anastomosis (ECA) is associated with reduced risk of post‐operative ileus without compromising on safety and oncological outcomes for minimally invasive right colectomy (MIRC). However, ICA is more technically challenging and comes with a learning curve (LC). This review aims to summarize the evidence and define the number of cases required to surmount the LC for ICA in MIRC, i.e., N LC .
Methods
A systematic search was performed on PubMed, Embase (Ovid), Scopus and the Cochrane database from inception to March 2026. Patients who underwent laparoscopic and/or robotic right and/or extended right colectomy were included. Data on the method of LC analysis, single surgeon vs. institutional LC and outcome measures were extracted and analysed. Poisson means were used to model the average N LC .
Results
There were six studies ( n = 7 data sets; 440 patients) on laparoscopic colectomy and four studies ( n = 6 data sets; 296 patients) on robotic colectomy. The pooled mean age was 67.9 years. Anastomotic leak occurred in 1.5% of laparoscopic cases and 3.0% of robotic cases. Operating time (OT) was the most evaluated surrogate marker of surgical proficiency. The pooled N LC for OT was similar between laparoscopic colectomy and robotic colectomy (laparoscopic: 27.2 (95% confidence interval (CI): 22.8–32.2), robotic: 26.6 (95% CI: 22.3–31.5), incidence rate ratio (IRR): 0.98, 95% CI: 0.48–2.00, p = 0.951).
Conclusion
This review provides a summary of existing evidence on the LC for ICA in MIRC. However, our findings are limited by heterogeneity in study populations, case selection and surgical experience.