A novel intracorporeal anastomosis for totally laparoscopic colectomy: A prospective IDEAL stage 2a study

Totally laparoscopic colectomy offers several advantages over laparoscopic-assisted colectomy, including smaller incision size and reduced risks of tumor compression and mesenteric traction bleeding. However, the existing intracorporeal anastomosis (IA) techniques remain technically demanding and resource-intensive. In this study, the safety and feasibility of a novel IA technique—U-tied functional end-to-end anastomosis (UEEA) was assessed within the framework of the IDEAL (Idea, Development, Exploration, Assessment, and Long-term follow-up) Stage 2a. In this prospective cohort study, 100 patients who underwent elective laparoscopic colectomy were enrolled between September 2022 and November 2024. Perioperative data were collected after patients had undergone UEEA. The outcomes included 30-day postoperative anastomotic leakage (primary), overall complications, operation time, intraoperative blood loss, lymph node retrieval, etc. A multivariate cumulative sum analysis of operative metrics was used to evaluate the learning curve. All procedures in the 100 patients were completed successfully, with a mean operative time of 193.89 ± 36.09 min and an anastomosis time of 20.73 ± 7.37 min. Anastomotic leakage occurred in 1% of the patients. The postoperative complication rates were 14% (patient-level) and 16% (event-level). There were no major complications recorded (Clavien‒Dindo grade ≥III). The average number of lymph nodes retrieved were 18 [15–25.25], with 97% of the patients meeting the oncological adequacy criteria (≥12 nodes). The learning curve analysis identified a transition point at 35 cases, after which the operative time and complication rates showed significant improvements, which was indicative of attaining procedural proficiency ( P <0.05). In conclusion, this study demonstrates that UEEA is a safe and feasible IA technique for totally laparoscopic colectomy, facilitating procedural standardization with minimal resource demands. Multicenter trials aimed at validating these findings are currently underway.