T. K. Kleinschmidt1, M. Ferrara1, J. Rosser1, M. Parker1 1Brookwood Baptist Health System,Department Of General Surgery,Birmingham, AL, USA
Introduction: The aim of this study is to compare the results of robotic versus laparoscopic colon resection for all causes performed by two high-volume private practice colon and rectal surgeons. Current recommendations are at least 150-250 cases on the da Vinci platform are needed to become adept. This study bears significance as current research shows inconsistent results in comparing the two modalities which could be in part because many of the current literature are meta-analyses incorporating multiple centers, surgeons and disparate patient populations.
Methods: Retrospective analysis was performed for all patients who had either robotic or laparoscopic colon resection over a 10 month period. Outpatient records were reviewed to ascertain demographic data such as: age, BMI, tobacco use, comorbidities and prior surgeries. Hospital records were accessed to determine: case length in OR, estimated blood loss (EBL), need for conversion of case, length of postoperative stay and complication rates. Complication rates were defined as: surgical site infections (SSI), need for reoperation and/or loss in quality of life as recorded in follow up office visits. Statistical analysis of data was performed using R software.
Results: The study included 166 patients (109 in the Robotic surgery (RS) and 57 patients in the Laparoscopic surgery (LS) groups). For RS patients: mean age was 57.8 years of age, 57% were female, mean BMI was 29.9 and the most common procedure performed was LAR (67%) and most common indication was diverticulitis (36.7%). For LS patients: mean age was 64.0 years of age, 47.4% were female, mean BMI was 27.5 and the most common procedure performed and indications were also LAR (50.9%) and diverticulitis (36.1%). Mean operative time was longer in RS group (138.3 versus 125.4 minutes, respectively [p=0.0380]). Estimated blood loss was less in RS (59.6 versus 106.3cc, respectively [p=0.0282]). Mean postoperative length of stay was shorter for RS than LS (2.85 versus 4.0 days [p=0.0046]). Complication rates were similar in LS (26.3%) and RS (20.2%) [p=0.3681], and the most common LS complication was SSI (32.3%%) and most common complication for RS was SSI (42.1%). Conversion of operative technique was similar in RS and in LS (19.3% versus 13.8%, respectively [p=0.3524]).
Conclusion: Robotic surgery for colon resection had decreased EBL, and significantly shorter postoperative hospital stay. Laparoscopic surgery had shorter operating time. Similar results were found between postoperative complications and conversion rates of surgery. In the hands of surgeons who have performed the reported amount of surgeries needed to become adept with the da Vinci Surgical System, robotic surgery has significant advantages for colon resection.