B. Ezekian1, Z. Sun1, M. Adam1, J. Kim1, M. C. Turner1, B. F. Gilmore1, C. T. Ong1, C. R. Mantyh1, J. Migaly1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: Interest in robotic technologies is burgeoning within the field of colorectal surgery. However, benefits of utilizing a robotic approach compared to the standard laparoscopic approach have not been well defined, especially in resections not involving pelvic anastomoses.
Methods: Patients who underwent either a robotic or laparoscopic colectomy from the 2012-2013 National Surgical Quality Improvement Program (NSQIP) database were selected. Short-term perioperative outcomes were compared between 1:1 propensity-matched groups. A subset analysis was performed among patients who underwent segmental resections only.
Results: Among the 15,976 patients included, 498 (3.1%) colectomies were performed robotically. After matching for demographic, clinical, and treatment characteristics, there were no differences between robotic and laparoscopic resections with regard to wound complications or other complications such as urinary tract infection, cardiopulmonary or thromboembolic events, renal insufficiency, anastomotic leaks, transfusion requirements, unplanned readmissions, or 30-day mortality (all p >0.05). However, operative time was significantly higher for the robotic colectomies (196 vs. 166 minutes, p <0.001). Among segmental resections only, operative time was still significantly longer for robotic colectomies (190 vs. 153 minutes, p <0.001) without differences in postoperative outcomes (all p >0.05).
Conclusion: In this early population-based experience, robotic colectomies appear to result in similar perioperative outcomes when compared to laparoscopic colectomies, but are associated with longer operative times. Given the current focus on value-based healthcare, utilizing robotic technologies in straightforward resections may not justify the cost.