L. Heidelberg1, E. Malone1, M. Morris1, D. Chu1, G. Kennedy1, J. Cannon1 1University Of Alabama at Birmingham,Division Of Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction:
Over the last 20 years, minimally invasive surgery has become the standard of care for most operations. While the laparoscopic approach offers demonstrable advantages over open approach, the benefit of robotic assistance in colorectal surgery is less well defined. Previous efforts comparing robotic and laparoscopic surgery have demonstrated equivocal short-term outcomes. However, the morbidly obese population is at particular risk for postoperative complication and is an area warranting further investigation. We hypothesized that robotic surgery would decrease conversion rates in the obese colorectal patient when compared to the standard laparoscopic approach.
Methods:
We conducted a retrospective review of patients undergoing elective colorectal surgery while following the Enhanced Recovery After Surgery (ERAS) protocol from 2014-2017. Patient data from the institutional ERAS database was obtained for all patients whose initial operation was performed with a laparoscopic or robotic approach. Patients were then stratified by body mass index (BMI) to normal or obese (BMI >30). Bivariate comparisons of patient clinical characteristics and comorbidities, surgical characteristics, and post-operative outcomes were made using χ2 or Fisher’s exact test and t-tests for categorical and continuous variables respectively.
Results:
A total of 220 colorectal patients were included: 128 laparoscopic and 92 robotic. Patients were demographically matched between the groups. Mean age was 57 with at least 25% of patients on steroids, over 50% with hypertension, approaching 50% obesity, and with at least 79% having an ASA 3 classification. The overall rate of conversion to open operation was significantly lower in the robotic group compared to the laparoscopic group (1.1 vs. 15.6%, p < 0.05). The conversion rate, however, was not associated with BMI (44% for obese vs. 56% for normal BMI patients, p > 0. 05). Overall post-operative complication rate was higher in the robotic group (14.8% vs. 27.2%, p < 0.05), however no specific complication other than post-operative UTI were statistically significant (0% vs. 4.4%, p < 0.05). Operative time was also shorter in the laparoscopic approach (3.2 hours vs 3.9 hours, p < 0.05) by a mean of 42 minutes.
Conclusion:
Patients undergoing robotically assisted colorectal surgery were significantly less likely to require conversion to open operation. Higher BMI did not correlate with need for conversion in either group. More research is needed to stratify outcomes by BMI category and identify which patient populations benefit most from robotic surgery.