Faculty Collaboration Database

The Use of Robotic and Laparoscopic Surgical Stapling Devices During Minimally Invasive Colon and Rectal Surgery: A Comparison. J Laparoendosc Adv Surg Tech A 2017 Feb;27(2):151-155

Date

11/29/2016

Pubmed ID

27893300

DOI

10.1089/lap.2016.0409

Scopus ID

2-s2.0-85012863833 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

PURPOSE: To date there exists no published study examining the safety and efficacy of the EndoWrist 45 (Intuitive Surgical, Inc.) robotic stapler. We compared outcomes between the robotic and comparable laparoscopic stapler in robotic-assisted colorectal procedures.

MATERIALS AND METHODS: We conducted a retrospective review of 93 patients who underwent robotic-assisted colorectal surgery at our institution from 2012 to 2014. Surgeries included left, sigmoid, subtotal and total colectomies, and low anterior rectal resections. Indications were malignancy and diverticular and inflammatory bowel disease. Preoperative demographics, intraoperative data, and postoperative outcomes were examined. Student's t-test and Fischer's exact used were appropriate.

RESULTS: Forty-five millimeters laparoscopic staplers were used in 58 cases, while the 45 mm robotic stapler was used in 35 cases. There was no difference in age (P = .651), gender (P = .832), or body mass index (P = .204) between groups. There was no difference in estimated blood loss (P = .524), operative time (P = .769), length of stay (P = .895), or complication rate (P = .778). The robotic stapler group had one anastomotic leak, while the laparoscopic stapler group had six (P = .705). There were more laparoscopic stapler fires (2.69) per patient than robotic stapler fires (1.86) (P = .001). The cost per patient for the laparoscopic group was $631.45 versus $473.28 for the robotic group (P = .001).

CONCLUSION: This is the first study to evaluate the robotic stapler. Advantages of the robotic stapler include large range of motion and 90° of articulation, which may provide a benefit when using the stapler in difficult areas like the pelvis. The robotic stapler has a comparable level of safety as a 45 mm laparoscopic stapler and is more cost effective.

Author List

Holzmacher JL, Luka S, Aziz M, Amdur RL, Agarwal S, Obias V

Author

Jeremy H. Levin MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anastomotic Leak
Colectomy
Colon, Sigmoid
Colorectal Neoplasms
Costs and Cost Analysis
Diverticulitis, Colonic
Female
Humans
Inflammatory Bowel Diseases
Laparoscopy
Male
Middle Aged
Operative Time
Rectum
Retrospective Studies
Robotic Surgical Procedures
Surgical Staplers
Surgical Stapling