Laparoscopic Versus Robotic Proctectomy Outcomes: An ACS-NSQIP Analysis. J Surg Res 2020 Nov;255:495-501
Date
07/06/2020Pubmed ID
32622164DOI
10.1016/j.jss.2020.05.094Scopus ID
2-s2.0-85087220088 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
BACKGROUND: The robotic platform is increasingly used in colorectal surgery. Recent upgrades in the robotic platform and introduction of proctectomy-specific reports from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) warrant updated evaluation of minimally invasive proctectomy outcomes. The aim of this study was to compare outcomes in robotic versus laparoscopic proctectomy using ACS-NSQIP data.
MATERIALS AND METHODS: The ACS-NSQIP data set was used to identify adult patients undergoing elective robotic and laparoscopic proctectomy in 2016 and 2017. Demographics, preoperative and intraoperative data, and postoperative outcomes were collected. Propensity-weighted analysis was used to estimate the effect of robotic versus laparoscopic surgery on outcomes.
RESULTS: Of 3845 patients meeting inclusion criteria, 2681 (70%) underwent a laparoscopic approach and 1164 (30%) underwent a robotic approach. Patients undergoing a robotic procedure were more likely to be older, have higher American Society of Anesthesiologists scores, low rectal tumors, and have undergone chemotherapy or radiation before surgery. After propensity adjustment, a robotic approach was associated with a decrease in conversion to open operation (estimated mean difference, -6.7%; P < 0.01), length of stay (-0.6 d; P = 0.01), occurrence of postoperative ileus (-3.7%; P = 0.01), and an increase in operative time (20.3 min; P < 0.01).
CONCLUSIONS: Using data from a national cohort, we found that compared with laparoscopy, robotic proctectomy is associated with decreased conversion to open operation, longer operation time, decreased length of stay, and decreased postoperative ileus. Our study identified several advantages to a robotic approach; however, further work is needed to assess cost-effectiveness in conjunction with clinical outcomes.
Author List
Hu KY, Wu R, Szabo A, Ridolfi TJ, Ludwig KA, Peterson CYAuthors
Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of WisconsinCarrie Peterson MD, MS, FACS, FASCRS Associate Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD, MS, FACS Associate Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Conversion to Open Surgery
Female
Humans
Ileus
Laparoscopy
Length of Stay
Male
Middle Aged
Operative Time
Postoperative Complications
Rectal Neoplasms
Retrospective Studies
Robotic Surgical Procedures