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13-01-2022 | Laparoscopy

Is robotic utilization associated with increased minimally invasive colorectal surgery rates? Surgeon-level evidence

Authors: Carla F. Justiniano, Adan Z. Becerra, Anthony Loria, Zhaomin Xu, Christopher T. Aquina, Larissa K. Temple, Fergal J. Fleming

Published in: Surgical Endoscopy | Issue 8/2022

Abstract

Background

It is unclear whether robotic utilization has increased overall minimally invasive colorectal surgery rates or if robotics is being adopted instead of laparoscopy. The goal was to evaluate whether increasing robotic surgery utilization is associated with increased rates of overall colorectal minimally invasive surgery.

Methods

The Statewide Planning and Research Cooperative System (New York) was used to identify patients undergoing elective colectomy or proctectomy from 2009 to 2015. Individual surgeons were categorized as having increasing or non-increasing robotic utilization (IRU or non-IRU, respectively) based on the annual increase in the proportion of robotic surgery performed. The odds of surgical approach across the study period were evaluated with multinomial regression.

Results

Among 72,813 resections from 2009 to 2015, minimally invasive-surgery increased (47–61%, p < 0.0001). For colectomy, overall minimally invasive-surgery rates increased (54–66%, p < 0.0001), laparoscopic remained stable (53–54%), and robotics increased (1–12%). For proctectomy, overall minimally invasive-surgery rates increased (22–43%, p < 0.0001), laparoscopic remained stable (20–21%), and robotics increased (2–22%). Over the study period, 2487 surgeons performed colectomies. Among 156 surgeons with IRU for colectomies, robotics increased (2–29%), while laparoscopy decreased (67–44%), and open surgery decreased (31–27%). Overall, surgeons with IRU performed minimally invasive colectomies 73% of the time in 2015 versus 69% in 2009. Over the study period, 1131 surgeons performed proctectomies. Among 94 surgeons with IRU for proctectomies, robotics increased (3–42%), while laparoscopy decreased (25–15%), and open surgery decreased (73–44%). Overall, surgeons with IRU performed minimally invasive proctectomy 56% of the time in 2015 versus 27% in 2009. Patients in the latter study period had 57% greater odds of undergoing robotic surgery.

Conclusions

Overall, minimally invasive colorectal resections increased from 2009 to 2015 largely due to increasing robotic utilization, particularly for proctectomies.

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Title: Is robotic utilization associated with increased minimally invasive colorectal surgery rates? Surgeon-level evidence
Authors: Carla F. Justiniano
Adan Z. Becerra
Anthony Loria
Zhaomin Xu
Christopher T. Aquina
Larissa K. Temple
Fergal J. Fleming
Publication date: 13-01-2022
Publisher: Springer US
Keywords: Laparoscopy
Colectomy
Colectomy
Published in: Surgical Endoscopy / Issue 8/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09023-1

At a glance: The STEP trials

Springer Medicine

Is robotic utilization associated with increased minimally invasive colorectal surgery rates? Surgeon-level evidence

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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