Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases

While the penetrance of robotic surgery into field of urology and gynecology has been significant, general surgeons have been slower adopters. We sought to compare laparoscopy and RAS among five different general surgical procedures with various penetrance of MIS.

Following IRB approval, the New York Statewide Planning and Research Cooperative System administrative data were used to identify five common laparoscopic general surgery procedures: cholecystectomy, colectomy, esophageal fundoplication (EF), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between 2008 and 2012. ICD-9 codes were used to select laparoscopic versus robotic procedures. Procedures were compared based on any complication and hospital length of stay (HLOS). Following descriptive analysis, propensity score analysis was used to estimate the population average differences between patients who underwent robotic-assisted and laparoscopic procedures.

There were 1458 patients who had undergone robotic-assisted surgery and 166,790 patients who had undergone laparoscopic surgery among the five procedures between 2008 and 2012. Of the 1458 robotic cases, 186 were cholecystectomy, 307 were RYGB, 118 were SG, 288 were EF, and 559 were colectomy. Initial univariate analysis showed a significantly higher rate of overall complications and HLOS in the laparoscopic group compared to the robotic-assisted group. Laparoscopic colectomy had a significantly higher rate of complications and longer length of stay compared to robotic approaches. No difference in complications or HLOS was seen in the cholecystectomy group. Following propensity score analysis, patients who had undergone robotic-assisted colectomy had significantly lower rate of complications compared to those who underwent conventional laparoscopic procedure (p value = 0.0022). In addition, patients who underwent robotic-assisted SG had on average 1.22 days longer HLOS (p value = 0.0037).

Robotic approaches may facilitate safer adoption of minimally invasive approaches in areas where penetrance of conventional laparoscopy is low, such as in colorectal surgery.