Robotic versus laparoscopic colectomy

This study compared the experience and cost of the DaVinci Robotic system and laparoscopy for colon resections.

For this study, 30 consecutive robotic and 27 consecutive laparoscopic colectomies were divided into right and sigmoid colectomies for analysis. Comparisons included indications for surgery, gender, age, body mass index (BMI), estimated blood loss (EBL), length of operation, length of hospital stay (LOS), complications, operating room (OR) cost, OR personnel cost, OR supply cost, OR time cost, and total hospital cost.

The comparison groups were similar in indications for surgery, gender, age, BMI, EBL, and LOS. The right colectomies included 17 robotic and 15 laparoscopic procedures. An intracorporeal anastomosis was performed in the robotic cases, and an extracorporeal anastomosis was performed in the laparoscopic cases. The total case time was 218.9 min for the robotic and 169.2 min for the laparoscopic procedures (p = 0.002). The total hospital cost was $9,255 for the robotic and $8,073 for the laparoscopic procedures (p = 0.430). The total OR cost was $5,823 for the robotic and $4,339 for the laparoscopic procedures (p < 0.000). The sigmoid colectomies included 13 robotic and 12 laparoscopic procedures. The robotic and laparoscopic cases were managed in similar sequence. The total case time was 225.2 min for the robotic and 199.4 min for the laparoscopic procedures (p = 0.128). The total hospital cost was $12,335 for the robotic and $10,697 for the laparoscopic procedures (p = 0.735). The total OR cost was $6,059 for the robotic and $4,974 for the laparoscopic procedures (p = 0.068). The complications in the robotic groups were more numerous, but were not attributable to equipment.

The comparison groups were similar. The robotic cases were significantly longer for right colectomies because of the intracorporeal anastomosis instead of the extracorporeal anastomosis performed in the laparoscopy cases. Every cost category was higher for the robotic cases. The right colectomies showed significant increases in total OR cost, OR personnel cost, OR supply cost, and OR time cost. The sigmoid colectomies had significant increases in OR personnel cost and OR supply cost. The total hospital cost was higher for the robotic groups, but the difference was not statistically significant.