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A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.
Surg Endosc 2016; 30(2):455-463SE

Abstract

BACKGROUND

Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness.

METHODS

This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality.

RESULTS

A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups.

CONCLUSIONS

When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing overall postoperative morbidity. These findings and the recent upgrades in minimally invasive technology warrant continued evaluation of the role of the robotic platform in colorectal surgery.

Authors+Show Affiliations

Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA.Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA.Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA. Robert.Cleary@stjoeshealth.org.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

25894448

Citation

Tam, Michael S., et al. "A Population-based Study Comparing Laparoscopic and Robotic Outcomes in Colorectal Surgery." Surgical Endoscopy, vol. 30, no. 2, 2016, pp. 455-463.
Tam MS, Kaoutzanis C, Mullard AJ, et al. A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surg Endosc. 2016;30(2):455-463.
Tam, M. S., Kaoutzanis, C., Mullard, A. J., Regenbogen, S. E., Franz, M. G., Hendren, S., ... Cleary, R. K. (2016). A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surgical Endoscopy, 30(2), pp. 455-463. doi:10.1007/s00464-015-4218-6.
Tam MS, et al. A Population-based Study Comparing Laparoscopic and Robotic Outcomes in Colorectal Surgery. Surg Endosc. 2016;30(2):455-463. PubMed PMID: 25894448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. AU - Tam,Michael S, AU - Kaoutzanis,Christodoulos, AU - Mullard,Andrew J, AU - Regenbogen,Scott E, AU - Franz,Michael G, AU - Hendren,Samantha, AU - Krapohl,Greta, AU - Vandewarker,James F, AU - Lampman,Richard M, AU - Cleary,Robert K, Y1 - 2015/04/17/ PY - 2015/01/11/received PY - 2015/04/04/accepted PY - 2015/4/21/entrez PY - 2015/4/22/pubmed PY - 2016/12/15/medline KW - Complication rates KW - Conversion rates KW - Hand-assisted laparoscopic colorectal surgery KW - Laparoscopic colorectal surgery KW - Length of hospital stay KW - Robotic colorectal surgery SP - 455 EP - 463 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 2 N2 - BACKGROUND: Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness. METHODS: This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality. RESULTS: A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups. CONCLUSIONS: When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing overall postoperative morbidity. These findings and the recent upgrades in minimally invasive technology warrant continued evaluation of the role of the robotic platform in colorectal surgery. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/25894448/A_population_based_study_comparing_laparoscopic_and_robotic_outcomes_in_colorectal_surgery_ L2 - https://dx.doi.org/10.1007/s00464-015-4218-6 DB - PRIME DP - Unbound Medicine ER -