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Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy.
Surg Endosc 2016; 30(7):2792-8SE

Abstract

BACKGROUND

The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy.

METHODS

The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches.

RESULTS

We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P < 0.01) and robotic approaches (AOR 1.04, 1.30, P < 0.01 and P = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P = 0.10, P = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P < 0.01).

CONCLUSION

Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach.

Authors+Show Affiliations

Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA. sdmills@uci.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26487196

Citation

Moghadamyeghaneh, Zhobin, et al. "Comparison of Open, Laparoscopic, and Robotic Approaches for Total Abdominal Colectomy." Surgical Endoscopy, vol. 30, no. 7, 2016, pp. 2792-8.
Moghadamyeghaneh Z, Hanna MH, Carmichael JC, et al. Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surg Endosc. 2016;30(7):2792-8.
Moghadamyeghaneh, Z., Hanna, M. H., Carmichael, J. C., Pigazzi, A., Stamos, M. J., & Mills, S. (2016). Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surgical Endoscopy, 30(7), pp. 2792-8. doi:10.1007/s00464-015-4552-8.
Moghadamyeghaneh Z, et al. Comparison of Open, Laparoscopic, and Robotic Approaches for Total Abdominal Colectomy. Surg Endosc. 2016;30(7):2792-8. PubMed PMID: 26487196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. AU - Moghadamyeghaneh,Zhobin, AU - Hanna,Mark H, AU - Carmichael,Joseph C, AU - Pigazzi,Alessio, AU - Stamos,Michael J, AU - Mills,Steven, Y1 - 2015/10/20/ PY - 2015/04/06/received PY - 2015/09/01/accepted PY - 2015/10/22/entrez PY - 2015/10/22/pubmed PY - 2017/8/3/medline KW - Cancer KW - Colectomy KW - Colitis KW - Colorectal KW - Laparoscopy KW - Robotic SP - 2792 EP - 8 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 7 N2 - BACKGROUND: The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy. METHODS: The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS: We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P < 0.01) and robotic approaches (AOR 1.04, 1.30, P < 0.01 and P = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P = 0.10, P = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P < 0.01). CONCLUSION: Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26487196/Comparison_of_open_laparoscopic_and_robotic_approaches_for_total_abdominal_colectomy_ L2 - https://dx.doi.org/10.1007/s00464-015-4552-8 DB - PRIME DP - Unbound Medicine ER -