Robotic versus standard laparoscopic elective colectomy

where are the benefits?

Audrey S. Kulaylat, Katelin A. Mirkin, Frances Puleo, Christopher S. Hollenbeak, Evangelos Messaris

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections. Methods Patients undergoing non-emergent laparoscopic (LC) or robotic (RC) colon resections were identified in National Surgical Quality Improvement Project (2013-2015). Patients were matched 1:1 between cohorts using propensity score matching. To account for the prolonged operative time associated with robotic cases, operative times were stratified into approach-specific (LC or RC) tertiles (low, medium, and high) as covariates in the matching algorithm. Results RC increased significantly over time and had lower conversion rates (6.0% among RC versus 11.5% among LC, P < 0.001). RC cases were longer (226 min versus 178 min, P < 0.001). Unadjusted complication rates were higher in the LC cohort (17.5% versus 15.2%, P < 0.001). After propensity score matching, RC was not associated with a significant difference in postoperative morbidity (15.2% among RC versus 15.9% among LC, P = 0.434). The robotic approach was associated with a one-half day shorter length of stay (4.6 d versus 5.2 d, P < 0.001), but similar 30-day readmission rates (8.9% versus 8.3%, P = 0.368). Conclusions After controlling for operative duration and patient covariates, RC was associated with similar rates of postoperative morbidity, but decreased conversion rates and shorter length of stay. Further studies examining costs are needed to evaluate whether these benefits offset the increased costs associated with robotic approaches.

Original languageEnglish (US)
Pages (from-to)72-78
Number of pages7
JournalJournal of Surgical Research
Volume224
DOIs
StatePublished - Apr 1 2018

Fingerprint

Colectomy
Robotics
Operative Time
Propensity Score
Morbidity
Length of Stay
Colon
Costs and Cost Analysis
Colorectal Surgery
Quality Improvement

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{1f73192d64a94b6ba094bf35cca7c561,
title = "Robotic versus standard laparoscopic elective colectomy: where are the benefits?",
abstract = "Background Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections. Methods Patients undergoing non-emergent laparoscopic (LC) or robotic (RC) colon resections were identified in National Surgical Quality Improvement Project (2013-2015). Patients were matched 1:1 between cohorts using propensity score matching. To account for the prolonged operative time associated with robotic cases, operative times were stratified into approach-specific (LC or RC) tertiles (low, medium, and high) as covariates in the matching algorithm. Results RC increased significantly over time and had lower conversion rates (6.0{\%} among RC versus 11.5{\%} among LC, P < 0.001). RC cases were longer (226 min versus 178 min, P < 0.001). Unadjusted complication rates were higher in the LC cohort (17.5{\%} versus 15.2{\%}, P < 0.001). After propensity score matching, RC was not associated with a significant difference in postoperative morbidity (15.2{\%} among RC versus 15.9{\%} among LC, P = 0.434). The robotic approach was associated with a one-half day shorter length of stay (4.6 d versus 5.2 d, P < 0.001), but similar 30-day readmission rates (8.9{\%} versus 8.3{\%}, P = 0.368). Conclusions After controlling for operative duration and patient covariates, RC was associated with similar rates of postoperative morbidity, but decreased conversion rates and shorter length of stay. Further studies examining costs are needed to evaluate whether these benefits offset the increased costs associated with robotic approaches.",
author = "Kulaylat, {Audrey S.} and Mirkin, {Katelin A.} and Frances Puleo and Hollenbeak, {Christopher S.} and Evangelos Messaris",
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Robotic versus standard laparoscopic elective colectomy : where are the benefits? / Kulaylat, Audrey S.; Mirkin, Katelin A.; Puleo, Frances; Hollenbeak, Christopher S.; Messaris, Evangelos.

In: Journal of Surgical Research, Vol. 224, 01.04.2018, p. 72-78.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Robotic versus standard laparoscopic elective colectomy

T2 - where are the benefits?

AU - Kulaylat, Audrey S.

AU - Mirkin, Katelin A.

AU - Puleo, Frances

AU - Hollenbeak, Christopher S.

AU - Messaris, Evangelos

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections. Methods Patients undergoing non-emergent laparoscopic (LC) or robotic (RC) colon resections were identified in National Surgical Quality Improvement Project (2013-2015). Patients were matched 1:1 between cohorts using propensity score matching. To account for the prolonged operative time associated with robotic cases, operative times were stratified into approach-specific (LC or RC) tertiles (low, medium, and high) as covariates in the matching algorithm. Results RC increased significantly over time and had lower conversion rates (6.0% among RC versus 11.5% among LC, P < 0.001). RC cases were longer (226 min versus 178 min, P < 0.001). Unadjusted complication rates were higher in the LC cohort (17.5% versus 15.2%, P < 0.001). After propensity score matching, RC was not associated with a significant difference in postoperative morbidity (15.2% among RC versus 15.9% among LC, P = 0.434). The robotic approach was associated with a one-half day shorter length of stay (4.6 d versus 5.2 d, P < 0.001), but similar 30-day readmission rates (8.9% versus 8.3%, P = 0.368). Conclusions After controlling for operative duration and patient covariates, RC was associated with similar rates of postoperative morbidity, but decreased conversion rates and shorter length of stay. Further studies examining costs are needed to evaluate whether these benefits offset the increased costs associated with robotic approaches.

AB - Background Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections. Methods Patients undergoing non-emergent laparoscopic (LC) or robotic (RC) colon resections were identified in National Surgical Quality Improvement Project (2013-2015). Patients were matched 1:1 between cohorts using propensity score matching. To account for the prolonged operative time associated with robotic cases, operative times were stratified into approach-specific (LC or RC) tertiles (low, medium, and high) as covariates in the matching algorithm. Results RC increased significantly over time and had lower conversion rates (6.0% among RC versus 11.5% among LC, P < 0.001). RC cases were longer (226 min versus 178 min, P < 0.001). Unadjusted complication rates were higher in the LC cohort (17.5% versus 15.2%, P < 0.001). After propensity score matching, RC was not associated with a significant difference in postoperative morbidity (15.2% among RC versus 15.9% among LC, P = 0.434). The robotic approach was associated with a one-half day shorter length of stay (4.6 d versus 5.2 d, P < 0.001), but similar 30-day readmission rates (8.9% versus 8.3%, P = 0.368). Conclusions After controlling for operative duration and patient covariates, RC was associated with similar rates of postoperative morbidity, but decreased conversion rates and shorter length of stay. Further studies examining costs are needed to evaluate whether these benefits offset the increased costs associated with robotic approaches.

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U2 - 10.1016/j.jss.2017.11.059

DO - 10.1016/j.jss.2017.11.059

M3 - Article

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JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

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