Skip to main content
SpringerLink
Log in

Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Robotic colorectal surgery is being increasingly adopted. Our objective was to compare early postoperative outcomes between robotic and laparoscopic colectomy in a nationally representative sample.

Methods

The American College of Surgeons National Surgical Quality Improvement Project Colectomy Targeted Dataset from 2012 to 2014 was used for this study. Adult patients undergoing elective colectomy with an anastomosis were included. Patients were stratified based on location of colorectal resection (low anterior resection (LAR), left-sided resection, or right-sided resection). Bivariate data analysis was performed, and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes.

Results

There were a total of 25,998 laparoscopic colectomies (30 % LAR’s, 45 % left-sided, and 25 % right-sided) and 1484 robotic colectomies (54 % LAR’s, 28 % left-sided, and 18 % right-sided). The risk-adjusted overall morbidity, serious morbidity, and mortality were similar between laparoscopic and robotic approaches in all anastomotic groups. Patients undergoing robotic LAR had a lower conversion rate (OR 0.47, 95 % CI 1.20–1.76) and postoperative sepsis rate (OR 0.49, 95 % CI 0.29–0.85) but a higher rate of diverting ostomies (OR 1.45, 95 % CI 1.20–1.76). Robotic right-sided colectomies had significantly lower conversion rates (OR 0.58, 95 % CI 0.34–0.96). Robotic colectomy in all groups was associated with a longer operative time (by 40 min) and a decreased length of stay (by 0.5 days).

Conclusions

In a nationally representative sample comparing laparoscopic and robotic colectomies, the overall morbidity, serious morbidity, and mortality between groups are similar while length of stay was shorter by 0.5 days in the robotic colectomy group. Robotic LAR was associated with lower conversion rates and lower septic complications. However, robotic LAR is also associated with a significantly higher rate of diverting ostomy. The reason for this relationship is unclear. Surgeon factors, patient factors, and technical factors should be considered in future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Patel SV, Van Koughnett JA, Howe B, Wexner SD (2015) Spin is common in studies assessing robotic colorectal surgery: an assessment of reporting and interpretation of study results. Dis Colon Rectum 58(9):878–884. doi:10.1097/DCR.0000000000000425

    Article  PubMed  Google Scholar 

  2. Wright JD, Tergas AI, Hou JY et al (2016) Effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery. JAMA Surg. doi:10.1001/jamasurg.2015.5508

    Google Scholar 

  3. Zarak A, Castillo A, Kichler K, de la Cruz L, Tamariz L, Kaza S (2015) Robotic versus laparoscopic surgery for colonic disease: a meta-analysis of postoperative variables. Surg Endosc 29(6):1341–1347. doi:10.1007/s00464-015-4197-7

    Article  PubMed  Google Scholar 

  4. Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD, Members of the SGC (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27(1):1–10. doi:10.1007/s00464-012-2592-x

    Article  PubMed  Google Scholar 

  5. Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19(12):3727–3736. doi:10.1245/s10434-012-2429-9

    Article  PubMed  Google Scholar 

  6. Xu H, Li J, Sun Y, Li Z, Zhen Y, Wang B, Xu Z (2014) Robotic versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 12:274. doi:10.1186/1477-7819-12-274

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wormer BA, Dacey KT, Williams KB, Bradley JF 3rd, Walters AL, Augenstein VA, Stefanidis D, Heniford BT (2014) The first nationwide evaluation of robotic general surgery: a regionalized, small but safe start. Surg Endosc 28(3):767–776. doi:10.1007/s00464-013-3239-2

    Article  PubMed  Google Scholar 

  8. Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, Gulla N, Noya G, Boselli C (2012) Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis 14(4):e134–e156. doi:10.1111/j.1463-1318.2011.02907.x

    Article  CAS  PubMed  Google Scholar 

  9. Tam MS, Kaoutzanis C, Mullard AJ, Regenbogen SE, Franz MG, Hendren S, Krapohl G, Vandewarker JF, Lampman RM, Cleary RK (2015) A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surg Endosc. doi:10.1007/s00464-015-4218-6

    Google Scholar 

  10. Scarpinata R, Aly EH (2013) Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum 56(2):253–262. doi:10.1097/DCR.0b013e3182694595

    Article  PubMed  Google Scholar 

  11. Rencuzogullari A, Gorgun E (2015) Robotic rectal surgery. J Surg Oncol 112(3):326–331. doi:10.1002/jso.23956

    Article  PubMed  Google Scholar 

  12. Tyler JA, Fox JP, Desai MM, Perry WB, Glasgow SC (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum 56(4):458–466. doi:10.1097/DCR.0b013e31827085ec

    Article  PubMed  Google Scholar 

  13. Xiong B, Ma L, Zhang C, Cheng Y (2014) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res 188(2):404–414. doi:10.1016/j.jss.2014.01.027

    Article  PubMed  Google Scholar 

  14. Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226. doi:10.1002/bjs.8841

    Article  CAS  PubMed  Google Scholar 

  15. Derrick J (2015) Everyone’s talking about ROLARR heading into intuitive surgical earnings: here’s what it means. Yahoo! Finance. http://finance.yahoo.com/news/everyones-talking-rolarr-heading-intuitive-173129658.html. Accessed 26 Feb 2016

  16. Wexner S (2015) Robotic versus laparoscopic resection for rectal cancer. https://www.linkedin.com/pulse/robotic-versus-laparoscopic-resection-rectal-cancer-steven. Accessed 26 Feb 2016

  17. Shiloach M, Frencher SK Jr, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, Richards KE, Ko CY, Hall BL (2010) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 210(1):6–16. doi:10.1016/j.jamcollsurg.2009.09.031

    Article  PubMed  Google Scholar 

  18. Miller PE, Dao H, Paluvoi N, Bailey M, Margolin D, Shah N, Vargas D (2016) Comparison of 30-day postoperative outcomes after laparoscopic versus robotic colectomy. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2016.03.041

    Google Scholar 

  19. Ezekian B, Sun Z, Adam MA, Kim J, Turner MC, Gilmore BF, Ong CT, Mantyh CR, Migaly J (2016) Robotic-assisted versus laparoscopic colectomy results in increased operative time without improved perioperative outcomes. J Gastrointest Surg. doi:10.1007/s11605-016-3124-0

    Google Scholar 

  20. Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK (2015) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc. doi:10.1007/s00464-015-4381-9

    PubMed  Google Scholar 

  21. Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks. (2015) National Institutes of Health. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm. Accessed 26 Jan 2016

  22. Morris MS, Graham LA, Chu DI, Cannon JA, Hawn MT (2015) Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg 261(6):1034–1040. doi:10.1097/sla.0000000000001125

    Article  PubMed  Google Scholar 

  23. Scarborough JE, Mantyh CR, Sun Z, Migaly J (2015) Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg 262(2):331–337. doi:10.1097/sla.0000000000001041

    Article  PubMed  Google Scholar 

  24. Reichenbach DJ, Tackett AD, Harris J, Camacho D, Graviss EA, Dewan B, Vavra A, Stiles A, Fisher WE, Brunicardi FC, Sweeney JF (2006) Laparoscopic colon resection early in the learning curve: What is the appropriate setting? Ann Surg 243(6):730–735; discussion 735–737. doi:10.1097/01.sla.0000220039.26524.fa

  25. Nfonsam V, Aziz H, Pandit V, Khalil M, Jandova J, Joseph B (2016) Analyzing clinical outcomes in laparoscopic right versus left colectomy in colon cancer patients using the NSQIP database. Cancer Treat Commun 8:1–4. doi:10.1016/j.ctrc.2016.03.006

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46(10):1371–1378; discussion 1378–1379. doi:10.1097/01.dcr.0000089054.22223.41

  28. Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261(1):129–137. doi:10.1097/SLA.0000000000000613

    Article  PubMed  Google Scholar 

  29. Kim CW, Baik SH, Roh YH, Kang J, Hur H, Min BS, Lee KY, Kim NK (2015) Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis. Medicine 94(22):e823. doi:10.1097/MD.0000000000000823

    Article  PubMed  PubMed Central  Google Scholar 

  30. Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149(2):177–184. doi:10.1001/jamasurg.2013.3660

    Article  PubMed  PubMed Central  Google Scholar 

  31. Baik SH, Kim NK, Lim DR, Hur H, Min BS, Lee KY (2013) Oncologic outcomes and perioperative clinicopathologic results after robot-assisted tumor-specific mesorectal excision for rectal cancer. Ann Surg Oncol 20(8):2625–2632. doi:10.1245/s10434-013-2895-8

    Article  PubMed  Google Scholar 

  32. Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27(9):3297–3307. doi:10.1007/s00464-013-2909-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA

    Scott C. Dolejs, Joshua A. Waters, Eugene P. Ceppa & Ben L. Zarzaur

Authors
  1. Scott C. Dolejs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua A. Waters
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugene P. Ceppa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ben L. Zarzaur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott C. Dolejs.

Ethics declarations

Disclosures

Dolejs, Waters, Ceppa, and Zarzaur have no conflicts of interests or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 78 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dolejs, S.C., Waters, J.A., Ceppa, E.P. et al. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 31, 2387–2396 (2017). https://doi.org/10.1007/s00464-016-5239-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5239-5

Keywords

Search

Navigation