Surgical Endoscopy

, Volume 30, Issue 4, pp 1576–1584 | Cite as

A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database

  • Anuradha R. Bhama
  • Vincent Obias
  • Kathleen B. Welch
  • James F. Vandewarker
  • Robert K. Cleary



Until randomized trials mature, large database analyses assist in determining the role of robotics in colorectal surgery. ACS NSQIP database coding now allows differentiation between laparoscopic (LC) and robotic (RC) colorectal procedures. The purpose of this study was to compare LC and RC outcomes by analyzing the ACS NSQIP database.


The ACS NSQIP database was queried to identify patients who had undergone RC and LC during 2013. Demographic characteristics, intraoperative data, and postoperative outcomes were identified. Using propensity score matching, abdominal and pelvic colorectal operative and postoperative outcomes were analyzed.


A total of 11,477 cases were identified. In the abdomen, 7790 LC and 299 RC cases were identified, and 2057 LC and 331 RC cases were identified in the pelvis. There were significant differences in operative time, conversion to an open procedure in the pelvis, and hospital length of stay. RC operative times were significantly longer in both abdominal and pelvic cases. Conversion rates in the pelvis were less for RC when compared to LC—10.0 and 13.7 %, respectively (p = 0.01). Hospital length of stay was significantly shorter for RC abdominal cases than for LC abdominal cases (4.3 vs. 5.3 days, p < 0.001) and for RC pelvic cases when compared to LC pelvic cases (4.5 vs. 5.3 days, p < 0.001). There were no significant differences in surgical site infection (SSI), organ/space SSI, wound complications, anastomotic leak, sepsis/shock, or need for reoperation within 30 days.


As the robotic platform continues to grow in colorectal surgery and as technical upgrades continue to advance, comparison of outcomes requires continuous reevaluation. This study demonstrated that robotic operations have longer operative times, decreased hospital length of stay, and decreased rates of conversion to open in the pelvis. These findings warrant continued evaluation of the role of minimally invasive technical upgrades in colorectal surgery.


Robotic colorectal surgery Laparoscopic colorectal surgery Outcomes Minimally invasive colorectal surgery 



Robert K. Cleary, M.D. and Vincent Obias, M.D. are educational speakers and have received honoraria from Intuitive Surgical Inc. Anuradha R. Bhama, M.D., Kathleen B. Welch, M.P.H, and James F. Vandewarker R.N. have no conflicts of interest or financial ties to disclose.


  1. 1.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525CrossRefPubMedGoogle Scholar
  2. 2.
    deSouza AL, Prasad LM, Ricci J, Park JJ, Marecik SJ, Zimmern A, Blumetti J, Abcarian H (2011) A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma. Dis Colon Rectum 54:275–282CrossRefPubMedGoogle Scholar
  3. 3.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487CrossRefPubMedGoogle Scholar
  4. 4.
    Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH (2010) Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 17:1614–1620CrossRefPubMedGoogle Scholar
  5. 5.
    Lim DR, Min BS, Kim MS, Alasari S, Kim G, Hur H, Baik SH, Lee KY, Kim NK (2013) Robotic versus laparoscopic anterior resection of sigmoid colon cancer: comparative study of long-term oncologic outcomes. Surg Endosc 27:1379–1385CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27:1887–1895CrossRefPubMedGoogle Scholar
  7. 7.
    Eriksen JR, Helvind NM, Jakobsen HL, Olsen J, Bundgaard M, Harvald T, Gögenur I (2013) Early results after robot-assisted colorectal surgery. Dan Med J 60:A4736PubMedGoogle Scholar
  8. 8.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639CrossRefPubMedGoogle Scholar
  9. 9.
    Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14:311–315CrossRefPubMedGoogle Scholar
  10. 10.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708CrossRefPubMedGoogle Scholar
  11. 11.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51:1627–1632CrossRefPubMedGoogle Scholar
  12. 12.
    deSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006CrossRefPubMedGoogle Scholar
  13. 13.
    Deutsch GB, Sathyanarayana SA, Gunabushanam V, Mishra N, Rubach E, Zemon H, Klein JD, Denoto G III (2012) Robotic vs. laparoscopic colorectal surgery: an institutional experience. Surg Endosc 26:956–963CrossRefPubMedGoogle Scholar
  14. 14.
    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 56:458–466CrossRefPubMedGoogle Scholar
  15. 15.
    Samia H, Lawrence J, Nobel T, Stein S, Champagne BJ, Delaney CP (2013) Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline? Am J Surg 205:264–267CrossRefPubMedGoogle Scholar
  16. 16.
    Morpurgo E, Contardo T, Molaro R, Zerbinati A, Orsini C, D’Annibale A (2013) Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv Surg Tech A 23:414–417CrossRefPubMedGoogle Scholar
  17. 17.
    Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T, Madden EB, Cleary RK (2014) Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg 208:33–40CrossRefPubMedGoogle Scholar
  18. 18.
    Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F, Di Marino M, Ricci F, Desiderio J, Cirocchi R, Parisi A (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29:1512–1521CrossRefPubMedGoogle Scholar
  19. 19.
    Trinh BB, Hauch AT, Buell JF, Kandi E (2015) Robot-assisted versus standard laparoscopic colorectal surgery. JSLS. doi: 10.1007/s00464-014-3835-9 Google Scholar
  20. 20.
    Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173CrossRefPubMedGoogle Scholar
  21. 21.
    Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835CrossRefPubMedGoogle Scholar
  22. 22.
    Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A (2010) Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 251:882–886CrossRefPubMedGoogle Scholar
  23. 23.
    Choi DJ, Kim SH, Lee PJ, Kim J, Woo SU (2009) Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients. Dis Colon Rectum 52:1824–1830CrossRefPubMedGoogle Scholar
  24. 24.
    deSouza AL, Prasad LM, Marecik SJ, Blumetti J, Park JJ, Zimmern A, Abcarian H (2010) Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance. Dis Colon Rectum 53:1611–1617CrossRefPubMedGoogle Scholar
  25. 25.
    Park YA, Kim JM, Kim SA, Min BS, Kim NK, Sohn SK, Lee KY (2010) Totally robotic surgery for rectal cancer: from splenic flexure to pelvic floor in one setup. Surg Endosc 24:715–720CrossRefPubMedGoogle Scholar
  26. 26.
    Koh DC, Tsang CB, Kim SH (2011) A new application of the four-arm standard da Vinci(R) surgical system: totally robotic-assisted left-sided colon or rectal resection. Surg Endosc 25:1945–1952CrossRefPubMedGoogle Scholar
  27. 27.
    Leong QM, Son DN, Cho JS, Baek SJ, Kwak JM, Amar AH, Kim SH (2011) Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc 25:2987–2992CrossRefPubMedGoogle Scholar
  28. 28.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Zawadzki M, Velchuru VR, Albalawi SA, Park JJ, Marecik S, Prasad LM (2013) Is hybrid robotic laparoscopic assistance the ideal approach for restorative rectal cancer dissection? Colorectal Dis 15:1026–1032CrossRefPubMedGoogle Scholar
  30. 30.
    Baek SJ, Kim CH, Cho MS, Bae SU, Hur H, Min BS, Lee KY, Kim NK (2015) Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy. Surg Endosc 29:1419–1424CrossRefPubMedGoogle Scholar
  31. 31.
    Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Colorectal Dis 29:1105–1111CrossRefPubMedGoogle Scholar
  32. 32.
    Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13:176–183PubMedPubMedCentralGoogle Scholar
  33. 33.
    Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202CrossRefPubMedGoogle Scholar
  34. 34.
    Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Anderoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24:2888–2894CrossRefPubMedGoogle Scholar
  35. 35.
    D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168CrossRefPubMedGoogle Scholar
  36. 36.
    Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP (2013) Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27:48–55CrossRefPubMedGoogle Scholar
  37. 37.
    Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison—open, laparoscopic, and robotic surgery. Ann Surg 257:95–101CrossRefPubMedGoogle Scholar
  38. 38.
    Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JR (2011) Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol 17:5214–5220CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC (2012) Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 19:2095–2101CrossRefPubMedGoogle Scholar
  40. 40.
    Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J, Perez CF, Diaz JS, Fernandez-Represa JA (2012) Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot 8:360–370CrossRefPubMedGoogle Scholar
  41. 41.
    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 19:3727–3736CrossRefPubMedGoogle Scholar
  42. 42.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2012) Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc 26:1–11CrossRefPubMedGoogle Scholar
  43. 43.
    Fung AK, Aly EH (2013) Robotic colonic surgery: is it advisable to commence a new learning curve? Dis Colon Rectum 56:786–796CrossRefPubMedGoogle Scholar
  44. 44.
    Liao G, Zhao Z, Lin S, Li R, Yuan Y, Du S, Chen J, Deng H (2014) Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol 12:122CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    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:e134–e156CrossRefPubMedGoogle Scholar
  46. 46.
    Papanikolaou IG (2014) Robotic surgery for colorectal cancer: systematic review of the literature. Surg Laparosc Endosc Percutan Tech 24:478–483PubMedGoogle Scholar
  47. 47.
    Kim CW, Kim CH, Baik SH (2014) Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 18:816–830CrossRefPubMedGoogle Scholar
  48. 48.
    Scarpinata R, Aly EH (2013) Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum 56:253–262CrossRefPubMedGoogle Scholar
  49. 49.
    Tam MS, Kaoutzanis C, Mullard AJ, Regenbogen SE, Franz MG, Hendren S, Krapohl G, Vandewarker JF, Lampam 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 PubMedGoogle Scholar
  50. 50.
    Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22:1601–1608CrossRefPubMedGoogle Scholar
  51. 51.
    Jimenez Rodriguez RM, Diaz Pavon JM, de Juan FDLP, Sillero EP, Dussort JMHC, Padillo J (2011) Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection. Cir Esp 89:432–438CrossRefPubMedGoogle Scholar
  52. 52.
    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 99:1219–1226CrossRefPubMedGoogle Scholar
  53. 53.
    Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R et al (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 27:233–241CrossRefPubMedGoogle Scholar
  54. 54.
    Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2012) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54:151–156CrossRefGoogle Scholar
  55. 55.
    Kuo LJ, Lin YK, Chang CC, Tai CJ, Chiou JF, Chang YJ (2014) Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis 29:555–562CrossRefPubMedGoogle Scholar
  56. 56.
    Halabi WJ, Kang CY, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, Pigazzi A (2013) Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes. World J Surg 37:2782–2790CrossRefPubMedGoogle Scholar
  57. 57.
    Araujo SE, Seid VE, Klajner S (2014) Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes. World J Gastroenterol 20:14359–14370CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Patel CB, Ragupathi M, Ramos-Valadez DI, Haas EM (2011) A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. Dis Colon Rectum 54:144–150CrossRefPubMedGoogle Scholar
  59. 59.
    Trinh BB, Jackson NR, Hauch AT, Hu T, Kandil E (2014) Robotic versus laparoscopic colorectal surgery. JSLS. doi: 10.4293/JSLS.2014.00187 Google Scholar
  60. 60.
    Byrn JC, Hrabe JE, Charlton ME (2014) An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience. Surg Endosc 28:3101–3107CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Anuradha R. Bhama
    • 1
  • Vincent Obias
    • 3
  • Kathleen B. Welch
    • 2
  • James F. Vandewarker
    • 1
  • Robert K. Cleary
    • 1
  1. 1.Division of Colon and Rectal Surgery, Department of SurgerySt. Joseph Mercy Health System - Ann ArborAnn ArborUSA
  2. 2.Center for Statistical Consultation and ResearchUniversity of MichiganAnn ArborUSA
  3. 3.Division Colon and Rectal Surgery, Department of SurgeryGeorge Washington UniversityWashingtonUSA

Personalised recommendations