Surgical Endoscopy

, Volume 28, Issue 1, pp 212–221 | Cite as

Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection

  • Deborah S. KellerEmail author
  • Anthony J. Senagore
  • Justin K. Lawrence
  • Brad J. Champagne
  • Conor P. Delaney



During the past 20 years, laparoscopy has revolutionized colorectal surgery. With proven benefits in patient outcomes and healthcare utilization, laparoscopic colorectal surgery has steadily increased in use. Robotic surgery, a new addition to colorectal surgery, has been suggested to facilitate and overcome limitations of laparoscopic surgery. Our objective was to compare the outcomes of robot-assisted laparoscopic resection (RALR) to laparoscopic resections (LAP) in colorectal surgery.


A national inpatient database was evaluated for colorectal resections performed over a 30-month period. Cases were divided into traditional LAP and RALR resection groups. Cost of robot acquisition and servicing were not measured. Main outcome measures were hospital length of stay (LOS), operative time, complications, and costs between groups.


A total of 17,265 LAP and 744 RARL procedures were identified. The RALR cases had significantly higher total cost ($5,272 increase, p < 0.001) and direct cost ($4,432 increase, p < 0.001), significantly longer operating time (39 min, p < 0.001), and were more likely to develop postoperative bleeding (odds ratio 1.6; p = 0.014) than traditional laparoscopic patients. LOS, complications, and discharge disposition were comparable. Similar findings were noted for both laparoscopic colonic and rectal surgery.


RALR had significantly higher costs and operative time than traditional LAP without a measurable benefit.


Robotic surgery Laparoscopic surgery Healthcare utilization Surgical outcomes Colorectal surgery 



This study was completed with support from Lobat Hashemi from Covidien’s Healthcare Economics and Outcomes Research Department.


Drs. Keller, Senagore, Lawrence, Champagne, and Delaney have no conflicts of interest or financial ties to disclose.


  1. 1.
    Patel VR, Palmer KJ, Coughlin G, Samavedi S (2008) Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol 22(10):2299–2305PubMedCrossRefGoogle Scholar
  2. 2.
    Abbou CC, Hoznek A, Salomon L, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D (2000) Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol 10(4):520–523PubMedGoogle Scholar
  3. 3.
    Abbou CC, Hoznek A, Salomon L, Olsson LE, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D (2001) Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 165(6 Pt 1):1964–1966PubMedGoogle Scholar
  4. 4.
    Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP (2012) Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27(1):48–55PubMedCrossRefGoogle Scholar
  5. 5.
    Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252(2):254–262PubMedCrossRefGoogle Scholar
  6. 6.
    Pigazzi A, Garcia-Aguilar J (2010) Robotic colorectal surgery: for whom and for what? Dis Colon Rectum 53(7):969–970PubMedCrossRefGoogle Scholar
  7. 7.
    Peplinski R (2006) Past, present and future of the da Vinci robot. 2nd UK robotic urology course. Guy’s Hospital, LondonGoogle Scholar
  8. 8.
    Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC (2008) A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 199(4):357.e1–357.e7Google Scholar
  9. 9.
    Mok ZW, Yong EL, Low JJ, Ng JS (2012) Clinical outcomes in endometrial cancer care when the standard of care shifts from open surgery to robotics. Int J Gynecol Cancer 22(5):819–825PubMedCrossRefGoogle Scholar
  10. 10.
    Cadeddu JA, Stoianovici D, Kavoussi LR (1997) Robotics in urologic surgery. Urology 49(4):501–507PubMedCrossRefGoogle Scholar
  11. 11.
    Ficarra V, Cavalleri S, Novara G, Aragona M, Artibani W (2007) Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol 51(1):45–55 discussion 56PubMedCrossRefGoogle Scholar
  12. 12.
    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(47):5214–5220PubMedCrossRefGoogle Scholar
  13. 13.
    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(7):2095–2101PubMedCrossRefGoogle Scholar
  14. 14.
    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(3):360–370PubMedGoogle Scholar
  15. 15.
    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):1219–1226PubMedCrossRefGoogle Scholar
  16. 16.
    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–e156PubMedCrossRefGoogle Scholar
  17. 17.
    Ostrowitz MB, Eschete D, Zemon H, DeNoto G (2009) Robotic-assisted single-incision right colectomy: early experience. Int J Med Robot 5(4):465–470PubMedGoogle Scholar
  18. 18.
    Link RE, Bhayani SB, Kavoussi LR (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243(4):486–491PubMedCrossRefGoogle Scholar
  19. 19.
    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(6):1480–1487PubMedCrossRefGoogle Scholar
  20. 20.
    Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493PubMedCrossRefGoogle Scholar
  21. 21.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46(12):1633–1639PubMedCrossRefGoogle Scholar
  22. 22.
    Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363(8):701–704PubMedCrossRefGoogle Scholar
  23. 23.
    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(12):2162–2168PubMedCrossRefGoogle Scholar
  24. 24.
    Leddy LS, Lendvay TS, Satava RM (2010) Robotic surgery: applications and cost effectiveness. Open Access Surg 3:99–107CrossRefGoogle Scholar
  25. 25.
    Dulan G, Rege RV, Hogg DC, Gilberg-Fisher KM, Arain NA, Tesfay ST, Scott DJ (2012) Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery 152(3):477–488PubMedCrossRefGoogle Scholar
  26. 26.
    Cormier B, Nezhat F, Sternchos J, Sonoda Y, Leitao MMJ (2012) Electrocautery-associated vascular injury during robotic-assisted surgery. Obstet Gynecol 120(2 Pt 2):491–493PubMedCrossRefGoogle Scholar
  27. 27.
    Shveiky D, Aseff JN, Iglesia CB (2010) Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 17(4):414–420PubMedCrossRefGoogle Scholar
  28. 28.
    Carreyrou J (2010) Surgical robot examined in injuries. Wall Street J Google Scholar
  29. 29.
    Citron Research Reports on Intuitive Surgical: has the halo been broken on intuitive surgical? Available at:
  30. 30.
    Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363(8):701–704PubMedCrossRefGoogle Scholar
  31. 31.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2012) Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc 26(1):1–11PubMedCrossRefGoogle Scholar
  32. 32.
    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(7):1000–1006PubMedCrossRefGoogle Scholar
  33. 33.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  34. 34.
    Averill RF, Goldfield N, Hughes JS, Bonazell J, McCullough EC et al (2003) All-Patient Refined Diagnosis Related Groups (APR-DRGs), Version. 20Google Scholar
  35. 35.
    Howington JA, Gunnarsson CL, Maddaus MA, McKenna RJ, Meyers BF, Miller D, Moore M, Rizzo JA, Swanson S (2012) In-hospital clinical and economic consequences of pulmonary wedge resections for cancer using video-assisted thoracoscopic techniques vs traditional open resections: a retrospective database analysis. Chest 141(2):429–435PubMedCrossRefGoogle Scholar
  36. 36.
    SAGES-MIRA Robotic Surgery Consensus Group (2007) A consensus document on robotic surgery. Available at: Accessed April 2013
  37. 37.
    Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, Gettman MT (2009) Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 103(4):448–453PubMedCrossRefGoogle Scholar
  38. 38.
    Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25(1):240–248PubMedCrossRefGoogle Scholar
  39. 39.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21(10):1701–1708PubMedCrossRefGoogle Scholar
  40. 40.
    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):1219–1226PubMedCrossRefGoogle Scholar
  41. 41.
    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(5):882–886PubMedCrossRefGoogle Scholar
  42. 42.
    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(6):1480–1487PubMedCrossRefGoogle Scholar
  43. 43.
    Bodner J, Augustin F, Wykypiel H, Fish J, Muehlmann G, Wetscher G, Schmid T (2005) The da Vinci robotic system for general surgical applications: a critical interim appraisal. Swiss Med Wkly 135(45–46):674–678PubMedGoogle Scholar
  44. 44.
    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(11):1824–1830PubMedCrossRefGoogle Scholar
  45. 45.
    Kim NK, Kang J (2010) Optimal total mesorectal excision for rectal cancer: the role of robotic surgery from an expert’s view. J Korean Soc Coloproctol 2010 26(6):377–387CrossRefGoogle Scholar
  46. 46.
    Delaney CP, Senagore AJ, Ponsky L (2010) Robot-assisted surgery and health care costs. N Engl J Med 363(22):2175; author reply 2176Google Scholar
  47. 47.
    OSHPD (2010) Patient discharge data file documentation. PDD (Public File). Available at: Accessed April 2013
  48. 48.
    Ahmed K, Ibrahim A, Wang TT, Khan N, Challacombe B, Khan MS, Dasgupta P (2012) Assessing the cost effectiveness of robotics in urological surgery: a systematic review. BJU IntGoogle Scholar
  49. 49.
    Sleeper J, Lotan Y (2011) Cost-effectiveness of robotic-assisted laparoscopic procedures in urologic surgery in the USA. Expert Rev Med Devices 8(1):97–103PubMedCrossRefGoogle Scholar
  50. 50.
    Franks PJ, Bosanquet N, Thorpe H, Brown JM, Copeland J, Smith AM, Quirke P, Guillou PJ (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95(1):6–12PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E, Anderberg B (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91(4):409–417PubMedCrossRefGoogle Scholar
  52. 52.
    Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1):67–72PubMedGoogle Scholar
  53. 53.
    Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247(5):819–824PubMedCrossRefGoogle Scholar
  54. 54.
    Baek JH, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25(2):521–525PubMedCrossRefGoogle Scholar
  55. 55.
    Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24(11):2888–2894PubMedCrossRefGoogle Scholar
  56. 56.
    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(2):176–183PubMedCentralPubMedGoogle Scholar
  57. 57.
    Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–840PubMedCrossRefGoogle Scholar
  58. 58.
    Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) “Fast track” postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88(11):1533–1538PubMedCrossRefGoogle Scholar
  59. 59.
    Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203(3):353–355 discussion 355–356PubMedCrossRefGoogle Scholar
  60. 60.
    Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46(4):503–509PubMedCrossRefGoogle Scholar
  61. 61.
    Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199(5):675–679PubMedCrossRefGoogle Scholar
  62. 62.
    Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254(6):868–875PubMedCrossRefGoogle Scholar
  63. 63.
    Coleman MG, Hanna GB, Kennedy R (2011) The National Training Programme for Laparoscopic Colorectal Surgery in England: a new training paradigm. Colorectal Dis 13(6):614–616PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Deborah S. Keller
    • 1
    Email author
  • Anthony J. Senagore
    • 2
  • Justin K. Lawrence
    • 1
  • Brad J. Champagne
    • 1
  • Conor P. Delaney
    • 1
  1. 1.Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center Case Western Reserve UniversityClevelandUSA
  2. 2.Division of Colorectal Surgery, Department of SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA

Personalised recommendations