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Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program

Abstract

Background

Minimally invasive surgery (MIS) for colorectal disease has well-known benefits, but many patients undergo open operations. When choosing an MIS approach, robotic technology may have benefits over traditional laparoscopy and is increasingly used. However, the broad adoption of MIS, and specifically robotics, across colorectal operations has not been well described. Our primary hypothesis is that rates of MIS in colorectal surgery are increasing, with different contributions of robotics to abdominal and pelvic colorectal operations.

Methods

Rates of MIS colorectal operations are described using a prospective cohort of elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP) from 2011 to 2018. The main outcome was proportion of cases approached using open, laparoscopic, and robotic surgery. Factors associated with increased use of MIS approaches were described.

Results

Across 21,423 elective colorectal operations, rates for MIS (laparoscopic or robotic surgery) increased from 44% in 2011 to 75% in 2018 (p < 0.001). Approaches for abdominal operations (n = 12,493) changed from 2 to 11% robotic, 43 to 63% laparoscopic, and 56 to 26% open (p < 0.001). Approaches for pelvic operations (n = 8930) changed from 3 to 33% robotic, 40 to 42% laparoscopic, and 57 to 24% open(p < 0.001). These trends were similar for high-(100 + operations/year) and low-volume hospitals and surgeons.

Conclusions

At SCOAP hospitals, the majority of elective colorectal operations is now performed minimally invasively. The increase in the MIS approach is primarily driven by laparoscopy in abdominal procedures and robotics in pelvic procedures.

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Funding

Kenley R. Unruh, MD, education, travel support from Intuitive Surgical, Inc.; Amir L. Bastawrous, MD, MBA, education, travel speaking, training support from Intuitive Surgical, Inc. Also serves on Medtronic advisory board; Greta V. Bernier, MD, education, travel support from Intuitive Surgical, Inc.; David R. Flum, MD MPH, no support from robotic companies; Anjali S. Kumar, MD, MPH, education, travel support from Intuitive Surgical, Inc.; Ravi Moonka, MD, education, travel support from Intuitive Surgical, Inc.; Richard C. Thirlby, MD, food, beverage from Medtronic USA, Inc.; Vlad V. Simianu, MD, MPH, education, travel support from Intuitive Surgical, Inc.

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Authors

Contributions

Kenley R. Unruh, MD – Substantial contributions to the conception and design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Amir L. Bastawrous, MD MBA – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Greta V. Bernier, MD – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

David R. Flum, MD MPH – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Anjali S. Kumar, MD MPH – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ravi Moonka, MD – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Richard C. Thirlby, MD – Substantial contributions to the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Vlad V. Simianu, MD, MPH – Substantial contributions to the conception and design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Vlad V. Simianu.

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Disclaimer

The Surgical Care Outcomes Assessment Program (SCOAP) is a clinical quality program of the Foundation for Health Care Quality. Dr. Bastawrous holds a position in the Speaker’s Bureau for Intuitive Surgical, Inc. and is on Medtronic advisory board.

Additional information

Meeting Presentations: E-poster presentation at American College of Surgeon Clinical Congress 2019, San Francisco, CA, October 27-31 2019. Podium presentation at Washington Chapter American College of Surgeon Meeting 2019, Chelan, WA, June 13-16 2019.

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Unruh, K.R., Bastawrous, A.L., Bernier, G.V. et al. Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program. J Gastrointest Surg 25, 2387–2397 (2021). https://doi.org/10.1007/s11605-020-04875-1

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Keywords

  • Robotic
  • Laparoscopic
  • MIS
  • Colorectal
  • Diverticulitis