Abstract
Background
Data are limited about the robotic platform in rectal dissections, and its use may be perceived as prohibitively expensive or difficult to learn. We report our experience with the initial robotic-assisted rectal dissections performed by a single surgeon, assessing learning curve and cost.
Methods
Following IRB approval, a retrospective chart review was conducted of the first 85 robotic-assisted rectal dissections performed by a single surgeon between 9/1/2010 and 12/31/2012. Patient demographic, clinicopathologic, procedure, and outcome data were gathered. Cost data were obtained from the University HealthSystem Consortium (UHC) database. The first 43 cases (Time 1) were compared to the next 42 cases (Time 2) using multivariate linear and logistic regression models.
Results
Indications for surgery were cancer for 51 patients (60 %), inflammatory bowel disease for 18 (21 %), and rectal prolapse for 16 (19 %). The most common procedures were low anterior resection (n = 25, 29 %) and abdominoperineal resection (n = 21, 25 %). The patient body mass index (BMI) was statistically different between the two patient groups (Time 1, 26.1 kg/m2 vs. Time 2, 29.4 kg/m2, p = 0.02). Complication and conversion rates did not differ between the groups. Mean operating time was significantly shorter for Time 2 (267 min vs. 224 min, p = 0.049) and remained significant in multivariate analysis. Though not reaching statistical significance, the mean observed direct hospital cost decreased ($17,349 for Time 1 vs. $13,680 for Time 2, p = 0.2). The observed/expected cost ratio significantly decreased (1.47 for Time 1 vs. 1.05 for Time 2, p = 0.007) but did not remain statistically significant in multivariate analyses.
Conclusions
Over the series, we demonstrated a significant improvement in operating times. Though not statistically significant, direct hospital costs trended down over time. Studies of larger patient groups are needed to confirm these findings and to correlate them with procedure volume to better define the learning curve process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694 discussion 1695–1686
Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525
Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC (2012) Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 19:2095–2101
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 19:3727–3736
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–e156
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 37:2782–2790
Miller AT, Berian JR, Rubin M, Hurst RD, Fichera A, Umanskiy K (2012) Robotic-assisted proctectomy for inflammatory bowel disease: a case-matched comparison of laparoscopic and robotic technique. J Gastrointest Surg 16:587–594
Perrenot C, Germain A, Scherrer ML, Ayav A, Brunaud L, Bresler L (2013) Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse. Dis Colon Rectum 56:909–914
American College of Surgeons National Surgical Quality Improvement Program. Available at: http://site.acsnsqip.org; Accessed April 20, 2014
University HealthSystem Consortium. Available at: https://www.uhc.edu; Accessed April 20, 2014
Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of C, Rectal S (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 56:535–550
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 54:275–282
Peterson CY, McLemore EC, Horgan S, Talamini MA, Ramamoorthy SL (2012) Technical aspects of robotic proctectomy. Surg Laparosc Endosc Percutan Tech 22:189–193
Byrn J (2012) Technical considerations in laparoscopic total proctocolectomy. Surg Laparosc Endosc Percutan Tech 22:180–182
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O, Enhanced Recovery After Surgery Society fPC, European Society for Clinical N, Metabolism, International Association for Surgical M, Nutrition (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37:259–284
Ma J, Shukla PJ, Milsom JW (2011) The evolving role of robotic colorectal surgery. Dis Colon Rectum 54:376 author reply 376–377
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 54:144–150
Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27:3297–3307
Salman M, Bell T, Martin J, Bhuva K, Grim R, Ahuja V (2013) Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg 79:553–560
Barbash GI, Glied SA (2010) New technology and health care costs–the case of robot-assisted surgery. N Engl J Med 363:701–704
Scarpinata R, Aly EH (2013) Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum 56:253–262
Wexner SD, Bergamaschi R, Lacy A, Udo J, Brolmann H, Kennedy RH, John H (2009) The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 23:438–443
Pigazzi A, Garcia-Aguilar J (2010) Robotic colorectal surgery: for whom and for what? Dis Colon Rectum 53:969–970
Disclosures
Drs. John Byrn, Jennifer Hrabe, and Mary Charlton have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Byrn, J.C., Hrabe, J.E. & Charlton, M.E. An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience. Surg Endosc 28, 3101–3107 (2014). https://doi.org/10.1007/s00464-014-3591-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3591-x