Vanitha Vasudevan, MD, Chetan Patel, MD, Joshua Parreco, MD, Srinivas Kaza, MD. Department of Surgery, University of Miami Miller School of Medicine, Palm Beach Regional Cmapus, Atlantis, FL.
Introduction – The purpose of this study is to evaluate the safety, effectiveness and short term outcomes of Robotic-assisted colon surgeries performed in a high volume community hospital. We believe that the learning curve for robotic-assisted surgery is shorter than that for laparoscopic colon surgery; hence, increased robotic experience in colon surgery will result in shorter operative times and improved outcomes as compared to what is reported in current literature.
Methods and Procedures – This is a retrospective cohort study of all Robotic-Assisted Colon Resections (da Vinci Surgical Robot System) performed in a high volume community hospital by a high volume surgeon between Jan 2011 and July 2013 for both benign and malignant colon diseases. Patient characteristics like age, sex, body mass index [BMI], American Society of Anesthesiologists classification [ASA], and indication for surgery (benign vs. malignant disease) were collected from chart analysis. Outcomes analyzed were operative times, conversion rates, post operative complications, length of hospital stay, and mortality. For malignant disease, we also evaluated the adequacy of margins and average lymph node yield.
Results – Sixty-seven patients underwent Robotic-assisted colon resections (right colectomy n=24; left colectomy n=43). The mean age of patients was 62 +/- 12.3 years. The mean BMI was 28.7. Fifty-five percent of patients were female. Forty-nine percent (n=33) belonged to ASA class 2 and 51% (n=34) to ASA class 3. Mean operating time, including robot docking time, was 71.2 +/- 20.2 min for right colectomy and 97.0 +/- 28.4 min for left colectomy. The operative time for right colectomy was significantly shorter than for left colectomy (p < 0.01). Conversion to an open procedure was noted in 2 patients (2.9%). Post-operative complications were noted in 6 patients (8.9%), which included 1 contained anastomotic leak. The 90-day mortality rate was 1.5% (n=1). The average length of hospital stay was 4.62 days (range 2 to 15) for right colectomy and 4.7 days (range 2-29) for left colectomy. There were 28 patients with malignant disease (42%), of whom 27 had adequate resection margins, and the average lymph node yield was 13.3.
Conclusion – We conclude that Robotic Colon surgery is safe and feasible for both right- and left-sided colon resections even in high operative risk patients (based on high ASA) with satisfactory outcomes. The conversion rate is low and oncologic yield in terms of lymph node and margins is excellent. Mean operating times in this study are shorter than those reported in literature, which we believe is related to the high volume of cases performed by the surgeon at this center. Future studies should focus on the overall cost-effectiveness of robotic surgery in light of reduced complications and hospital stay.