Zhobin Moghadamyeghaneh, MD, Mark H Hanna, MD, Grace Hwang, MD, Joseph C Carmichael, MD, Alessio Pigazzi, MD, Michael J Stamos, MD, Steven D Mills, MD. University of California, Irvine
There is limited data regarding comparison of robotic approach surgery with open and laparoscopic approaches in colorectal surgery. We sought to compare outcomes of patients who underwent total abdominal colectomy according to three approaches; laparoscopic, open, and robotic.
The NIS databases were used to examine the clinical data of patients undergoing total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches.
We sampled a total of 34,437 patients who underwent total colectomy. Of these, 26086(75.8%) had an open operation, while 9580(27.8%) had a minimally invasive approach (9339 laparoscopic surgery, and 242 robotic surgery). Overall, 54.6% of patients were admitted electively. The most common indication for operation was ulcerative colitis (54.2%) followed by diverticulosis (20.6%) and colon cancer (20.1%). Conversion rate of laparoscopic surgery to open was 13.6% and robotic procedures did not have any conversions. The median length of hospitalization for minimally invasive procedures was 7 days (6 days robotic and 7 days laparoscopic), while the median length of hospitalization length of patients who underwent open colectomy was significantly higher (10 vs. 7 days, P<0.01). Following multivariate analysis of data, mortality risk (AOR: 3.90, P<0.01) and postoperative complications of respiratory failure (AOR: 4.29, P<0.01), pneumonia (AOR: 2.43, P<0.01), and myocardial infarction (AOR: 2.10, P<0.01) were significantly higher in open compared to minimally invasive approaches. However, there was no significant difference in intra-abdominal abscess/ anastomosis leakage between open colectomy and minimally invasive approaches (AOR: 1.11, P=0.26).
Minimally invasive approach to total colectomy is safe, with the advantage of lower mortality, morbidity, and hospitalization length compared to an open approach. There is no significant difference in intra-abdominal abscess/ anastomosis leakage between open and minimally invasive approaches. Robotic approach to total colectomy procedure had the advantage of a significantly lower conversion rate compared to laparoscopic approach.