Elizabeth E Price, DO, Matthew Robinson, DO, Robert Carman, DO. UPMC Pinnacle Community Osteopathic Hospital
Introduction: Robotic surgery is becoming more prevalent in colorectal surgery. Some question if the cost associated with robotic training and its equipment is superior to its laparoscopic counterpart. There have been few studies comparing postoperative outcomes and pain control between the two approaches to identify if one approach is superior to the other. This study compares operative times and postoperative outcomes between laparoscopic and robotic approaches by a single fellowship-trained colorectal surgeon during his first two years of performing robotic colectomies.
Methods: The study is a retrospective single institution review of patients who underwent an elective sigmoid colectomy by a single surgeon. Sixteen patients had an elective laparoscopic sigmoid colectomy from August 2014 to December 2016 and twenty-one patients had an elective robotic sigmoid colectomy from November 2016 to July 2018. All resections were performed for diverticular disease, polyps unamenable to endoscopic resection or malignancy. Data was collected on anesthesia times, procedure times, length of stay, return of bowel function, days until on discharge diet and postoperative days requiring intravenous narcotics.
Results: Mean anesthesia time was 198 minutes and 215 minutes in the robotic and laparoscopic groups respectively. Mean procedure time was 166 minutes robotically compared to 171 minutes laparoscopically. Our data shows decreased operative and anesthesia times in the robotic group. Mean length of stay was 3.67 days for the robotic group versus 3.75 days for the laparoscopic group. Return of bowel function was 2.24 days for the robotic group versus 2.31 days for the laparoscopic group. Postoperative day to discharge diet was 3.24 days in the robotic group and 3.56 days in the laparoscopic group. Patients had less postoperative pain in the robotic group than the laparoscopic group. A majority of the robotic group patients did not require patient-controlled-analgesia and days until off intravenous narcotics was decreased compared to the laparoscopic group, 0.62 days versus 1.38 days.
Conclusion: A robotic approach for elective sigmoid colectomy appears to be an acceptable alternative to a laparoscopic approach. On average, anesthesia and operative times were decreased in the robotic group compared to the laparoscopic group. Length of stay, return of bowel function and day until discharge diet were similar between the two groups. However, postoperative pain was decreased in the robotic group as evident by reduced patient-controlled-analgesia and intravenous narcotic use. Further study is needed with larger sample sizes to define if a robotic approach is superior over a laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94649
Program Number: P352
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster