Joseph B Oliver, MD, MPH1, Advaith Bongu, MD1, Devin Toledo2, Abdel-Kareem Beidas, MD1, Sanjiv K Patankar, MD2. 1Rutgers, New Jersey Medical School, 2Saint Peter’s University Hospital
Introduction: Robotic surgery affords increased degrees of freedom of movement, stereoscopic vision and increased magnification. However robotic surgery is not without its own shortcomings including a lack of haptic feedback, steep learning curve, increased operative times and overall costs. Conceivably these costs can be offset by reduced complications, shorter hospital stays and improved recovery times. We sought to examine our complication rates with robotic surgery in our initial learning period.
Methods: Between January 2012 and July 2014, all robotic colorectal procedures performed by a single surgeon were identified from the operative records. This includes the initial proctored cases. The surgeon only had the following exclusion criteria for robotic surgery: emergency cases, and previous stoma or colorectal resection. Information was obtained from the medical record on demographics, operative characteristics, outcomes and complications. Patient comorbidities were graded according to the Charlson Comorbidity Index (CCI) (Charlson, J Chron Dis 1987). Our primary outcome was complications graded according to the Clavien-Dindo Scale (Dindo, Ann Surg 2004). Data is presented as median (range) or percentage (number)
Results: 129 robotic procedures were identified. The median age was 61 (16-93), with a BMI of 27 (17-45) and a CCI of 3 (0-7). The table shows the patient outcomes. There were 6 patients converted to open (5%). Total operative time was 3.4 hours (1.10-9.83 hours) and length of stay was 4 days (1-19 days). Overall the rate of complications was 14% (18/129) with only 1% (1/129) Grade 4. 78% (14/18) of complications were grade 1 requiring no intervention. There were 2 reoperations and 13 readmissions within the 30 day perioperative period. Having any complication was strongly correlated with longer operative times (R=0.300, p<0.001) and increased blood loss (R=0.517, p<0.001).
| Patient Data | |
|
Preoperative Diagnosis: Diverticulitis Cancer or suspicious polyp Miscellaneous |
21% (27) 68% (88) 11% (14) |
|
Procedure: APR LAR Right Colectomy All other procedures |
4.7% (6) 31.8% (41) 37.2% (48) 26.3% (34) |
| Conversions | 5% (6) |
| # Nodes | 19 (1-57) |
| EBL (ml) | 0 (0-800) |
| Operative Time (hrs) | 3.42 (1.10-9.83) |
|
Complications Clavien-1 Clavien-2 Clavien-3 Clavien-4 |
14% (18) 11% (14) 1% (1) 2% (2) 1% (1) |
| Anastomotic Leak | 0.8% (1) |
| Reoperations (30 days) | 2% (2) |
| LOS (days) | 4 (1-19) |
| Readmissions (30 days) | 10% (13) |
|
Final Pathology of Cancer or Suspicious polyp (n=80) Adenocarcinoma Neuroendocrine Adenoma |
57.5% (46) 3.8% (3) 33.8% (27) |
Conclusions: In this large series of robotic colon surgeries from a single surgeon, we demonstrated that robotic colorectal surgery can be done with very low rate of complications and significantly reduced 30 day readmission rate.