Madhu Gorrepati, MD1, Shilpa Mehendale, MS, MBA1, Elizabeth Raskin, MD2. 1Intuitive Surgical Inc, 2Loma Linda University Medical Center
INTRODUCTION: Crohn’s disease is an incurable inflammatory disorder that can affect the entire gastrointestinal tract. While medical management is considered first-line treatment, approximately 70% of patients with Crohn’s disease require surgery within 10 years of their initial diagnosis. Traditionally, surgery has been performed via an open approach with poor adoption of minimally invasive technique. The aim of this study is to demonstrate the feasibility of robotic-assisted approach as a minimally invasive option for surgical management of Crohn’s disease and compare the perioperative outcomes with traditional laparotomy.
METHODS: Patients who underwent elective resection of the intestine for Crohn’s disease by robotic-assisted or laparotomy approach from 2011 to Q3 2015 were identified using ICD-9 codes from Premier Healthcare Database. All the procedures were performed by either general surgeons or colorectal surgeons. Since hospital characteristics were comparable between the two cohorts before propensity-score matching, 1:1 matching was performed using patient characteristics such as age, gender, race, Charlson index score and year of the surgery to create comparable cohorts. Sample selection and creation of analytic variables were performed using Instant Health Data (IHD) platform (BHE, Boston, MA). All tests were two-sided, with statistical significance set at a value of p<0.05. Statistical analyses were undertaken with R-statistical software, version 3.2.1.
RESULTS: There were 3,641 patients who received elective segmental intestinal resection for Crohn’s disease. 1910 (52.5%) were performed by laparotomy and 109 (3%) were performed by robotic-assisted approach. Patient characteristics, such as age, gender and Charlson score, were comparable after propensity-score matching. Post-matched comparison between cohorts (N=108 in each cohort) showed that robotic-assisted cases were longer (mean of 240.7 min vs. 181 min, p<0.0001), but had shorter length of stay by a median of 2 days and a lower 30-day complication rate (24 % vs. 38%, p=0.039). Transfusion rates and rate of ileus were similar between the two cohorts.
CONCLUSION: This nationwide real-world comparison of contemporary surgical approaches for segmental bowel resection for Crohn’s disease demonstrates that the robotic-assisted approach is feasible and a viable minimally invasive option for selected patients. Although the mean operative time was longer, the robotic-assisted approach offers the benefits of shorter length of stay and lower 30-day complication rate when compared to laparotomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87118
Program Number: P815
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster