Minimally Invasive Approach to Treatment of all Colorectal pathology: A retrospective chart review and experience of One Surgeon

Anna Goldenberg, DO, Devin Flaherty, DO, PhD, Mara Piltin, MSIII, Roy L Sandau, DO

University of Medicine and Dentistry of New Jersey-SOM Kennedy University Hospital

Introduction:

Over the last 30 years the face of surgery has been moving in the direction of minimally invasive techniques for colorectal pathology. In the last decade, with the forthcoming of multiple robotic surgical systems, Da Vinci used most commonly, more options are available to surgeons for overcoming difficulties inherent to laparoscopic surgery. The aim of the study was to retrospectively compare open, laparoscopic, and robotic approaches for treatment of all colorectal pathology in a community hospital performed by one surgeon.

Methods:

The study design is a retrospective chart review of 89 patients surgically treated by a single surgeon for acute and elective colorectal procedures between the dates August 1st, 2009 – September 1st, 2012. Laparoscopic procedure included laparoscopic assisted, hand assisted and single access surgeries. Robotic assisted included laparoscopic assisted and single access surgeries. For this study procedures included fifteen open, fifty laparoscopic, six laparoscopic converted to open, and seventeen robotic colectomies. Diseases included malignancy, diverticulitis, volvulus, c.difficile colitis, diverticular bleeding, and ischemia. The factors analyzed were operative time, length of stay, complications, oncologic outcomes, and conversion rates. Statistics were calculated by Anova single factor analysis. P value of <0.05 is considered clinically significant.

Results:

Eighty-nine patients were studied retrospectively. There were 15 open procedures(OP) with mean age of 64, mean length of stay (LOS) of 9 ± 2.8, lymph nodes (LN) sampled during oncologic procedures of 10.25 ±3.8, mean operative time of 149 ± 19 minutes, and 12% (n=2) complications. There were 50 laparoscopic procedures (LP) with a mean age of 59, mean LOS of 4.8 ± 2.8 days, mean number of LN sampled was 14.5 ± 6.3, mean operative time of 210 ± 62 min, 16 % (n=8) rate of complications. The conversion to an open procedure was 12% (n=6). Seventeen robotic assisted laparoscopic (RALS) procedure were included in the study with a mean age of 65, mean LOS of 4.2 ± 2.1 days, mean number of LN sampled were 11.3 ± 3.7, mean operative time of 289 ± 82 min, 6 % (n=1) rate of complications and a 0% (n=0) converstion rate. Statistical significance was seen for operative time (p<0.05) and length of stay (p<0.05), favoring robotic procedures.

Conclusion:

Minimally invasive colorectal surgery is gaining acceptance and popularity in more complex and acute colorectal cases. The availability of the Da Vinci robotic system in small community based hospitals can greatly change the options available to both surgeons and patients for various procedures.


Session: Poster Presentation

Program Number: P122

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