Robotic Colorectal Surgery Costs are comparable to Laparoscopic Colorectal Surgery: A Costs and Outcome analysis

Vanitha Vasudevan, MD, Ryan Reusche, Hannah Wallace, Srinivas Kaza, MD, FACS. University of Miami Palm Beach Regional Campus

INTRODUCTION: The purpose of this study is to compare and analyze the overall costs and short-term clinical outcomes of Laparoscopic and Robotic Colorectal surgery performed in a high-volume community hospital. We believe that the Robotic platform offers a feasible and economical approach with a shorter learning curve as compared to Laparoscopy.

METHODS AND PROCEDURES: After obtaining Institutional Review Board approval, we performed a retrospective comparative analysis of all Robotic and Laparoscopic colon resections performed for benign and malignant colorectal diseases at a high-volume community hospital between January 2011 and July 2013. We manually reviewed the electronic medical records to include pertinent patient characteristics such as age, sex, body mass index [BMI], American Society of Anesthesiologists classification [ASA], and indication for surgery (benign vs. malignant disease). For comparison, we classified the type of colon resection as Right colectomy and Left colectomy (Sigmoidectomy and Low anterior resection). Outcome analysis included duration of surgery, conversion rates, postoperative complications, length of hospital stay, 90-day readmission rates, 30-day mortality, and overall hospital costs. Outcomes and costs between the two cohorts were analyzed using the student t-test and Fisher’s exact test

RESULTS: Two hundred and twenty seven were included in this comparative analysis out of which 131 patients underwent laparoscopic and 96 underwent robotic colon resections. The mean age (in years) of patients in the Robotic cohort was significantly lower than the laparoscopic cohort (63.6 +12.7 vs 70.9 + 13.4, p<0.001). The mean BMI was comparable between the 2 groups (27.9.vs 26.9, p=0.15). Most of the patients belonged to ASA 2 or 3 in both groups. Around 62% of the patients in both groups were operated for malignant disease. Left sided colectomy was significantly more common in the robotic arm as compared to Laparoscopic arm (69% vs 46%, p=0.001)

The mean operating time was comparable between the laparoscopic and robotic group (113 min vs 109 min, p=0.59). Conversion was noted in 13 patients in the robotic arm (to open or Lap) as compared to 12 patients in lap group (p=0.44, NS). The mean length of hospital stay (6.6 vs 5.7days, p=0.14) and major postoperative complications (3.2% vs 7%, p=0.21) was also comparable between the laparoscopic and robotic arms. No mortality was noted in either group and the 90-day all-cause readmission rate was 10% in Lap vs 8% in the robotic cohort (p=0.8, NS). The mean overall hospital costs were $114,853 for the Laparoscopic group and $107,220 for the robotic group and no significant difference noted statistically (p=0.448, NS)

CONCLUSIONS: Our results demonstrate that Robotic colectomies were comparable to Laparoscopic colectomies in terms of overall hospital costs and short-term clinical outcomes, including length of stay and conversion rates. Robotic surgery was the favored approach for left sided colectomy. We believe that with shorter learning curves and wider availability, robotic approach offers both technically and economically feasible minimally invasive platform for complex colorectal resections.

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