Patricio Lynn, David Schwartzberg, MD, H. Hande Aydinli, MD, Mitchell Bernstein, MD, FACS, FASCRS, Alexis Grucela, MD, FACS, FASCRS. New York University Langone Medical Center
Introduction: Laparoscopic subtotal colectomy (LSTC) was initially controversial in patients with severe acute Ulcerative Colitis (UC) given patients’ severity of illness, toxicity, and technical factors such as colonic dilatation. Since then, it has been shown to be feasible and safe in experienced hands. The development and adoption of the Intuitive da Vinci® Xi Robot has allowed ease of use for multiquadrant surgery with minimal docking time. Our goal is to compare the intraoperative and postoperative outcomes of our early experience with Robotic Subtotal Colectomy(RSTC) vs. LSTC.
Methods: We queried our prospectively maintained database of patients who underwent RSTC from 2015-2017. We identified patients who underwent RSTC for severe acute UC and compared them to a matched cohort of patients who underwent LSTC for the same diagnosis. Statistical significance was set at 0.05. The Intuitive da Vinci Xi was used for all Robotic approaches. Port placement and specimen extraction(via the ileostomy site) were uniform within both groups.
Results: We identified 6 patients who underwent RSTC(4 females, median age: 41.5 years) and 13 patients who underwent LSTC (6 females, median age: 29 years). They were well matched for gender and demographic variables. The RSTC group had more patients with significant comorbidities (5/6 = 83%) than the LSTC group (3/13 = 23%) (p=0.01). There were no differences in operative time (mean RSTC 314.0 vs. LSTC 294 minutes, p=0.5) or estimated blood loss (RSTC 79 ml vs. LSTC 75 ml, p=0.9). Mean length of stay was shorter (1.2 days) for RTSC (3.4 vs. 4.6 days, p=0.2) and return of bowel function was earlier (0.7 days) in the RSTC group (1.3 vs. 2 days, p=0.1), however, these were not statistically different. There were no intraoperative complications in either group. Postoperative major complication rates were similar (RSTC, 1/6 =16% vs.3/13= 23% for LSTC; p=0.9). Readmission rate was less for the RSTC group (16%) than LSTC group (38.4%) (p=0.3). No patient required reoperation in the RSTC group (0%) vs. 2 patients (15.3%) in the LSTC (p=0.2).
Conclusions: RSTC for severe acute UC is at least as safe as the laparoscopic approach. Although the robotic cohort had more comorbidities, major postoperative complications, readmissions, and reoperation rates were less when compared to LSTC. RSTC was also associated with an earlier return of bowel function and shorter length of stay. A prospective study with larger numbers is needed to see if the superiority of robotic versus laparoscopic approaches is reproducible.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85069
Program Number: P238
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard