Emre Gorgun, Erman Aytac, Brooke Gurland, Meagan M Costedio. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio.
INTRODUCTION: Robotic assisted colorectal surgery is an emerging technique. In this study we aimed to compare peri-operative and short-term outcomes of robotic colorectal operations to laparoscopy.
METHODS AND PROCEDURES: Patients undergoing robotic colorectal surgery between 11/2010 and 7/2013 were included. Robotic cases were case-matched to laparoscopic counterparts based on diagnosis and operation type. Operative and short-term postoperative outcomes were compared. Quantitative data were reported as mean±standard deviation and categorical data as numbers.
RESULTS: There were 57 patients who underwent robotic colorectal surgery. There were no differences between the groups in terms of age (52 vs.57 years;p=0.29), gender (29 vs.35 males;p=0.26), body mass index (28 vs.28 kg/m2;p=0.94) and history of previous abdominal operations (22 vs.21;p=0.85). ASA score was higher in patients who underwent robotic surgery (2 vs.3;p=0.01). Blood loss (300 vs.374 ml;p=0.27) and conversion rate to open surgery (6 vs.5;p=0.75) were similar between the groups. Operating time was longer in robotic surgery (185 vs.267 min;p<.0001). Time to first bowel movement (4 vs.4 days;p=0.38), hospital stay (7 vs.8 days;p=0.22) and postoperative complications were comparable between the groups (table).
CONCLUSIONS: Our early experience in robotic colorectal surgery shows similar short-term outcomes when compared to a carefully matched group of patients who underwent conventional laparoscopy. With increasing experience and numbers, the benefits of robotic colorectal surgery may declare.
| Laparoscopic (n=57) | Robotic (n=57) | P value | |
| Operations performed, (n) | >0.99 | ||
| Abdominoperineal resection | 14 | 14 | |
| Completion proctectomy/proctocolectomy end ileostomy | 2 | 2 | |
| Ileocolectomy | 1 | 1 | |
| Ileal pouch anal anastomosis | 9 | 9 | |
| Proctosigmoidectomy | 16 | 16 | |
| Rectopexy | 5 | 5 | |
| Right colectomy | 1 | 1 | |
| Sigmoidectomy | 3 | 3 | |
| Sigmoidectomy/rectopexy | 6 | 6 | |
| Diagnosis, (n) | >0.99 | ||
| Cancer | 33 | 33 | |
| Crohn’s disease | 3 | 4 | |
| Rectal prolapse | 11 | 11 | |
| Ulceratice colitis | 9 | 8 | |
| Diverticulitis | 1 | 1 | |
| Specific complications, (n) | |||
| Abdomino-pelvic abscess | 1 | 4 | 0.36 |
| Anastomotic leak | 2 | 5 | 0.44 |
| Stoma retraction | 1 | 0 | >0.99 |
| Ileus | 7 | 14 | 0.09 |
| Postoperative bleeding | 2 | 0 | 0.5 |
| Pneumonia | 0 | 2 | 0.5 |
| Sepsis | 1 | 1 | >0.99 |
| Wound infection | 2 | 1 | >0.99 |
| Urinary retention | 5 | 5 | >0.99 |
| Urinary tract infection | 3 | 0 | 0.24 |
| Venous thromboembolism | 1 | 1 | >0.99 |
| Overall morbidity, (n) | 24 | 23 | 0.85 |
| Mortality, (n) | 1 | 0 | >0.99 |
| Reoperation, (n) | 3 | 4 | >0.99 |
| Readmission, (n) | 6 | 9 | 0.41 |
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