Robotic vs. Laparoscopic Colorectal Surgery: an Institutional Experience

Gary B Deutsch, MD MPH, Vikraman Gunabushanam, MD, Nitin Mishra, MD, Eugene Rubach, MD, Harry Zemon, MD, Jonathan D S Klein, MD, George DeNoto, MD. North Shore University Hospital, Manhasset, NY

Introduction
Robotic colorectal surgery is gaining interest in general surgery. The use of the DaVinci Robotic system has been postulated to improve outcomes, primarily by increasing the dexterity and facility with which complex dissections can be performed. Only a few published accounts of robot-assisted colorectal surgery exist, composed mainly of small case series. We report a large, single institution, comparative study of laparoscopic and robotic colectomies, attempting to better elucidate the benefits of robotic surgery in patients with colorectal disease.

Methods
We conducted a retrospective review of 171 patients who underwent robotic and laparoscopic colectomies (79 and 92, respectively) at our institution between November 2004 and November 2009. The two groups were further subdivided by their anatomical location, into right-sided and left-sided procedures. All procedures were performed by experienced general surgeons, trained in minimally invasive techniques using laparoscopic and robotic technology. The following patient characteristics were compiled: age, sex, body mass index, American Society of Anesthesiology (ASA) score, indication for surgery, and tumor staging (using TNM system), if applicable. Perioperative outcomes measured included operative time, operative blood loss, time to return of bowel function, time to discontinuation of patient controlled anesthesia, length of stay, and intraoperative or postoperative complications. Chi-square testing was employed for categorical variables and analysis of variance (ANOVA) was used for continuous variables. A p value of less than 0.05 was considered to be statistically significant.

Results
Our results indicate that there is no statistical difference in length of stay, time to return of bowel function, and time to discontinuation of patient controlled anesthesia between robotic and laparoscopic left and right colectomies. Interestingly, the total procedure time difference between the laparoscopic and robotic colectomies was much smaller than previously published accounts (mean 140 min vs. 135 min for right colectomy; mean 168 min vs. 203 min for left colectomy). The operative blood loss sustained during robotic right colectomy was less than its laparoscopic counterpart (p<0.0358). The subgroup analysis by BMI, ASA score, and indication for procedure did not yield any statistically significant difference.

Conclusion
While our study was retrospective, it is the largest review of robotic colorectal surgery to date. We believe our results further demonstrate the equivalence of robotic surgery to laparoscopic surgery in colorectal procedures. Furthermore, as surgeon experience increases, the difference in operative time between robotic and laparoscopic procedures decreases. Future research should also focus on surgeon specific variables, such as comfort, ergonomics, distractability, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.