The Impact of Non-pelvic Robotic Colorectal Surgery on Robotic Rectal Resections

Laila Rashidi, MD, Jennifer Lee, MD, Oliver Bellevue, MD, Amir Bastawrous, MD. Swedish Colon and Rectal Clinic

INTRODUCTION: The role of robotic surgery for colon and rectal surgery is still being defined.  Some colorectal surgeons have advocated for limiting the use of da Vinci technology for rectal dissections only, where the advantages over laparoscopic surgery are less in question.  Others have recommended a liberal utilization for all colon and rectal procedures.  The objective of this study was to determine differences in short-term outcomes in robotic rectal procedures of surgeons who limited their robotic experience to pelvic surgery as opposed to those who perform both rectal and colon procedures.

METHOD: We conducted a retrospective review of all patients who underwent robotic Left Colectomy, Low Anterior Resection and Abdominal Perineal Resection between January 2011 and September 2015 at Swedish Medical Center (Seattle, WA).  Patients were grouped according to the robotic philosophy of the operating surgeon.  Patients in Group A had surgeons who performed only robotic pelvic resections, whereas those in Group B included surgeons who performed all types of colorectal operations robotically.  Data elements include gender, age, operative time, type of anastomosis, length of hospital stay (LOS), postoperative complications, conversion to open, and time to return of bowel function.

RESULTS: A total of 177 patients were analyzed. Group A consisted of 48 patients (27%) versus Group B included 129 patients (73%). There was no significant difference in type of operation. There was a significant difference in the percent of intracorporeal anastomosis performed in Group A vs. Group B (54.17 vs. 79.1 %, p<0.0001). Overall operative time was significantly longer in Group A compared to Group B (335 vs. 252 min, p<0.0001). Both the time to return of bowel function and length of stay were longer in Group A vs. Group B (2.97 vs. 2.10 days, p<0.0001; 5.40 vs. 4.10  days, p<0.02, respectively). Group A had more complications and a higher conversion rate to open (18% vs. 5%, p< 0.0001; 14 %vs. 1%, p< 0.0004).

CONCLUSION: Our results demonstrate a correlation between broader robotic experience and improved outcomes when performing pelvic colorectal resections. Surgeons who limited their robotic procedures had longer operative times, longer hospital stays, longer return of bowel function, as well as a higher complication and conversion rates.  There may be cumulative benefits to an expanded use of the da Vinci platform.  Expanded use may demonstrate a more complete or more rapid progression through the learning curve.

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