Robotic versus standard laparoscopic elective colectomy: where are the benefits?

Background: Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections.

Methods: Patients undergoing non-emergent laparoscopic (LC) or robotic (RC) colon resections were identified in National Surgical Quality Improvement Project (2013-2015). Patients were matched 1:1 between cohorts using propensity score matching. To account for the prolonged operative time associated with robotic cases, operative times were stratified into approach-specific (LC or RC) tertiles (low, medium, and high) as covariates in the matching algorithm.

Results: RC increased significantly over time and had lower conversion rates (6.0% among RC versus 11.5% among LC, P < 0.001). RC cases were longer (226 min versus 178 min, P < 0.001). Unadjusted complication rates were higher in the LC cohort (17.5% versus 15.2%, P < 0.001). After propensity score matching, RC was not associated with a significant difference in postoperative morbidity (15.2% among RC versus 15.9% among LC, P = 0.434). The robotic approach was associated with a one-half day shorter length of stay (4.6 d versus 5.2 d, P < 0.001), but similar 30-day readmission rates (8.9% versus 8.3%, P = 0.368).

Conclusions: After controlling for operative duration and patient covariates, RC was associated with similar rates of postoperative morbidity, but decreased conversion rates and shorter length of stay. Further studies examining costs are needed to evaluate whether these benefits offset the increased costs associated with robotic approaches.