JACKSONVILLE, FLA. – Robotic-assisted colectomy took longer than the laparoscopic operation but didn’t result in better surgical outcomes in a large NSQIP data–based study.
As health care moves away from fee-for-service to a value-based model, the longer operative times and comparative outcomes to laparoscopic colectomy suggest that the use of robotic technologies in straightforward colon resections may not be justified at this time, investigators at Duke University concluded.
“This is the largest analysis to date of robotic-assisted vs. laparoscopic colectomy,” Dr. Brian Ezekian, general surgery resident at Duke, reported at the Association for Academic Surgery/Society of University Surgeons Academic Surgical Congress. “While the robotic approach is still in its infancy, the technology is associated with increased operative times without improved clinical outcomes, so our study suggests that the routine use of robotic surgery for colectomy may not be financially justifiable at this time.”
The study sampled the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database for patients who had either a robotic or laparoscopic colectomy from 2012 to 2013. Among the 15,976 patients included, 498 of them (3.1%) had robotic colectomy, Dr. Ezekian said.
“The major finding of our study was that robotic-assisted colectomy was associated with roughly 30-minute longer operative times, whereas the short-term clinical outcomes were comparable between the two groups,” Dr. Ezekian said. “This held true for a subset analysis of patients undergoing segmental colectomy only.”
The analysis found no significant difference between the two approaches in rates of wound complications, urinary tract infections, cardiopulmonary or thromboembolic complications, kidney failure or insufficiency, anastomotic leaks, transfusions, unplanned readmissions, or 30-day death.
The key difference was in the operative times associated with each approach. The median time for robotic-assisted colectomy was 196 minutes vs. 166 minutes for the laparoscopic approach. The study found a similar gap for segmental resections only: 190 minutes for the robotic-assisted approach vs. 153 minutes for the laparoscopic approach.
Dr. Ezekian acknowledged that this observation might merely reflect an early experience with this novel technology. “A future direction for this research is to see if operative times for robotic-assisted surgery decrease over time once there are more years in the NSQIP database or in single-institution studies,” he said.
The authors had no financial relationships to disclose.