Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy

• Published in: Surgical endoscopy Vol. 30; no. 7; pp. 2792 - 2798
• Main Authors: Moghadamyeghaneh, Zhobin, Hanna, Mark H., Carmichael, Joseph C., Pigazzi, Alessio, Stamos, Michael J., Mills, Steven
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2016; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Adult; Aged; Colectomy - economics; Colectomy - methods; Colitis, Ulcerative - surgery; Colonic Diseases - surgery; Colorectal Neoplasms - surgery; Colorectal surgery; Conversion to Open Surgery; Crohn Disease - surgery; Databases, Factual; Diverticulitis, Colonic - surgery; Diverticulosis, Colonic - surgery; Elective Surgical Procedures - economics; Elective Surgical Procedures - methods; Female; Gastroenterology; Gynecology; Hepatology; Hospital Charges; Hospitals; Humans; Inflammatory bowel disease; Laparoscopy; Laparoscopy - economics; Laparoscopy - methods; Laparotomy - economics; Laparotomy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - economics; Minimally Invasive Surgical Procedures - methods; Morbidity; Mortality; Multivariate Analysis; Patients; Postoperative Complications - epidemiology; Proctology; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - economics; Robotic Surgical Procedures - methods; Surgery; Treatment Outcome; United States > US; Laparoscopy; Colectomy; Colorectal; Colitis; Robotic; Cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-015-4552-8

Background The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy. Methods The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009–2012. Multivariate regression analysis was performed to compare the three surgical approaches. Results We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P  < 0.01) and robotic approaches (AOR 1.04, 1.30, P  < 0.01 and P  = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P  = 0.10, P  = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P  < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P  < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P  < 0.01). Conclusion Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach.