Propensity Score-Matched Analysis of Clinical and Financial Outcomes After Robotic and Laparoscopic Colorectal Resection

Al-Mazrou, Ahmed M.; Başer, Onur; Kiran, Ravi P.

doi:10.1007/s11605-018-3699-8

Cited by 19 publications

(15 citation statements)

References 19 publications

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“…In addition, Premier charge Masterfile was utilized to identify the different approaches. 9 ICD-9-CM codes were used to identify conversion to OS (V64.41) and intraoperative complications and postoperative complications up to 30 days.…”

Section: Methodsmentioning

confidence: 99%

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Raskin

Keller

Gorrepati

et al. 2019

JSLS

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Background and Objectives:The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States.Methods:This is a retrospective propensity score–matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons.Results:There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications—ileus, wound complications, and acute renal failure—and more patients discharged directly to home.Conclusions:The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.

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Section: Methodsmentioning

confidence: 99%

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Raskin

Keller

Gorrepati

et al. 2019

JSLS

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“…A few studies utilized nation-wide databases, while others performed retrospective reviews, case-matched studies, or propensity-matched groups. Several studies report equivalent conversion rates between laparoscopic and robotic procedures [7][8][9][10] . Feinberg et al [11] performed a retrospective National Surgical Quality Improvement Program study of over 8,864 patients undergoing either laparoscopic or robotic colorectal procedures, finding a statistically significant difference in the conversion rate of 13.7% and 9.5% for laparoscopic and robotic procedures, respectively (P < 0.008).…”

Section: Conversion Ratementioning

confidence: 99%

“…Ramji et al [24] found the intraoperative robotic costs to be twice as much compared to laparoscopic costs Some evidence exists that increased experience over time leads to fewer charges with robotic procedures. Al-Mazrou et al [7] found that, despite a significantly higher cost with the robot over a span of three years, the cost difference reduced over time for the robotic group: $2698 in 2012, $2235 in 2013, and $1402 in 2014. Given the lack of significant differences in many perioperative parameters between the two groups, the cost associated with the robotic procedure is the one consistent metric upon which improvements can be made.…”

Section: Costmentioning

confidence: 99%

Robotic or laparoscopic surgery for rectal cancer - which is the best answer? a comprehensive review of non-oncological outcomes and learning curve

Kavalukas¹,

Ghuman²,

Sharp³

et al. 2020

Mini-invasive Surg

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Much effort has been spent evaluating the difference between robotic and laparoscopic surgery platforms for rectal cancer. There is a plethora of literature comparing outcomes for intraoperative events, postoperative complications, long term outcomes, cost, and learning curve. The data are conclusive regarding the higher cost of robotic surgery compared to laparoscopic surgery. This article is a comprehensive review of the available literature regarding intraoperative and postoperative outcomes. For practically all parameters evaluated, there are no significant differences between the two platforms. The ultimate decision on whether to perform robotic vs. laparoscopic surgery should be based on surgeon preference and familiarity with equipment, as well as local resources.

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“…Clinical results are encouraging: conversion rates to open surgery, length of hospital stay, return to normal activities and work as well as recovery time are comparable [14,15]. On the other hand, skeptics claim higher costs, longer operative time due to docking and redocking and the rather long learning curve [16,17]. Concerning colorectal surgery, the learning curve is estimated to comprise 35 procedures.…”

mentioning

confidence: 98%

Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients

Gass

Daume²,

Schneider³

et al. 2022

Surg Endosc

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Background Robotic-assisted colorectal surgery has gained more and more popularity over the last years. It seems to be advantageous to laparoscopic surgery in selected situations, especially in confined regions like a narrow male pelvis in rectal surgery. Whether robotic-assisted, left-sided colectomies can serve as safe training operations for less frequent, low anterior resections for rectal cancer is still under debate. Therefore, the aim of this study was to evaluate intra- and postoperative results of robotic-assisted laparoscopy (RAL) compared to laparoscopic (LSC) surgery in left-sided colectomies. Methods Between June 2015 and December 2019, 683 patients undergoing minimally invasive left-sided colectomies in two Swiss, high-volume colorectal centers were included. Intra- and postoperative outcome parameters were collected and analyzed. Results A total of 179 patients undergoing RAL and 504 patients undergoing LSC were analyzed. Baseline characteristics showed similar results. Intraoperative complications occurred in 0.6% of RAL and 2.0% of LSC patients (p = 0.193). Differences in postoperative complications graded Dindo ≥ 3 were not statistically significant (RAL 3.9% vs. LSC 6.3%, p = 0.227). Occurrence of anastomotic leakages showed no statistically significant difference [RAL n = 2 (1.1%), LSC n = 8 (1.6%), p = 0.653]. Length of hospital stay was similar in both groups. Conversions to open surgery were significantly higher in the LSC group (6.2% vs.1.7%, p = 0.018), while stoma formation was similar in both groups [RAL n = 1 (0.6%), LSC n = 5 (1.0%), p = 0.594]. Operative time was longer in the RAL group (300 vs. 210.0 min, p < 0.001). Conclusion Robotic-assisted, left-sided colectomies are safe and feasible compared to laparoscopic resections. Intra- and postoperative complications are similar in both groups. Most notably, the rate of anastomotic leakages is similar. Compared to laparoscopic resections, the analyzed robotic-assisted resections have longer operative times but less conversion rates. Further prospective studies are needed to confirm the safety of robotic-assisted, left-sided colectomies as training procedures for low anterior resections.

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Propensity Score-Matched Analysis of Clinical and Financial Outcomes After Robotic and Laparoscopic Colorectal Resection

Abstract: Robotic colorectal surgery can be performed with comparable clinical outcomes to laparoscopy. With greater use of the technology, some further recovery benefits may be evident. The robotic approach is more expensive but cost differences have been diminishing over time.

Cited by 19 publications

References 19 publications

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease

Robotic or laparoscopic surgery for rectal cancer - which is the best answer? a comprehensive review of non-oncological outcomes and learning curve

Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients

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