Robotic vs laparoscopic rectal tumour surgery: a cohort study

Abstract

Aim The aim of this study was to compare robotic and laparoscopic rectal surgery in terms of perioperative data, short‐term outcome and compliance to the Enhanced Recovery After Surgery (ERAS) protocol. Method In this cohort study, 224 patients scheduled for rectal resection for cancer or adenoma between January 2011 and January 2017 were evaluated. In the first time period (12 January 2011 to 23 April 2014), 47 (46%) of 102 patients had laparoscopic surgery. In the second time period (24 April 2014 to 30 January 2017), 72 (59%) of 122 patients had robotic surgery. Perioperative data and short‐term outcome were collected from the ERAS database and patient charts. Data obtained from laparoscopic and robotic surgery in the two time periods studied were compared. Primary outcome was hospital length of stay (LOS) and secondary outcomes were compliance to the ERAS protocol, difference in postoperative complications and conversion to open surgery. Results Compliance to the ERAS protocol was 81.1% in the robotic group and 83.4% in the laparoscopic group (P = 0.890). Robotic surgery was associated with shorter median LOS (3 days vs 7 days, P < 0.001), lower conversion rate (11.1% vs 34.0%, P = 0.002), lower rate of postoperative complications (25% vs 49%, P < 0.01) and longer duration of surgery (5.8 h vs 4.5 h, P < 0.001). The differences remained after multivariate analysis. Conclusion Robotic surgery was associated with shorter LOS, lower conversion rates and fewer postoperative complications compared with laparoscopic surgery. Robotic surgery may add benefits to the ERAS protocol.

Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?

“…Patients with stomas have to be educated by a stoma care nurse before discharge on how to take care of their stomas and patients with ileostomies are prone to electrolyte abnormalities for a variable period of time in the immediate postoperative period and can only be discharged after this has normalised. In contrast to studies with much shorter lengths of hospital stay our readmission rate was low and did not differ between the three patient groups [16][17][18]. This is a benefit of the longer hospitalisation rate; complications that would otherwise require re-hospitalisation happened during the primary hospital stay.…”

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

“…With ERAS, RTME has been associated with a shorter LOS and fewer postoperative complications, but longer duration of surgery compared with LTME. The medicoeconomic impact of ERAS for rectal surgery is difficult to demonstrate.…”

Strukturierte Implementierung und modulares inhouse Training als zentrale Erfolgsfaktoren in der robotisch assistierten Chirurgie – Evaluation am Beispiel der kolorektalen Chirurgie

“…Plan Die wichtige Frage nach dem "Warum soll ein robotisches Operationssystem in unserem Krankenhaus eingeführt werden", wurde bei uns wie folgt beantwortet: ▪ Für die Patienten Erbringung des nachgewiesenen klinischen Vorteils der geringeren Invasivität der Robotik in Bezug auf geringere Konversionsraten und Hospitalisierungszeiten [5,6,7,8,9,10,11], eine bessere postoperative Sexualfunktion [12,13] und weniger Schmerzen [14]. Traditionell werden nicht zuletzt durch den eigenen Berufsstand arbeitsmedizinische Betrachtungen (Haltungsschäden [17] und HWS-Beschwerden [18] laparoskopisch tätiger Chirurgen) ausgeblendet.…”