title: A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.
abstract: OBJECTIVE
  Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures.
  
  
  METHODS
  Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure.
  
  
  RESULTS
  There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P < .01) and hand-assisted (P < .001) techniques; however, this difference was not maintained in cases with low pelvic anastomoses. The overall mean length of stay was 3.3 ± 1.8 days with no significant difference between the groups. Pathological analysis of malignant cases revealed a median lymph node extraction of 17 with no significant difference among the 3 modalities.
  
  
  CONCLUSIONS
  In this 3-arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.
authors.affiliation: Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Chirag B
authors.initials: CB
authors.lastname: Patel
authors.forename: Madhu
authors.initials: M
authors.lastname: Ragupathi
authors.forename: Diego I
authors.initials: DI
authors.lastname: Ramos-Valadez
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
mesh_terms: D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D007081:Ileostomy; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D016555:Matched-Pair Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012371:Robotics; D013997:Time Factors