title: Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes.
abstract: BACKGROUND
  While robotic-assisted colorectal surgery (RACS) is becoming increasingly popular, data comparing its outcomes to other established techniques remain limited to small case series. Moreover, there are no large studies evaluating the trends of RACS at the national level.
  
  
  METHODS
  The Nationwide Inpatient Sample 2009-2010 was retrospectively reviewed for robotic-assisted and laparoscopic colorectal procedures performed for cancer, benign polyps, and diverticular disease. Trends in different settings, indications, and demographics were analyzed. Multivariate regression analysis was used to compare selected outcomes between RACS and conventional laparoscopic surgery (CLS).
  
  
  RESULTS
  An estimated 128,288 colorectal procedures were performed through minimally invasive techniques over the study period, and RACS was used in 2.78 % of cases. From 2009 to 2010, the use of robotics increased in all hospital settings but was still more common in large, urban, and teaching hospitals. Rectal cancer was the most common indication for RACS, with a tendency toward its selective use in male patients. On multivariate analysis, robotic surgery was associated with higher hospital charges in colonic ($11,601.39; 95 % CI 6,921.82-16,280.97) and rectal cases ($12,964.90; 95 % CI 6,534.79-19,395.01), and higher rates of postoperative bleeding in colonic cases (OR = 2.15; 95 % CI 1.27- 3.65). RACS was similar to CLS with respect to length of hospital stay, morbidity, anastomotic leak, and ileus. Conversion to open surgery was significantly lower in robotic colonic and rectal procedures (0.41; 95 % CI 0.25-0.67) and (0.10; 95 % CI 0.06-0.16), respectively.
  
  
  CONCLUSIONS
  The use of RACS is still limited in the United States. However, its use increased over the study period despite higher associated charges and no real advantages over laparoscopy in terms of outcome. The one advantage is lower conversion rates.
authors.affiliation: Department of Surgery, University of California Irvine, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA, wissamhalabi@gmail.com.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Celeste Y
authors.initials: CY
authors.lastname: Kang
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods* / Q000639:trends; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000191:economics / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012002:Rectal Diseases / Q000191:economics / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
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