title: Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection.
abstract: BACKGROUND
  During the past 20 years, laparoscopy has revolutionized colorectal surgery. With proven benefits in patient outcomes and healthcare utilization, laparoscopic colorectal surgery has steadily increased in use. Robotic surgery, a new addition to colorectal surgery, has been suggested to facilitate and overcome limitations of laparoscopic surgery. Our objective was to compare the outcomes of robot-assisted laparoscopic resection (RALR) to laparoscopic resections (LAP) in colorectal surgery.
  
  
  METHODS
  A national inpatient database was evaluated for colorectal resections performed over a 30-month period. Cases were divided into traditional LAP and RALR resection groups. Cost of robot acquisition and servicing were not measured. Main outcome measures were hospital length of stay (LOS), operative time, complications, and costs between groups.
  
  
  RESULTS
  A total of 17,265 LAP and 744 RARL procedures were identified. The RALR cases had significantly higher total cost ($5,272 increase, p < 0.001) and direct cost ($4,432 increase, p < 0.001), significantly longer operating time (39 min, p < 0.001), and were more likely to develop postoperative bleeding (odds ratio 1.6; p = 0.014) than traditional laparoscopic patients. LOS, complications, and discharge disposition were comparable. Similar findings were noted for both laparoscopic colonic and rectal surgery.
  
  
  CONCLUSIONS
  RALR had significantly higher costs and operative time than traditional LAP without a measurable benefit.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA, debby_keller@hotmail.com.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Justin K
authors.initials: JK
authors.lastname: Lawrence
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Champagne
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D003082:Colectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome