title: Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers.
abstract: BACKGROUND
  Robotic-assisted general and bariatric surgery is gaining popularity among surgeons. The aim of this study was to analyze the utilization and outcome of laparoscopic versus robotic-assisted laparoscopic techniques for common elective general and bariatric surgical procedures performed at Academic Medical Centers.
  
  
  METHODS
  We analyzed data from University HealthSystem Consortium clinical database from October 2010 to February 2014 for all patients who underwent laparoscopic versus robotic techniques for eight common elective general and bariatric surgical procedures: gastric bypass, sleeve gastrectomy, gastric band, antireflux surgery, Heller myotomy (HM), cholecystectomy (LC), colectomy, rectal resection (RR). Utilization and outcome measures including demographics, in-hospital mortality, major complications, 30-day readmission, length of stay (LOS), and costs were compared between techniques.
  
  
  RESULTS
  96,694 laparoscopic and robotic procedures were analyzed. Utilization of the robotic approach was the highest for RR (21.4%), followed by HM (9.1%). There was no significant difference in in-hospital mortality or major complications between laparoscopic versus robotic techniques for all procedures. Only two procedures had improved outcome associated with the robotic approach: robotic HM and robotic LC had a shorter LOS compared to the laparoscopic approach (2.8 ± 3.6 vs. 2.3 ± 2.1; respectively, p < 0.05 for HM and 2.9 ± 2.4 vs. 2.3 ± 1.7; respectively, p < 0.05 for LC). Costs were significantly higher (21%) in the robotic group for all procedures. A subset analysis of patients with minor/moderate severity of illness showed similar results.
  
  
  CONCLUSIONS
  This national analysis of academic centers showed a low utilization of robotic-assisted laparoscopic elective general and bariatric surgical procedures with the highest utilization for rectal resection. Compared to conventional laparoscopy, there were no observed clinical benefits associated with the robotic approach, but there was a consistently higher cost.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, 333 City Blvd. West, Suite 850, Orange, CA, 92868, USA, 8jpv@queensu.ca.
authors.forename: James
authors.initials: J
authors.lastname: Villamere
authors.forename: Alana
authors.initials: A
authors.lastname: Gebhart
authors.forename: Stephen
authors.initials: S
authors.lastname: Vu
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000046:Academic Medical Centers; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000379:methods*