title: A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.
abstract: BACKGROUND
  Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness.
  
  
  METHODS
  This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality.
  
  
  RESULTS
  A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups.
  
  
  CONCLUSIONS
  When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing overall postoperative morbidity. These findings and the recent upgrades in minimally invasive technology warrant continued evaluation of the role of the robotic platform in colorectal surgery.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Tam
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Kaoutzanis
authors.affiliation: Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mullard
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Franz
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.affiliation: Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Vandewarker
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lampman
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA. Robert.Cleary@stjoeshealth.org.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Cleary
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Complication rates; Conversion rates; Hand-assisted laparoscopic colorectal surgery; Laparoscopic colorectal surgery; Length of hospital stay; Robotic colorectal surgery