title: Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases.
abstract: BACKGROUND
  While the penetrance of robotic surgery into field of urology and gynecology has been significant, general surgeons have been slower adopters. We sought to compare laparoscopy and RAS among five different general surgical procedures with various penetrance of MIS.
  
  
  METHODS
  Following IRB approval, the New York Statewide Planning and Research Cooperative System administrative data were used to identify five common laparoscopic general surgery procedures: cholecystectomy, colectomy, esophageal fundoplication (EF), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between 2008 and 2012. ICD-9 codes were used to select laparoscopic versus robotic procedures. Procedures were compared based on any complication and hospital length of stay (HLOS). Following descriptive analysis, propensity score analysis was used to estimate the population average differences between patients who underwent robotic-assisted and laparoscopic procedures.
  
  
  RESULTS
  There were 1458 patients who had undergone robotic-assisted surgery and 166,790 patients who had undergone laparoscopic surgery among the five procedures between 2008 and 2012. Of the 1458 robotic cases, 186 were cholecystectomy, 307 were RYGB, 118 were SG, 288 were EF, and 559 were colectomy. Initial univariate analysis showed a significantly higher rate of overall complications and HLOS in the laparoscopic group compared to the robotic-assisted group. Laparoscopic colectomy had a significantly higher rate of complications and longer length of stay compared to robotic approaches. No difference in complications or HLOS was seen in the cholecystectomy group. Following propensity score analysis, patients who had undergone robotic-assisted colectomy had significantly lower rate of complications compared to those who underwent conventional laparoscopic procedure (p value = 0.0022). In addition, patients who underwent robotic-assisted SG had on average 1.22 days longer HLOS (p value = 0.0037).
  
  
  CONCLUSIONS
  Robotic approaches may facilitate safer adoption of minimally invasive approaches in areas where penetrance of conventional laparoscopy is low, such as in colorectal surgery.
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA. altieri.m@gmail.com.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Altieri
authors.affiliation: Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Jiawen
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Halbert
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA. aurora.pryor@stonybrookmedicine.edu.
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*
keywords: General surgery; Laparoscopic surgery; Outcomes; Robotic surgery