Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy.
The utilization of minimally invasive surgery is increasing in colorectal surgery. We sought to compare the outcomes of patients who underwent elective open, laparoscopic, and robotic total abdominal colectomy.



The NIS database was used to examine the clinical data of patients who underwent an elective total colectomy procedure during 2009-2012. Multivariate regression analysis was performed to compare the three surgical approaches.



We sampled a total of 26,721 patients who underwent elective total colectomy. Of these, 16,780 (62.8 %) had an open operation, while 9934 (37.2 %) had a minimally invasive approach (9614 laparoscopic surgery, and 326 robotic surgery). The most common indication for an operation was ulcerative colitis (31 %). Patients who underwent open surgery had significantly higher mortality and morbidity compared to laparoscopic (AOR 2.48, 1.30, P < 0.01) and robotic approaches (AOR 1.04, 1.30, P < 0.01 and P = 0.04, respectively). There was no significant difference in mortality and morbidity between the laparoscopic and robotic approaches (AOR 0.96, 1.03, P = 0.10, P = 0.78). However, conversion rate of laparoscopic surgery to open was significantly higher than that of robotic approach (13.3 vs. 1.5 %, P < 0.01). Patients who underwent laparoscopic surgery had significantly lower total hospital charges compared to patients who underwent open surgery (mean difference = $21,489, P < 0.01). Also, total hospital charges for a robotic approach were significantly higher than for a laparoscopic approach (mean difference = $15,595, P < 0.01).



Minimally invasive approaches to total colectomy are safe, with the advantage of lower mortality and morbidity compared to an open approach. Although there was no significant difference in the morbidity between minimally invasive approaches, robotic surgery had a significantly lower conversion rate compared to laparoscopic approach. Total hospital charges are significantly higher in robotic surgery compared to laparoscopic approach.
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Zhobin
Z
Moghadamyeghaneh
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Mark H
MH
Hanna
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Joseph C
JC
Carmichael
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Alessio
A
Pigazzi
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Michael J
MJ
Stamos
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA. sdmills@uci.edu.
Steven
S
Mills
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D061887:Conversion to Open Surgery; D003424:Crohn Disease / Q000601:surgery; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000601:surgery; D043963:Diverticulosis, Colonic / Q000601:surgery; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods; D005260:Female; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D009026:Mortality; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
Cancer; Colectomy; Colitis; Colorectal; Laparoscopy; Robotic