title: Robotic-Assisted Versus Laparoscopic Colectomy Results in Increased Operative Time Without Improved Perioperative Outcomes.
abstract: Interest in robotic technology is burgeoning within the field of colorectal surgery. However, benefits of robotic-assisted colectomy (RAC) compared with laparoscopic colectomy (LC) remain ambiguous.
  
  
  
  Patients who underwent minimally invasive colectomy during 2012-2013 were identified from the National Surgical Quality Improvement Program (NSQIP) database. Short-term perioperative outcomes were compared between 1:1 propensity-matched groups. A subset analysis was performed among patients who underwent segmental resections.
  
  
  
  Among the 15,976 patients included, 498 (3.1 %) colectomies were performed with robotic assistance. After matching for demographic, clinical, and treatment characteristics, there were no differences between RAC and LC in complications such as wound infection, urinary tract infection, cardiopulmonary or thromboembolic events, renal insufficiency, anastomotic leaks, transfusions, readmissions, or 30-day mortality (all p > 0.05). However, operative time was markedly higher for RAC (196 vs. 166 min, p < 0.001). Among segmental resections, operative time remained significantly longer for RAC (190 vs. 153 min, p < 0.001) without differences in perioperative outcomes (all p > 0.05).
  
  
  
  In this early experience, RAC resulted in similar perioperative outcomes when compared to LC but was associated with longer operative time. Given the focus on value-based healthcare, utilizing RAC in straightforward colectomies may not be financially justifiable at this stage of adoption.
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA. brian.ezekian@duke.edu.
authors.forename: Brian
authors.identifier: 0000-0002-3687-0185
authors.initials: B
authors.lastname: Ezekian
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Turner
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gilmore
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Cecilia T
authors.initials: CT
authors.lastname: Ong
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects
keywords: Colectomy; Laparoscopic; Outcomes; Robotic-assisted