title: The Use of Robotic and Laparoscopic Surgical Stapling Devices During Minimally Invasive Colon and Rectal Surgery: A Comparison.
abstract: OBJECTIVE
  To date there exists no published study examining the safety and efficacy of the EndoWrist 45 (Intuitive Surgical, Inc.) robotic stapler. We compared outcomes between the robotic and comparable laparoscopic stapler in robotic-assisted colorectal procedures.
  
  
  METHODS
  We conducted a retrospective review of 93 patients who underwent robotic-assisted colorectal surgery at our institution from 2012 to 2014. Surgeries included left, sigmoid, subtotal and total colectomies, and low anterior rectal resections. Indications were malignancy and diverticular and inflammatory bowel disease. Preoperative demographics, intraoperative data, and postoperative outcomes were examined. Student's t-test and Fischer's exact used were appropriate.
  
  
  RESULTS
  Forty-five millimeters laparoscopic staplers were used in 58 cases, while the 45 mm robotic stapler was used in 35 cases. There was no difference in age (P = .651), gender (P = .832), or body mass index (P = .204) between groups. There was no difference in estimated blood loss (P = .524), operative time (P = .769), length of stay (P = .895), or complication rate (P = .778). The robotic stapler group had one anastomotic leak, while the laparoscopic stapler group had six (P = .705). There were more laparoscopic stapler fires (2.69) per patient than robotic stapler fires (1.86) (P = .001). The cost per patient for the laparoscopic group was $631.45 versus $473.28 for the robotic group (P = .001).
  
  
  CONCLUSIONS
  This is the first study to evaluate the robotic stapler. Advantages of the robotic stapler include large range of motion and 90° of articulation, which may provide a benefit when using the stapler in difficult areas like the pelvis. The robotic stapler has a comparable level of safety as a 45 mm laparoscopic stapler and is more cost effective.
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Holzmacher
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Luka
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Madiha
authors.initials: M
authors.lastname: Aziz
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Samir
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Obias
mesh_terms: D057868:Anastomotic Leak / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D012809:Colon, Sigmoid / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D003365:Costs and Cost Analysis; D004239:Diverticulitis, Colonic / Q000601:surgery; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D013528:Surgical Staplers / Q000706:statistics & numerical data*; D017792:Surgical Stapling / Q000295:instrumentation
keywords: colorectal; robotic; stapler