Robotic colorectal surgery in Australia: a cohort study examining clinical outcomes and cost
Bruce Wilkie A F , Zara Summers A , Richard Hiscock B , Nilmini Wickramasinghe C , Satish Warrier D E and Philip Smart A EA Department of Surgery, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia. Email: zarasukalo@gmail.com; philsmartsurgeon@gmail.com
B Epworth Healthcare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email: richardjhiscock@gmail.com
C Health Informatics, Epworth Healthcare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email: nilmini.work@gmail.com
D Department of Surgery, Peter McCallum Cancer Centre, 305 Grattan Street, Melbourne, Vic. 3000, Australia. Email: satishwarrier96101@gmail.com
E General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, 89 Bridge Road, Richmond, Vic. 3121, Australia.
F Corresponding author. Email: brucedwilkie@gmail.com
Australian Health Review 43(5) 526-530 https://doi.org/10.1071/AH18093
Submitted: 8 May 2018 Accepted: 14 December 2018 Published: 29 March 2019
Abstract
Objective The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost.
Methods A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type.
Results No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group.
Conclusion Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost.
What is known about the topic? Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety.
What does this paper add? This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres.
What are implications for practitioners? In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission.
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