Surgical and medical outcomes in robotic compared to laparoscopic colectomy global prospective cohort from the American college of surgeons national surgical quality improvement program

Background Evidence regarding the outcomes benefits of robotic approach, when compared to a laparoscopic approach, in colectomy remain limited. Objective This study aimed to analyze the value of robotic approach compared to laparoscopic approach in minimally invasive colectomy. Design Cohort study of the National Surgical Quality Improvement Program (NSQIP). Setting This study included data from the NSQIP from 1/2016 to 12/2021. Patient Adult patients undergoing minimally invasive (laparoscopic or robotic) colorectal surgery. Intervention Robotic versus laparoscopic colectomy. Outcome measures Risk ratios for the incidence of medical and surgical morbidity and overall mortality. Results Compared to laparoscopic, robotic colectomy was associated with a significant decrease in postoperative morbidity [RR 0.84 (95%CI 0.72-0.96), P < 0.001], a significant reduction in postoperative mortality [RR 0.83 (95%CI 0.79-0.90), P 0.010)], and in post operative ileus [RR: 0.80 (95%CI 0.75-0.84), P < 0.001]. Yet, robotic approach was associated with a significant increase in total operative time despite a significant decrease in total length of stay. No benefit was observed regarding anastomotic leak. Limitations Observational nature of the study cannot exclude residual bias. Conclusions In this prospective cohort from the NSQIP, robotic colectomy was associated with a significant reduction in postoperative ileus, unplanned conversion to open surgery, morbidity, and overall mortality when compared to laparoscopic colectomy.