EP433 - A Comparison of Outcomes in Elective Robotic Versus Laparoscopic Colectomies: An Analysis of the NSQIP Database.

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Purpose/Background: Robotic platforms are increasingly utilized in operations across surgical specialties. In 2023 over two million surgeries were performed using da Vinci surgical systems, a 22% increase compared to 2022. The benefits of robotic surgery over laparoscopic surgery have been debated. The purpose of this study is to compart the morbidity and mortality in patients undergoing elective robotic versus laparoscopic colectomy.

Methods/Interventions: Data were obtained from the NSQIP database. All patients undergoing elective colectomy from 2018 to 2022 were included. Exclusion criteria included urgent/emergent cases, open cases, and cases that did not have any information regarding the approach of surgery. T-tests, Chi2, and multivariate analyses were used to evaluate the data as appropriate.

Results/Outcomes: A total of 29,345 patients were included; 52.0% were females, with a mean (SD) age of 60.9 (14.9) years, and mean (SD) BMI of 28.8 (7.2) kg/m2. Data were categorized based on if the patient underwent colectomy via a robotic or laparoscopic approach. Patients who underwent robotic colectomy were younger (p0.0019), had a higher BMI (p < 0001), were more likely to be functionally independent (p < 0001), and more likely to be smokers (p < 007) (Table 1). A higher percent of patients in the robotic colectomy group completed a mechanical bowel preparation (p < 0001) and underwent preoperative chemotherapy (p < 0.0001). A higher percent of patients in the laparoscopic colectomy group were on steroids (p < 0001) or had disseminated cancer at the time of surgery (p < 006) (Table 1). On univariable analysis robotic surgery was associated with longer operative time (p < 0.001), shorter length of stay (p < 0.0001), lower rates of postoperative bleeding (p < 0.001), less ileus (p < 0.001), less conversion to an open procedure (5.1% vs 10.7%, p< 0.0001), and lower overall mortality (Table 1). There were no differences in anastomotic leak or return to the operating room between approaches. On multivariable analysis predictors of postoperative ileus were a laparoscopic approach (p0.03), lack of mechanical bowel preparation (p < 0.0001), advanced age (p < 0.0001), preoperative chemotherapy (p < 0.0001), disseminated cancer (p0.0034), smoking (p < 0.0001), and poor baseline functional status (p < 0.0005). Predictors of conversion to open surgery were laparoscopic surgery (p < 0.0001), advanced age (p < 0.0001), BMI (p < 0.0001), smoking (p < 0.0001), and no mechanical bowel preparation (p < 0.0001).

Conclusion/Discussion: Robotic colectomy is associated with a significantly longer operative time, decreased length of stay, lower rates of postoperative bleeding, less ileus, less conversion to open surgery, and lower overall mortality, when compared to laparoscopic surgery. Additionally, a laparoscopic approach is an independent predictor of both ileus and conversion to open surgery on multivariable analysis. Our findings support the use of a robotic approach to elective colectomy to reduce morbidity and mortality.