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Session: ePoster: Quality and Cost 5 (Mon8)

EP656 - Experiences and Results of a Canadian Colorectal Robotic Surgery Program: the First Five Years

Monday, May 12, 2025
8:05 AM – 8:10 AM PT
Location: Monitor 8, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Susan Muncner, MD

    General Surgery Resident PGY3
    University of Alberta
    Edmonton, AB, Canada

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • JD

    Jaspreet Dosanjh, RN MN

    Registered Nurse
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • MD

    Mark Dykstra, MD MSc FRCSC

    Assistant Professor
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

  • RS

    Ryan Snelgrove, MD FRCSC

    Assistant Professor
    University of Alberta
    Edmonton, Alberta, Canada

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • HW

    Haili Wang, MD MSc FRCSC

    Associate Professor
    University of Alberta
    Edmonton, Alberta, Canada

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Susan Muncner, MD: This individual has no financial relationships with ineligible companies.
Ryan Snelgrove, MD FRCSC: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Although robotic colorectal surgery is common in many American centres, Canadian uptake has been limited. Our study describes the experiences and results five years following the establishment of the first colorectal robotic program in Western Canada.

Methods/Interventions: This was an observational cohort study using an established prospective database of all robotic colorectal procedures performed from November 2018 - 2023 at a single Canadian tertiary centre. Demographic information, procedural details, pathology reports, and information regarding short-term postoperative outcomes were collected. Descriptive statistics were used to analyse demographics and procedural details. One-way ANOVA and Tukey’s HSD test were performed on logarithmically transformed data to compare the effect of program duration on operative time (OT) and hospital stay (HS). A subgroup analysis of OT and HS was performed on patients who underwent low anterior resection (LAR) and abdominoperineal resection (APR).

Results/Outcomes: The study sample included a total of 261 patients (mean [SD] age 59.1 [14.4] years, 96 female [36.8%], BMI 28.0 [5.69], ASA II/III 51.7/44.8% [n=135,117]) over five years. These cases were completed by three surgeons, the third who joined the robotic program in 2021. The indication for surgery was rectal cancer for 70.1% of patients (n=183). In patients with a pathologic diagnosis of rectal cancer, 9% had a pathologic complete response (n=16), and TME was complete or nearly complete in 94.3% (n=148). The most common procedures were LAR (44.4%, n=116) and APR (24.1%, n=63). Our team performed only one right hemi-colectomy within the five years of the program, choosing to focus on pelvic surgery. Mean OT [SD] in the first year was 327.8 minutes [103.7] which decreased year over year to a mean of 213.2 minutes [59.7] (p < 0.0001). Mean HS in the first year was 6.9 days [6.4], which decreased to 4.2 days [3.2] in the fifth year when one outlier was removed (p=0.0046). Our readmission rate over five years was 15.9%. Next, APR and LAR were analysed independently. One-way ANOVA revealed statistically significant differences in mean OT and mean HS for LAR between the years ( p< 0.0001, p=0.0143). In the APR group, there was no significant difference between HS over the years, however, mean OT did significantly decrease (p < 0.0001).

Conclusion/Discussion: Operative time and hospital stay decreased significantly over the course of five years for robotic colorectal surgery. We have still not reached a plateau in our operative times, suggesting in addition to the surgical learning curve, there may be institutional factors impacting efficiency, such as nursing experience, docking time, among others. As Canada looks to embrace robotic colorectal surgery, our experience provides valuable lessons to other institutions looking to start similar publicly funded programs.