Outcomes after laparoscopic or robotic colectomy and open colectomy when compared by operative duration for the procedure

Philip, Sunu; Jackson, Nancy; Mittal, Vijay K.

doi:10.1016/j.amjsurg.2017.04.020

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…The initial prolonged operative time does not appear to adversely impact patient perioperative outcomes [48]. Longer operative times in RAS compared to laparoscopy appear less common in RAS rectopexy compared to other RAS colorectal procedures [49,50]. This may be explained by the fact that suturing time can be improved using RAS compared to laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

Keating

Brannigan²,

Balla³

et al. 2022

Tech Coloproctol

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Background Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the views of a group of surgeons will have published on robotic rectopexy. Methods A three-round Delphi process was performed. Combined qualitative, Likert scale and binary responses were utilised in rounds one and two with binary responses seeking overall consensus in round two and three. Particular areas that were studied included: clinical aspects of patient selection, technical aspects of using RAS to perform rectopexy, ergonomic factors, training, and consideration of the 'learning-curve'. Consensus was defined as agreement > 80% among participants. Potential experienced RAS rectopexy surgeons were identified using PubMed where authors of studies reporting outcomes from RAS rectopexy were searched and invited. Results Twenty surgeons participated from the following countries:

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Section: Discussionmentioning

confidence: 99%

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

Keating

Brannigan²,

Balla³

et al. 2022

Tech Coloproctol

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“…ncreased operative time is associated with worse surgical outcomes, including higher rates of readmission, reoperation, anastomotic leak, length of stay (LOS), and surgical-site infection (SSI). [1][2][3][4][5][6] These associations have been shown with both open and laparoscopic approaches, 1,2 but most studies are limited by their examination of only a single operation. [3][4][5][6][7][8] Laparoscopic and robotic approaches to colorectal surgery (collectively referred to as minimally invasive surgery [MIS] approaches) have improved outcomes over the same operations using an open approach, including lower levels of postoperative pain, LOS, rates of SSI, and overall hospital cost.…”

mentioning

confidence: 99%

“…[9][10][11][12] These benefits appear to exist despite the consistently longer operative times that these MIS approaches incur compared to an open approach for a wide range of colorectal operations. 1,2,8,[11][12][13] In addition to this seemingly conflicting perspective on the impact of operative time on surgical outcomes, an additional shortcoming of the literature is the lack of a consistent definition of when a given operation becomes "prolonged" and portends worse outcomes. Most studies define "prolonged" operations using an arbitrary time cutoff that is not easily applied across operations or surgical approaches.…”

mentioning

confidence: 99%

“…Most studies define "prolonged" operations using an arbitrary time cutoff that is not easily applied across operations or surgical approaches. 1,2,4,[6][7][8]14,15 Therefore, to better describe the interplay between operative time, surgical approach, and outcomes, we first define prolonged operative time for several common elective colorectal operations and surgical approaches. We then use this definition to describe the impact of prolonged operative time on short-term surgical outcomes for these operations across both open and MIS approaches.…”

mentioning

confidence: 99%

“…Increased operative time is associated with worse surgical outcomes, including higher rates of readmission, reoperation, anastomotic leak, length of stay (LOS), and surgical-site infection (SSI). 1–6 These associations have been shown with both open and laparoscopic approaches, 1,2 but most studies are limited by their examination of only a single operation. 3–8…”

mentioning

confidence: 99%

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The Impact of Prolonged Operative Time Associated with Minimally Invasive Colorectal Surgery: A Report from the Surgical Care Outcomes Assessment Program

Unruh,

Bastawrous,

Kanneganti

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Further, the definition of “prolonged” operative time has not been consistently defined. OBJECTIVE: The first objective was to define prolonged operative time across multiple colorectal operations and surgical approaches. The second was to describe the impact of prolonged operative time on length of stay and short-term outcomes. DESIGN: Retrospective-cohort study. SETTING: Forty-two hospitals in the Surgical Care Outcomes Assessment Program from 2011-2019 PATIENTS: There were a total of 23,098 adult patients (age 18 years and older), undergoing 6 common, elective colorectal operations: right colectomy, left/sigmoid colectomy, total colectomy, low anterior resection, ileal-pouch anal anastomosis, or abdominoperineal resection. MAIN OUTCOME MEASURES: Prolonged operative time defined as the 75th quartile of operative times for each operation and approach. Outcomes were length of stay, discharge home, and complications. Adjusted models were used to account for factors that could impact both operative time and outcomes across the strata of open and minimally invasive approaches. RESULTS: Prolonged operative time was associated with longer median length of stay (7 vs. 5 days open, 5 vs. 4 days laparoscopic, 4 vs. 3 days robotic), more frequent complications (42% vs. 28% open, 24% vs. 17% laparoscopic, 27% vs. 13% robotic), but similar discharge home (86% vs. 87% open, 94% vs. 94% laparoscopic, 93% vs. 96% robotic). After adjustment, each additional hour of operative time above the median for a given operation was associated with 1.08 (1.06, 1.09) relative risk of longer length of stay for open operations and 1.07 (1.06, 1.09) relative risk for minimally invasive operations. LIMITATIONS: Our study was limited by being retrospective, resulting in selection bias, possible confounders for prolonged operative time, and lack of statistical power for subgroup analyses. CONCLUSIONS: Operative time has consistent overlap across surgical approaches. Prolonged operative time is associated with longer length of stay and higher probability of complications, but this negative effect is diminished with minimally invasive approaches..

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Robotic versus laparoscopic colectomy outcomes in colon adenocarcinoma in the elderly population: a propensity-score matched analysis of the National Cancer Database

Pacheco,

Harris-Gendron,

Luciano

et al. 2023

Int J Colorectal Dis

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Outcomes after laparoscopic or robotic colectomy and open colectomy when compared by operative duration for the procedure

Cited by 8 publications

References 5 publications

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy

The Impact of Prolonged Operative Time Associated with Minimally Invasive Colorectal Surgery: A Report from the Surgical Care Outcomes Assessment Program

Robotic versus laparoscopic colectomy outcomes in colon adenocarcinoma in the elderly population: a propensity-score matched analysis of the National Cancer Database

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