Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy

Abstract

Background: The use of robotics in foregut surgery has become more prevalent in the United States over the last 10 years. We sought to find the differences in the clinical outcomes of robotic surgery compared with traditional laparoscopy in patients undergoing Heller myotomy. Materials and Methods: A retrospective population-based analysis was performed using the National Inpatient Sample (NIS) database for the span of 2010 to 2015. All patients who underwent laparoscopic or robotic Heller myotomy were included. Weighted multivariable random intercept linear and logistic regression models were used to assess the impact of robotic surgery on patient outcomes compared with laparoscopy. Results: There was a total of 11,562 patients with a median age of 54.2 years. Robotic Heller myotomy has a significantly decreased risk of overall complications for all centers (odds ratio=0.46; 95% confidence interval=0.29, 0.74). A subset analysis was performed looking specifically at high-volume centers (>20 operations per year), and overall complications remained lower in the robotic group. However, in high-volume centers, the robotic cohort did have a higher rate of esophageal perforation (2.7% vs. 0.8%, P<0.001). There was a higher length of stay in the laparoscopic Heller cohort (3.0 vs. 2.6 d, P=0.06) but higher overall charges in the robotic Heller cohort ($42,900 vs. $34,300, P=0.03). Conclusions: Robotic Heller myotomy is associated with lower overall complications and improved outcomes compared with laparoscopic Heller myotomy, even in high-volume centers. Robotic Heller myotomy is associated with a higher rate of esophageal perforations in high-volume centers despite the reduction in overall complications.

Robotic Heller’s cardiomyotomy for achalasia: early outcomes for a high-volume UK centre

“…Other published literature does not report significant differences in length of stay (LOS) when comparing RHCM with LHCM. 19 – 23 , 34 , 35 However, in the present cohort, 12/13 patients were discharged as either day cases or had a single overnight stay. We believe that the reduced risk of oesophageal perforation has increased our team’s confidence in early discharge of these patients.…”

“… 32 – 34 A retrospective review of the USA National Inpatient Sample of patients undergoing RHCM was associated with increased cost (US$42,900 vs US$34,300) when compared with LHCM. 35 Another publication from the USA has also demonstrated that LHCM is significantly cheaper than RHCM (US$7,441±7,897 vs US$9,415±5,515). 34 Although cost reduction strategies are likely to arise with the increasing utilisation of robotics, 32 , 34 , 36 at present the robotic approach should be considered to be more expensive.…”

The impact of robotic surgery on the treatment of benign esophageal and gastric disease. Early experience of a specialized unit

“…[19] A population-based analysis revealed that even in high-volume centers, average length of stay is shorter with the robotic approach although average cost Is elevated. [24] Data on robot-assisted hiatal hernia repair also show excellent results regarding safety and perioperative outcomes even in technically demanding cases [25][26][27][28]. Results regarding postoperative complications are currently inconclusive, as certain studies comparing the laparoscopic and robotic approaches for hiatal hernia repair present dominance of the robotic approach, while others report increased incidence of respiratory complications in patients who undergo robotic repair [29,30].…”