Robotic colorectal surgery in Australia: a cohort study examining clinical outcomes and cost

Abstract

Objective The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost. Methods A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type. Results No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group. Conclusion Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost. What is known about the topic? Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety. What does this paper add? This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres. What are implications for practitioners? In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission.

Outsourcing robotic‐assisted operations to private hospitals: cost analysis of a retrospective cohort

“…In 2019, Wilkie et al published a study comparing 59 robotic colorectal operations to 154 equivalent laparoscopies and found longer procedure times, length of stay, more frequent intensive care admission and higher consumable costs 16 . Their findings stand in contrast to ours, but we suspect this is due to several aspects.…”

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

“…Only one included study 22 reported hernia rates and none reported pain scores. Robotic colorectal surgery has been shown to be significantly more costly compared to laparoscopic surgery in Australian cohorts with equivalent clinical outcomes 45,46 . Given the high initial overhead and running costs associated with establishing a robotics program, future health economic studies should be conducted with a view to determining its cost‐effectiveness compared to standard care.…”

Outcome of Colorectal Robotic Surgery in Newly Established Robotic Surgery Center: A Case Series

“…reported 1.7% 90 days mortality and the ROLARR mortality rate was 0.9%; all deaths were related to septic complications [13,21] [15]. Other studies report a range between 4 and 7 days [20,[22][23][24][25]29].…”