Abstract
Background
Robotic surgery for colorectal pathology has gained interest as it can overcome technical challenges and limitations of traditional laparoscopic surgery. A lack of training and costs have been cited as reasons for limiting its use in Canada. The objective of this paper was to assess the impact of robotic surgery on outcomes and costs in a Canadian setting.
Methods
This is a retrospective study of consecutive patients undergoing left sided colorectal surgery (“Pre-Robotic Phase” n = 145 vs. “Post Robotic Phase” n = 150) and a single tertiary care centre in Ontario, Canada. Utilization and success of minimally invasive surgery (MIS), length of stay, complications and hospital costs were compared. Univariate and Multivariate analysis was used for these comparisons.
Results
Characteristics, diagnosis and type of resection were similar between groups. Robotic Implementation resulted in higher rates of successful MIS (i.e. attempt at MIS without conversion) (85% vs. 47%, P < 0.001), shorter mean length of stay (4.7 days vs. 8.4 days, P < 0.001), and similar mean operative times (3.9 h vs. 3.9 h, P = 0.93). Emergency Department visits were fewer in the Robotic Phase (24% vs. 34%, P = 0.04), with no difference in readmission, anastomotic leak or unplanned reoperation. After robotic implementation, the mean total hospital costs decreased, but this was not statistically significant (−$1453, 95% CI −$3974 to +$1068, P = 0.25). Regression analysis, adjusting for age, gender, obesity, ASA and procedure showed similar findings (Robotic Phase −$657, 95% CI −$3038 to +$1724, vs Pre Robotic Phase [Reference], P = 0.59).
Interpretation
Implementation of a robotic colorectal surgery program in a Canadian tertiary care centre showed improved clinical outcomes, without a significant increase in the cost of care. Although this study is from a single institution, we have demonstrated that robotic colorectal surgery is feasible and can be cost effective in the right setting.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00464-022-09059-3/MediaObjects/464_2022_9059_Fig1_HTML.png)
Similar content being viewed by others
References
Gawande A (2012) Two hundred years of surgery. N Engl J Med 366(18):1716–1723
Schlich T, Tang CL (2016) Patient choice and the history of minimally invasive surgery. The Lancet 388(10052):1369–1370
Abraha I, Binda GA, Montedori A, Arezzo A, Cirocchi R (2017) Laparoscopic versus open resection for sigmoid diverticulitis. Cochrane Database Syst Rev 2017(11):1–51
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005(3):1–51
Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2014(4):1–51
Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774
Bissolati M, Orsenigo E, Staudacher C (2015) Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis. Updat Surg 67(4):353–365
Sica GS, Biancone L (2013) Surgery for inflammatory bowel disease in the era of laparoscopy. World J Gastroenterol 19(16):2445–2448
Kindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL et al (2015) Laparoscopy in trauma: an overview of complications and related topics. Int J Crit Illn Inj Sci 5(3):196–205
Drohan AE, Hoogerboord CM, Johnson PM, Flowerdew GJ, Porte GA (2020) Real-world impact of laparoscopic surgery for rectal cancer: a population-based analysis. Curr Oncol 27(3):e251–e258
Hoogerboord CM, Levy AR, Hu M, Flowerdew G, Porter G (2018) Uptake of elective laparoscopic colectomy for colon cancer in Canada from 2004/05 to 2014/15: a descriptive analysis. CMAJ Open 6(3):E384–E390
Hoogerboord M, Ellsmere J, Caycedo-Marulanda A, Brown C, Jayaraman S, Urbach D et al (2019) Laparoscopic colectomy: trends in implementation in Canada and globally. Can J Surg 62(2):139–141
Moloo H, Haggar F, Martel G, Grimshaw J, Coyle D, Graham ID et al (2009) The adoption of laparoscopic colorectal surgery: a national survey of general surgeons. Can J surg 52(6):455–462
Hawkins AT, Ford MM, Benjamin Hopkins M, Muldoon RL, Wanderer JP, Parikh AA et al (2018) Barriers to laparoscopic colon resection for cancer: a national analysis. Surg Endosc 32(2):1035–1042
Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147(8):724–731
Whealon M, Vinci A, Pigazzi A (2016) Future of minimally invasive colorectal surgery. Clin Colon Rectal Surg 29(3):221–231
Karcz WK, von Braun W (2016) Minimally invasive surgery for the treatment of colorectal cancer. Visc Med 32(3):192–198
Brannigan AE, De Buck S, Suetens P, Penninckx F, D’Hoore A (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge. Surg Endosc 20(6):952–955
Phan K, Kahlaee HR, Kim SH, Toh JWT (2019) Laparoscopic vs robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol 23(3):221–230
Atallah S, Sylla P, Wexner SD (2019) Norway versus The Netherlands: will taTME stand the test of time? Tech Coloproctol 23(9):803–806
Caycedo-Marulanda A, Brown CJ, Chadi SA, Ashamalla S, Lee L, Stotland P et al (2020) Canadian taTME expert collaboration (CaTaCO) position statement. Surg Endosc 34(9):3748–3753
Crawford A, Firtell J, Caycedo-Marulanda A (2019) How is rectal cancer managed: a survey exploring current practice patterns in Canada. J Gastrointest Cancer 50(2):260–268
Caycedo-Marulanda A, Patel S, Merchant S, Brown C (2020) Introduction of new techniques and technologies in surgery: where is transanal total mesorectal excision today? World J Gastrointest Surg 12(5):203–207
Ramji KM, Cleghorn MC, Josse JM, MacNeill A, O’Brien C, Urbach D et al (2016) Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc 30(4):1337–1343
Yeo HL, Isaacs AJ, Abelson JS, Milsom JW, Sedrakyan A (2016) Comparison of open, laparoscopic, and robotic colectomies using a large national database: outcomes and trends related to surgery center volume. Dis Colon Rectum 59(6):535–542
Cleary RK, Mullard AJ, Ferraro J, Regenbogen SE (2018) The cost of conversion in robotic and laparoscopic colorectal surgery. Surg Endosc 32(3):1515–1524
Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. JSLS 18(2):211–224
Al-Mazrou AM, Baser O, Kiran RP (2018) Propensity score-matched analysis of clinical and financial outcomes after robotic and laparoscopic colorectal resection. J Gastrointest Surg 22(6):1043–1051
Simianu VV, Gaertner WB, Kuntz K, Kwaan MR, Lowry AC, Madoff RD et al (2020) Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy. Ann Surg 272(2):334–341
Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226
Baek SJ, Kim SH, Cho JS, Shin JW, Kim J (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36(11):2722–2729
Quijano Y, Nuñez-Alfonsel J, Ielpo B, Ferri V, Caruso R, Durán H et al (2020) Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study. Tech Coloproctol 24(3):247–254
Simianu VV, Gaertner WB, Kuntz K, Kwaan MR, Lowry AC, Madoff RD, et al (2020) Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy. Ann Surg 272(2):334–341. https://doi.org/10.1097/SLA.0000000000003196
Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580
Beach ML, Baron J (2005) Bias from historical controls, Encyclopedia of biostatistics. Wiley Online Library. https://onlinelibrary.wiley.com/doi/book/10.1002/0470011815
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Dr. Antonio Caycedo-Marulanda receives personal fees from ETHICON and Southmedic. Drs. Sunil V Patel, Vanessa Wiseman, Lisa Zhang, P. Hugh MacDonald, Shaila M. Merchant and Mrs. Kathleen Wattie Barnett have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Patel, S.V., Wiseman, V., Zhang, L. et al. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short term outcomes: A Canadian perspective. Surg Endosc 36, 6084–6094 (2022). https://doi.org/10.1007/s00464-022-09059-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09059-3