Understanding the Value of Both Laparoscopic and Robotic Approaches Compared to the Open Approach in Colorectal Surgery.

Autor:	Hollis RH; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama., Cannon JA; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama., Singletary BA; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama., Korb ML; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama., Hawn MT; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.; 2 Department of Surgery, Stanford University School of Medicine , Stanford, California., Heslin MJ; 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
Jazyk:	angličtina
Zdroj:	Journal of laparoendoscopic & advanced surgical techniques. Part A [J Laparoendosc Adv Surg Tech A] 2016 Nov; Vol. 26 (11), pp. 850-856. Date of Electronic Publication: 2016 Jul 11.
DOI:	10.1089/lap.2015.0620
Abstrakt:	Intro: Although the use of laparoscopy has significantly increased in colorectal procedures, robotic surgery may enable additional cases to be performed using a minimally invasive approach. We separately evaluated the value of laparoscopic and robotic colorectal procedures compared to the open approach. Methods: Patients undergoing nonemergent colorectal operations from 2010 to 2013 with National Surgical Quality Improvement Project data were identified. Robotic and laparoscopic procedures were separately matched (1:1) to open cases. Outcomes included 30-day composite morbidity, length of stay, operative time, and inpatient costs. Frequently used intraoperative disposable items were categorized, and significant cost contributors were identified by surgical approach. Statistical differences were determined with Chi-square and Wilcoxon signed-rank tests. Results: Both laparoscopic (n = 67) and robotic (n = 45) approaches were associated with decreased composite morbidity compared to matched open cases (lap vs. open: 22.4% vs. 49.2%, P < .01; robotic vs. open: 6.7% vs. 33.3%, P < .01). Median length of stay was significantly shorter for both laparoscopic and robotic compared to open surgery (lap vs. open: 5 vs. 7 days, P < .01; robotic vs. open: 5 vs. 7 days, P < .01). Median hospital costs were similar between laparoscopic and open surgery ($13,319 vs. $14,039; P = .80) and robotic and open surgery ($13,778 vs. $13,629; P = .48). Conclusion: These findings illustrate the value for both laparoscopic and robotic approaches to colorectal surgery compared to the open approach in terms of short-term outcomes and inpatient costs. Advanced intraoperative disposable items such as cutting staplers and energy devices are important targets for additional cost containment.
Databáze:	MEDLINE
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