Laparoscopic Versus Da Vinci Robotic Large Bowel Resections. Comparative Analysis of the Perioperative Results
DOI:
https://doi.org/10.14748/0wkgd369Keywords:
perioperative results, colon resection, robotic, laparoscopicAbstract
Introduction: The minimally invasive approach in the field of colorectal surgery is nowadays the gold standard. The advantages compared to open surgery have been proven both in terms of faster recovery and late results. Robotic platforms provide a good alternative to standard laparoscopy. In the modern literature, there is more and more data based on the advantages of the Da Vinci robotic platforms in colorectal surgery. However, in the Bulgarian literature there is a lack of large comparative analyses in this direction.
Aim: The aim of this article is to perform a comparative analysis of perioperative outcomes in groups of patients undergoing laparoscopic and Da Vinci robotic colon resections.
Materials and Methods: Retrospective analysis over a period of 3 years, covering 163 patients with minimally invasive colon resections divided into 2 study groups: 64 patients with laparoscopic resections and 119 with the Da Vinci robotic approach, was conducted. A comparative analysis of the distribution by gender, age, hospital stay, morbidity, mortality, duration of surgical interventions, blood loss, type of colon resection performed and type of anastomosis was performed.
Results: The comparative analysis showed that in the group of Da Vinci robotic colon resections compared to laparoscopic resections the gender distribution was 54.6% men/45.4% women to 50% men/50% women, respectively. The mean age was 64.9 years vs. 67.8 years. The type of resection performed was as follows: 94.9% right colectomies + sigmoid resections vs. 73%. Intracorporeal anastomosis was 16.8% vs. 68.75%. The mean operative time was 219 min vs.114 min. The mean blood loss was 23.0 mL vs. 36.1 mL. The morbidity rate was 13 (10.9%) vs. 9 (14.06%). The mortality rate was 0% vs. 1.56% (1 patient). The median hospital stay was 5.92 days vs. 6.02 days.
Conclusion: The comparative analysis of the studied patient groups showed that the robotic approach had a non-significant advantage in terms of perioperative morbidity and mortality when the patients in the study groups were at a relatively younger age. Approximately 95% of the robotic resections were right colectomies and sigmoid resections, while greater heterogeneity was observed in laparoscopic operations. The hospital stay was comparable. There was a significant difference in terms of operative time—approximately 2 times longer in the robotic group, and the type of anastomosis performed was mainly extracorporeal, while the anastomosis in laparoscopic operations was mainly intracorporeal.
References
1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1(3):144–50
2. Fowler DL, White SA. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1991;1(3):183–8.
3. Monson JR., Darzi A, Carey PD, et al. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients. Lancet. 1992;340:831–3. doi: 10.1016/0140-6736(92)92694-B.
4. Falk PM, Beart RW, Jr. Wexner SD, et al. Laparoscopic colectomy: A critical appraisal. Dis Colon Rectum. 1993;36(1):28–34. doi: 10.1007/BF02050298.
5. Killeen S, Mannion M, Devaney A, et al. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis. 2014;16(8):577–94. doi: 10.1111/codi.12616.
6. Wu Q, Wei M, Ye Z, Bi L, Zheng E et al. Laparoscopic colectomy versus open colectomy for treatment of transverse colon cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg TechA. 2017 Oct;27(10):1038-50. doi: 10.1089/lap.2017.0031.
7. Myamoto Y, Hioshi Y, Tokunaga R, et al. Postoperative complications are associated with poor survival outcome after curative resection for colorectal cancer: a propensity-score analysis. J Surg Oncol. 2020 Aug;122(2):344-349. doi: 10.1002/jso.25961..
8. Jeong SY, Park JW, Nam BH, et al. 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. 2014 Jun;15(7):767-74. doi: 10.1016/S1470-2045(14)70205-0.
9. H Jaap Bonjer, Charlotte L Deijen, Gabor A Abis et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015 Apr 2:372(14):1324-32
10. Fleshman J, Branda ME, Sargent DJ, et al. Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial. Ann Surg. 2019 Apr;269(4):589-95. doi: 10.1097/SLA.0000000000003002.
11. Stevenson A, Solomon M, Brown C, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: The Astralasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg. 2019 Apr;269(4):596-602. doi: 10.1097/SLA.0000000000003021.
12. Zhou MW, Gu XD, Xiang JB, et al. Clinical safety and outcomes of laparoscopic surgery versus open surgery for palliative resection of primary tumors in patients with stage IV colorectal cancer: a meta-analysis. Surg Endosc. 2016 May;30(5):1902-10. doi: 10.1007/s00464-015-4409-1.
13. Guo Y, Gao Y, Chen G, et al. Minimally Invasive versus Open Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Meta-Analysis. Am Surg. 2018;84(2):192-200.
14. Ye SP, Qiu H, Liao SJ, et al. Mini-invasive vs open resection of colorectal cancer and liver metastases: A meta-analysis. World J Gastroenterol. 2019;25(22):2819-32. doi: 10.3748/wjg.v25.i22.2819.
15. Administration USFaD 510(k) Premarket Notification [Internet]. [(accessed on 28 February 2024)]; Available online: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K990144
16. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45(12):1689–94; discussion 1695–1786. doi: 10.1007/s10350-004-7261-2.
17. Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg. Endosc. 2002;16(8):1187–91. doi: 10.1007/s004640080154.
18. Zmora O, Bar-Dayan A, Khaikin M, et al. Laparoscopic colectomy for transverse colon carcinoma. Tech Coloproctol. 2010;14(1):25–30. doi: 10.1007/s10151-009-0551-x.
19. Colon Cancer Laparoscopic or Open Resection Study Group; Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009 Jan;10(1):44-52. doi: 10.1016/S1470-2045(08)70310-3.
20. Yao Q, Nan-Sun Q, Zhou Jia-Jie, et al. Robotic-assisted intracorporeal versus extracorporeal techniques in sigmoidectomy: a propensity score-matched analysis. J Robot Surg. 2023 Oct;17(5):2479-85. doi: 10.1007/s11701-023-01678-9.
21. Dohrn N, Yikilmaz H, Laursen M, et al. Intracorporeal versus extracorporeal anastomosis in robotic right colectomy: a multicenter triple-blind randomized clinical trial. Ann Surg. 2022 Nov 1;276(5):e294-e301. doi: 10.1097/SLA.0000000000005254.
22. Köckerling F. Robotic vs. Standard Laparoscopic Technique—What is Better? Front. Surg. 2014;1:15. doi: 10.3389/fsurg.2014.00015.
23. Liu H, Kinoshita T, Tonouchi A, et al. What are the reasons for a longer operation time in robotic gastrectomy than in laparoscopic gastrectomy for stomach cancer? Surg. Endosc. 2019;33(1):192–8. doi: 10.1007/s00464-018-6294-x.
24. Negrut RL, Cote A, Caus V, et al. Systematic review and meta-analysis of laparoscopic versus robotic-assisted surgery for colon cancer: efficacy safety, and outcomes – a focus on studies from 2020-2024. Cancers (Basel). 2024 Apr 18;16(8):1552. doi: 10.3390/cancers16081552.
25. Farah E, Abreu AA, Rail B, et al. Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World J Surg Oncol. 2023 Aug 30;21(1):272. doi: 10.1186/s12957-023-03138-y.
26. Lin CY, Liu YC, Chen CC, et al. Robotic-Assisted Colon Cancer Surgery: Faster Recovery and Less Pain Compared to Laparoscopy in a Retrospective Propensity-Matched Study. Cancers (Basel). 2025 Jan 13;17(2):243. doi: 10.3390/cancers17020243.
