Abstract
Introduction
The use of the robot in general surgery has exploded in the last decade. The Veterans
Health Administration presents a unique opportunity to study differences between surgical
approaches due to the ability to control for health system and insurance variability.
This study compares clinical outcomes between robot-assisted and laparoscopic or open
techniques for three general surgery procedures.
Methods
A retrospective observational study using the Veterans Affair Surgical Quality Improvement
Program database. Operative time, length of stay, and complications were compared
for cholecystectomy (robot-assisted versus laparoscopic), ventral, and inguinal hernia repair (robot-assisted versus laparoscopic or open) from 2015 to 2019.
Results
More than 80,000 cases were analyzed (21,652 cholecystectomy, 9214 ventral hernia
repairs, and 51,324 inguinal hernia repairs). Median operative time was longer for
all robot-assisted approaches as compared to laparoscopic or open techniques with
the largest difference seen between open and robot-assisted primary ventral hernia
repair (unadjusted difference of 93 min, P < 0.001). Median length of stay was between 1 and 4 d and significantly for robot-assisted
ventral hernia repairs (versus open, P < 0.01; versus lap for recurrent hernia, P < 0.05). Specific postoperative outcomes of interest were overall low with few differences
between techniques.
Conclusions
While the robotic platform was associated with longer operative time, these findings
must be interpreted in the context of a learning curve and indications for use (i.e.,
use of the robot for technically challenging cases). Our findings suggest that at
the Veterans Health Administration, the robot is as safe a platform for common general
surgery procedures as traditional approaches. Future studies should focus on patient-centered
outcomes including pain and cosmesis.
Keywords
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Article info
Publication history
Published online: July 07, 2022
Accepted:
June 11,
2022
Received in revised form:
June 3,
2022
Received:
February 4,
2022
Identification
Copyright
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