Background: Minimally invasive surgical techniques improve metrics designed to measure quality and efficiency. Compared to open surgery (OS) and laparoscopy (LAP), robotic assisted colorectal surgery (RACS) has shorter length of stay (LOS), less estimated blood loss (EBL), and complications. RACS cost-per-case has been significantly reduced in recent years, which has made the technique cost-effective. In our ongoing retrospective observational study, we analyzed the initial 57 cases of colorectal malignancy managed with RACS in a community hospital. Methods: comparative study of the first 57patients treated with RACS for malignant tumors done from 6/17 to 7/19 in a community hospital. The data was then compared to the published literature. Two outliers with multiple comorbidities and prolonged LOS were excluded from the LOS calculation. Results: 51% were male (n=29) and 49% were female (n=28). The mean EBL was 62.5 ml with 7% (n=4) requiring a blood transfusion. Mean OR time (minutes): 238.5, conversion rate:17% (n=10), mean LOS: 8 days and the major complication rate (Clavien-Dindo grades 3-5) was 12% (n=7). The readmission rate was 9% (n=5). PGH- RACS (n=57) Literature RACS Literature LAP Literature OS OR (minutes) 238 225 189 195 LOS (days) 8 5 6 9 Transfusion 7% (n=4) 5% 8% 13% Sepsis 2% (n=1) 2% 2% 5% Ileus 7% (n=4) 9% 10% 21% Readmission rate 8% 10% 8% 10% Mortality 1% (n=1) 0.5% 0.3% 0.5% Conclusions: RACS is safe, with minimal mortality, and few complications. Except for LOS, our initial experience utilizing RACS for colorectal malignancies appears to be comparable with published data, replicating the improvement in quality metrics of RACS over LAP and OS. The data in our series establishes a clear goal to reduce LOS at our institution. OR time, transfusion rate, sepsis, ileus, and readmission rates compare favorably to published metrics for RACS and LAP, and better than those published for OS. Prospective data collection will be an integral part of improving outcomes for RACS.
