Department of Surgery, Queens University, Kingston, ON, Canada.
Kingston Health Sciences Centre, Kingston, ON, Canada.
Surg Endosc. 2022 Aug;36(8):6084-6094. doi: 10.1007/s00464-022-09059-3. Epub 2022 Feb 25.
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.
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.
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).
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.
机器人手术在结直肠病理学中越来越受到关注，因为它可以克服传统腹腔镜手术的技术挑战和局限性。培训和成本不足被认为是限制其在加拿大使用的原因。本文的目的是评估机器人手术在加拿大环境下对结果和成本的影响。
这是一项回顾性研究，纳入了在加拿大安大略省一家三级保健中心连续接受左半结直肠手术的患者（“机器人前阶段”n=145 与“机器人后阶段”n=150）。比较了微创手术（MIS）的利用率和成功率、住院时间、并发症和医院费用。采用单变量和多变量分析进行这些比较。
两组患者的特征、诊断和切除类型相似。机器人的应用导致更高的 MIS 成功率（即无转换尝试的 MIS）（85%比 47%，P<0.001）、更短的平均住院时间（4.7 天比 8.4 天，P<0.001）和相似的平均手术时间（3.9 小时比 3.9 小时，P=0.93）。机器人阶段急诊就诊次数较少（24%比 34%，P=0.04），但再入院、吻合口漏或非计划再次手术无差异。机器人应用后，平均总住院费用下降，但无统计学意义（-$1453，95%CI -$3974 至 +$1068，P=0.25）。调整年龄、性别、肥胖、ASA 和手术程序后，回归分析得出类似的结果（机器人阶段 -$657，95%CI -$3038 至 +$1724，与机器人前阶段[参考]相比，P=0.59）。
在加拿大一家三级保健中心实施机器人结直肠手术计划显示出改善的临床结果，而护理成本没有显著增加。尽管这项研究来自单一机构，但我们已经证明，机器人结直肠手术在适当的情况下是可行且具有成本效益的。
