by Jacqueline Mitchell, Beth Israel Deaconess Medical Center
A new study shows that robotic surgery provides several important advantages over the laparoscopic approach to colorectal resections. The retrospective cohort study, published in the Journal of Robotic Surgery, compared patients who underwent robotic versus laparoscopic colorectal resections and examined their postoperative pain, postoperative opioid requirements and time of return to work. The robotic approach outperformed laparoscopic in all three areas.
A colorectal resection is a surgical procedure in which part or all of the colon (large intestine) and/or rectum is removed, often performed to treat conditions such as colorectal cancer, diverticulitis or inflammatory bowel disease. The goal of the surgery is to remove the diseased or damaged portion of the colon or rectum, and in some cases, to reconnect the healthy ends of the digestive tract.
Depending on a number of variables, the surgeon may use open surgery, laparoscopy, or robotic-assisted techniques -- in which the surgeon performs the operation by using joysticks to control robotic arms -- for the resection.
The study described 578 patients who underwent either robotic or laparoscopic colorectal surgery between 2018 and 2022. The investigators found that -- after adjusting for variables -- patients in the robotic group reported experiencing less pain both during hospitalization and at one-week after discharge than those in the laparoscopic group.
Patients in the robotic group also had significantly lower opioid use. Finally, among patients who returned to work, those who underwent robotic surgery went to work earlier than those in the laparoscopic group -- nearly two days earlier on average, 2.1 days after discharge versus 3.8.
The scientists suggest that the robotic arm's multiple internal joints and enhanced steadiness decrease disturbance to the tissues of the abdominal wall, thus speeding postoperative healing.
"Most patients and physicians are aware that minimally invasive surgery, which includes both laparoscopic and robotic surgery, is better than open surgery, when feasible," Umut Sarpel, MD, Chief of the division of Surgical Oncology at BIDMC. "But I don't think it is appreciated that robotic surgery offers additional advantages over laparoscopic surgery. This paper nicely demonstrates what robotic surgeons have suspected for some time, which is that patients experience less pain with this approach."