Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 1;235(2):149-156.
doi: 10.1097/XCS.0000000000000218. Epub 2022 Apr 5.

Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes

Michael A Napolitano  1 , James A Zebley  1 , Kelly Wagner  1 , Timothy J Holleran  1 , Gregor Werba  1 , Andrew D Sparks  1 , Gregory Trachiotis  2 , Fred Brody  1
Affiliations

Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes

Michael A Napolitano et al. J Am Coll Surg. .

Abstract

Background: Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration.

Study design: This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest.

Results: A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001).

Conclusions: Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.

PubMed Disclaimer

Comment in

References

    1. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991;1:138–143.
    1. Damani T, Ballantyne G. Robotic foregut surgery. Surg Clin North Am. 2020;100:249–264.
    1. Heemskerk JWM, van Gemert WG, Greve JW, Bouvy ND. Robot-assisted versus conventional laparoscopic Nissen fundoplication: s comparative retrospective study on costs and time consumption. Surg Laparosc Endosc Percutan Tech. 2007;17:1–4.
    1. Morino M, Pellegrino L, Giaccone C, et al. Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg. 2006;93:553–558.
    1. Melvin WS, Needleman BJ, Krause KR, et al. Computer-enhanced vs. standard laparoscopic antireflux surgery. J Gastrointest Surg. 2002;6:11–15; discussion 15.

LinkOut - more resources