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Comparative Study
. 2024 May 1;159(5):493-499.
doi: 10.1001/jamasurg.2024.0016.

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Nicole Lunardi  1 , Aida Abou-Zamzam  2 , Katherine L Florecki  3 , Swathikan Chidambaram  4 , I-Fan Shih  5 , Alistair J Kent  3 , Bellal Joseph  6 , James P Byrne  3 , Joseph V Sakran  3
Affiliations
Comparative Study

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Nicole Lunardi et al. JAMA Surg. .

Erratum in

  • Error in Key to Figure 1.
    [No authors listed] [No authors listed] JAMA Surg. 2024 May 1;159(5):593. doi: 10.1001/jamasurg.2024.1326. JAMA Surg. 2024. PMID: 38717510 Free PMC article. No abstract available.

Abstract

Importance: Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.

Objectives: To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.

Design, setting, and participants: A retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.

Exposure: Surgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.

Main outcomes and measures: The primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.

Results: During the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days).

Conclusions and relevance: While robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shih reported being employed by Intuitive Surgical during the conduct of the study. Dr Kent reported receiving travel fees paid for by Intuitive Surgical for robotic training courses; was the director of an American College of Surgeons–organized robotic skills competition for Maryland surgical trainees; and received grant and equipment administrative support provided to Maryland American College of Surgeons by Intuitive Surgical contributing to support for this event. Dr Joseph reported receiving honoraria from CSl Behring for travel and lecture fees outside the submitted work. Dr Sakran reported receiving consultant and speaking fees from Intuitive Surgical outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Use of Operative Approach for Emergency General Surgery Between 2013 and 2021
Figure 2.
Figure 2.. Temporal Trends and Robotic Approaches in the Use of Robotic Emergency General Surgery, 2013-2021
A, Trends in the use of robotic emergency general surgery. B, Proportion of robotic emergency general surgery use in 2013 compared with 2021.
See this image and copyright information in PMC

Comment on

References

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