Low morbidity and mortality with robotic surgery
MedWire News: The use of robotics in general surgery can be safely performed with an acceptable risk profile and low mortality rate, results from a single-center study show.
In addition, conversion to manual surgery and reoperation rates were low, despite there being relatively little patient selection in the present analysis, report Pier Giulianotti (University of Illinois, Chicago, USA) and colleagues.
The findings, published in the Archives of Surgery, highlight 884 robotic procedures performed by experienced surgeons at the group's academic medical center.
The robotic operations performed by the surgeons included basic procedures with little dissection and/or reconstruction, intermediate procedures requiring substantial dissection and/or reconstruction (and usually a mechanical device for the anastomosis), and advanced procedures requiring advanced dissection in difficult-to-reach areas as well as complex reconstruction (and often hand-sewn anastomosis).
Among the surgeries, 17.9%, 58.4%, and 23.7% were classified as basic, intermediate, and advanced procedures, respectively.
Of the operations, 2% were converted to manual surgery, including eight procedures for oncologic reasons, five for technical problems, and two for bleeding. There were 21 reoperations, including four for postoperative hernias, three for gastrointestinal leaks, and two for wound infections.
The overall mortality rate was 0.5% and the postoperative morbidity rate was 16.7%. Two patients died following cardiac arrhythmias and both were older than 75 years and had a high surgical risk.
Regarding complications, urinary retention, wound problems, constipation, and transitory desaturation occurred following cholecystectomy, while diarrhea, pneumonia, and pulmonary embolism occurred after fundoplication, hernia repair, and biopsy, respectively.
In an attempt to identify risk factors for complications following robotic surgery, the researchers performed a multivariate analysis and identified several significant independent risk factors. These included a body mass index of less than 30 kg/m2, hypertension, malignant disease, type of procedure, the need for blood transfusion, and multi-quadrant surgery.
Multi-quadrant surgery is likely a risk factor for increased morbidity given that maneuvering the robotic cart and/or trocars can lead to an increase in operative time, say the researchers. Being older than 70 years was identified as a risk factor for morbidity and mortality only in univariate analysis, but elderly patients should be considered as a population at risk for complications, they add.
"The experience of the surgical team is another factor to consider," according to Giulianotti and colleagues. "A low-volume hospital or a low surgeon case volume is related to a higher mortality rate."
The group points out that they perform more than 270 robotic procedures annually, making them a high-volume center.
By MedWire Reporters