eP570 - Robotic versus Hand-Assisted Laparoscopic Surgery for Left-Sided Colectomy

Purpose/Background: Minimally invasive surgery (MIS) can include laparoscopic, hand-assisted laparoscopic surgery (HALS), or robotic-assisted (RA) approaches. Prior studies have compared various types of MIS approaches for different types of colorectal resections, but studies comparing RA and HALS for left colectomy are lacking. The aim of this study was to compare early clinical outcomes of RA and HALS approaches for left-sided colectomy.Methods/Interventions: This study was conducted at a single high-volume tertiary care referral center. Five surgeons contributed to the study: 3 perform all MIS left colectomies with HALS and 2 perform both RA and HALS. Patients who underwent a left-sided HALS or RA colon resection (left colectomy, sigmoidectomy and anterior resection) between January 2021 and September 2023 were included. Patients with a pre-existing diversion were excluded. A prospectively maintained operative database as well as the electronic medical records were queried. Primary outcomes were length of stay and conversion rate. Secondary outcomes were operative time, estimated blood loss (EBL), and time to return of bowel function. The surgeons’ preoperative and postoperative perceived level of difficulty of the case were collected prospectively.Results/Outcomes: A total of 240 patients were analyzed, including 58 RA and 182 HALS. There were more cancers in the RA group than the HALS group (28% vs. 13%, p=0.026). Compared to HALS, RA had a longer median operative time (240 min, interquartile range (IQR) 240-300 vs. 210 min (IQR 180-270), shorter length of stay (median 3 days (IQR 3-4) vs. 4 days (IQR 3-6), p < 0.001), and lower EBL (median 75 mL (IQR 50-100) vs. 100 mL (IQR 50-200), p=0.004). RA surgeries were also more likely to include an intracorporeal anastomosis (21% vs. 0%, p < 0.001), have a high ligation of the pedicle (16% vs. 5%, p < 0.001), and extract via a Pfannensteil versus lower midline incision (90% vs. 67%, p < 0.001). There was only one conversion to open in each group. Twenty-five (44%) of the RA cases however, were converted to HALS (due to case complexity/inadequate mobilization). When compared to RA completed procedures, RA surgeries converted to HALS took longer (median 270 min (IQR 240-300) vs. 240 min (IQR 210-300), p=0.035), had slightly longer LOS (median 4 days (IQR 3-4) vs. 3 (IQR 2.5-3), p=0.012), required more splenic flexure mobilizations (73% vs. 16%, p < 0.001), and were judged by the surgeon both preoperatively (85% vs. 56%, p=0.036) and postoperatively (92% vs. 62%, p=0.012) to be hard/very hard.Conclusion/

Discussion: In this single institution non-randomized series for left-sided colon resections, RA procedures had shorter LOS, but at the cost of longer operative times, compared to HALS. For surgeons who are comfortable with both techniques, conversion to an open approach is rarely necessary. Furthermore, converting from RA to HALS appears to preserve many of the advantages of MIS surgery, even for the most challenging of cases.Table 1: HALS vs RA comparison dataComparison of demographics, operative details, primary and secondary outcomes of HALS vs RA surgery for left-sided colectomy (HALS= hand-assisted laparoscopic surgery, SD= standard deviation, BMI= body mass index, ASA= American College of Anesthesiologists score, HTNf hypertension, CAD= coronary artery disease, MI= myocardial infarction, IQR= interquartile range)