eP426 - A Robotic Colorectal Surgery Program in a Philippine Government Hospital: Approaching the First 100 Cases

Purpose/Background: More than one million surgeries have been performed globally using the robotic platform, and there has been a steady increase in robotic surgery penetration rate by 20% each year since 2012. A study by Hairawala showed that robotic colorectal surgery had a 307% increase in use from 2013 to 2018. As of 2023, only 4 hospitals in the Philippines offer robotic surgery. Among these, the Philippine General Hospital (PGH) is the only government institution. All use the da Vinci® SI Surgical System. We aim to describe the experience of the PGH in robotic colorectal surgery within the setting of a lower middle-income country (LMIC) and compare our learning curve and outcomes with international data.Methods/Interventions: Using a retrospective cohort design, the investigators gathered data using the electronic database of the Department of Surgery from January 2019 to September 2023. All patients who underwent robot-assisted colon or rectal surgery were included in the study. The descriptive and outcome variables were collected using the electronic medical records of the hospital. In-patient and 30-day outcomes were gathered to investigate postoperative outcomes that included anastomotic leak rate and other causes of morbidity or mortality. The data collected were then compared with published international figures.Results/Outcomes: A total of 96 colorectal surgeries were done using the robotic platform, with the first done on March 2019.The mean age of patients was 58.2 years. Sixty-eight (70.8%) were male. Only three cases (3.12%) were colon surgeries. Of the 93 who had a rectal resection, all underwent surgery for rectal cancer and 75 (83.3%) had sphincter-saving procedures. Median length of stay (LOS) was 8 days, with a median postoperative LOS of 5 days. The mean estimated blood loss (EBL) was 472 ml (range 40-2600 ml), with an average total operating time of 427 minutes (range 197-860 mins). Five (5.2%) required conversion to an open approach. Nine (9.4%) surgeries involved another surgical subspecialty.Eleven patients (12%) developed postoperative ileus. Six (6.5%) had urinary retention, while four (4.3%) had nosocomial pneumonia. Anastomotic dehiscence (5/78 patients, 6.4%) occurred in four patients (5.1%) during the same admission, while one (1.3%) presented after discharge. Two other patients (2.2%) had intestinal obstruction due to twisted stomas, with both requiring surgical revision. One mortality (1.1%) was due to an acute myocardial infarction. While our morbidity rate is comparable to international data, we had longer LOS, greater EBL, longer operating time, and higher anastomotic leak rate.Only 72 cases were available for the analysis of the team's learning curve. The CUSUM graph showed two vertices at the 20th and 36th cases. The analysis shows that our robotic team reached competency earlier in Phase 1 but required more cases in Phase 2 when compared with the data presented by Tran et al.Conclusion/

Discussion: Our current state shows that, compared to published data, we reached the competent period (Phase 2) earlier but needed more cases to reach the challenging period (Phase 3). Factors such as laparoscopic and open surgery experience, robotic simulator training, or case mix may have had an impact on our learning curve. Postoperative outcomes also depict that while we have surpassed the first two phases, there is still much to be done for the institution to be in line with existing international standards in skill and expertise.Figure 1Tabulated demographic and operative data, and learning curve, of the robotic colorectal team in our institution. Two vertices (red dots) in the learning curve graph show the start of phase 2 (competent period) and phase 3 (challenging period), at cases 20 and 36, respectively.