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Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
Published on: September 22, 2023
565
Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and
Michael A Napolitano1, James A Zebley1, Kelly Wagner1
1From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Journal of the American College of Surgeons
|July 15, 2022
Summary
Robotic-assisted foregut surgery (RAF) in veterans showed shorter operative times and fewer complications like pulmonary issues and renal failure compared to laparoscopic surgery. Outcomes improve as surgeons gain experience with the robotic platform.
Area of Science:
- Minimally Invasive Surgery
- Surgical Technology
- Comparative Effectiveness Research
Background:
- Robotic surgery historically has longer operative times and higher costs than laparoscopic surgery.
- Robotic platforms may offer advantages in complex surgical areas like the gastroesophageal junction due to improved visualization and dexterity.
- This study evaluates 30-day outcomes comparing robotic-assisted foregut surgery (RAF) with laparoscopic-assisted foregut surgery.
Purpose of the Study:
- To compare 30-day postoperative outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery.
- To identify differences in complication rates and operative times between the two surgical approaches.
- To assess the impact of surgical approach on patient outcomes within the Veterans Health Administration system.
Main Methods:
- Retrospective review of the Veterans Affairs Quality Improvement Program database (2008-2019).
- Identification of patients undergoing laparoscopic-assisted foregut surgery and RAF using specific CPT codes and robotic modifier.
- Multivariable logistic regression and generalized linear models were used for outcome analysis.
Main Results:
- A total of 9,355 minimally invasive fundoplications were analyzed.
- Robotic-assisted foregut surgery (RAF) was associated with significantly decreased odds of pulmonary complications (aOR 0.44), acute renal failure (aOR 0.14), and venous thromboembolism (aOR 0.44).
- RAF demonstrated a significantly shorter adjusted mean operative time (332 minutes vs 361 minutes) and an increased odds of infectious complications (aOR 1.60).
Conclusions:
- Veterans undergoing robotic-assisted foregut surgery experienced shorter operative times and reduced complications compared to those undergoing laparoscopic surgery.
- The adoption of robotic platforms in foregut surgery is increasing, with improving clinical outcomes and operative times.
- Robotic assistance is particularly beneficial in confined surgical spaces requiring enhanced articulation and visualization.
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