Rise of the robots: implementing robotic surgery into the acute care surgery practice.

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Acute Care Surgery

Background:

• Acute Care Surgery (ACS) admissions and procedures are increasing, contributing significantly to surgical morbidity and mortality.
• Minimally invasive techniques improve outcomes and reduce hospital stay in ACS.
• Robotic surgery adoption by ACS surgeons has lagged behind laparoscopy.

Purpose of the Study:

• To evaluate the feasibility of integrating robotic surgery into Acute Care Surgery practice.
• To assess the safety and outcomes of robotic procedures performed by ACS surgeons.

Main Methods:

• A retrospective review of robotic General Surgery operations performed by ACS staff across 5 facilities over 15 months.
• Data collected included patient demographics, procedure types, total supply and implant charges (TSI), conversion to open, length of stay (LOS), and 30-day readmission and mortality rates.

Main Results:

• 200 robotic operations were analyzed, with Cholecystectomy, Inguinal hernia repair, and Ventral hernia repair being the most common procedures.
• Median patient age was 48 years, BMI 29.9 kg/m², with most cases being sub-acute (46%) or elective (33.5%).
• Median TSI was $1,770, median LOS was 0.1 days for outpatient and 3 days for inpatient cases (O:E=0.96). No 30-day mortality was observed, with 5 readmissions.

Conclusions:

• Robotic techniques can be safely implemented by Acute Care Surgery surgeons.
• Robotic surgery in ACS demonstrated comparable LOS to laparoscopic cases with a low conversion rate to open procedures.
• Future research should include multi-center prospective trials comparing robotic to laparoscopic approaches in ACS.