Robotic right colectomy is associated with reduced conversion to open surgery in patients with obesity

Obesity is associated with an increased risk of conversion to open surgery, which in turn is associated with worse postoperative outcomes. We hypothesize that, with its improved ergonomics and instrument dexterity, the robotic approach to right colectomy will be associated with a decreased risk of conversion to open compared with laparoscopic right colectomy (LRC).

Obese adults (body mass index [BMI], ≥30 kg/m²) undergoing elective LRC or robotic right colectomy (RRC) for colon adenocarcinoma (2015-2022) were identified from the American College of Surgeons National Surgical Quality Improvement Program and its colectomy-targeted participant user file. The primary outcome was conversion to open surgery. Secondary outcomes included operative time and the development of postoperative complications.

A total of 11,026 patients (81.9%) underwent LRC, and 2430 (18.1%) underwent RRC. Patients undergoing RRC were younger (64.8 vs 65.8 years; P <.001), more likely to be White (77.9% vs 67.9%; P <.001), and more obese (BMI, 36.1 vs 35.5 kg/m²; P <.001). On multivariate analysis, RRC remained associated with decreased conversion to open surgery (odds ratio [OR], 0.55; P <.001) but increased operative time (b = 51.8 min; P <.001) and a higher incidence of postoperative kidney injury (OR, 2.10; P <.001). There were no differences in the rates of postoperative transfusion, surgical site infection, or anastomotic leak.

In patients with obesity, RRC is associated with a nearly 50% reduction in conversion rate but increased operative time. Given the difficulties of converting to open in patients with obesity and worse postoperative outcomes associated with conversion, the robotic platform may be beneficial for patients with obesity who require a right colectomy.