Water Under the Bridge: Ureteral Injury After Robotic Versus Laparoscopic Rectal Surgery
Zeyu Liu1, Abiha Abdullah2, Mehsa Hashim3
1From the Department of Surgery, David Geffen School of Medicine of UCLA, Los Angeles, CA.
Summary
Robotic rectal surgery does not reduce ureteral injury risk compared to laparoscopic surgery. While robotic approaches offer better short-term outcomes, they come with significantly higher hospitalization costs.
Area of Science:
- Urology
- Surgical Innovation
- Patient Outcomes
Background:
- Robotic surgery is gaining traction for rectal procedures, offering ergonomic advantages over laparoscopic surgery.
- Concerns remain regarding the comparative incidence of ureteral injury between robotic and laparoscopic rectal surgery.
- This study investigates the association between surgical approach and ureteral injury rates.
Purpose of the Study:
- To determine if robotic rectal surgery is associated with a lower incidence of ureteral injury compared to laparoscopic rectal surgery.
- To evaluate secondary outcomes including in-hospital mortality, major complications, length of stay, nonhome discharge, and hospitalization costs.
- To provide evidence-based insights into the comparative effectiveness and safety of robotic versus laparoscopic rectal surgery.
Main Methods:
- A retrospective cohort study utilizing the Nationwide Readmissions Database (2017-2022).
- Inclusion criteria: adults undergoing all-cause laparoscopic or robotic rectal surgery.
- Statistical analysis involved entropy balance adjustment and multivariable regression to assess the association between surgical approach and outcomes, with ureteral injury as the primary outcome.
Main Results:
- Robotic rectal surgery was not associated with a reduced risk of ureteral injury (aOR: 1.12, 95% CI: 0.76-1.66, P = 0.563).
- Robotic surgery showed lower odds of gastrointestinal complications (aOR: 0.57, 95% CI: 0.43-0.76, P < 0.001).
- Robotic approach correlated with a shorter length of stay (β: -0.34 days) but significantly higher costs (+$5900).
Conclusions:
- The surgical approach (robotic vs. laparoscopic) does not impact the risk of ureteral injury in rectal surgery.
- Robotic rectal surgery demonstrates improved short-term clinical outcomes, such as fewer gastrointestinal complications and shorter hospital stays.
- Despite clinical benefits, robotic rectal surgery is associated with substantially higher hospitalization costs compared to the laparoscopic approach.
