Recent patterns in minimally invasive colectomies: Where are we now?

Abstract

Objective

Minimally invasive surgery (MIS) techniques such as laparoscopy and robotic surgery for colorectal resection have been cited as superior to traditional open surgery because of their associations with decreased operating room time, hospital stay length, and postoperative morbidity. Despite these benefits, the open approach remains a common surgical method for colorectal resection procedures. We aim to evaluate the most recent yearly trends in open, laparoscopic, and robotic approaches to provide insight into uptake and present the status of MIS in the field of colorectal surgery.

Methods

Data were collected from the American College of Surgeons National Surgical Quality Improvement Program targeted colectomy database for the years 2014–2020. The surgical approach was classified as either open, laparoscopic, or robotic. Analysis was performed to identify trends in colorectal surgery categorized by year, patient age, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and emergency status.

Results

There was an overall decline in both open and laparoscopic surgery cases (from 38.4% to 34.4% and from 57.4% to 50.8%, respectively) and an overall increase in robotic surgery cases (from 4.2% to 14.8%) from 2014 through 2020. Open surgery was the most common approach for the lowest BMI category (<18.5 kg/m²), highest risk ASA classes (4–5) and most emergent surgeries, whereas robotic surgery rates were negligible for these groups. Laparoscopy was the most prevalent approach for all other categories.

Conclusion

Laparoscopy was the most prevalent approach in colorectal surgery, although the total case proportions generally tended to decrease. While open surgery remains the approach of choice for emergent procedures, laparoscopic case proportions increased marginally in this category, likely owing to increases in surgeon comfort and continued expansion of laparoscopic training efforts. Importantly, the total prevalence of robotic surgery increased significantly between 2014 and 2020, which may be attributable to advancements in the robotic platform and increases in familiarity and competence with the technology. We anticipate a continuation of these trends in the future and recommend the creation of a national robotic surgery training standard.