While the use of minimally invasive surgery (MIS) has expanded in many specialties, colon resection is still routinely performed as open surgery in much of the United States.
In a retrospective study of more than 88,000 Vizient records, NYU Langone Health researchers found that, compared with open surgery, minimally invasive colon resection improves short-term outcomes, including length of stay, readmission rate, mortality, and cost.
“Our study shows that patients who have minimally invasive colectomy will have superior outcomes.”Collin E. Brathwaite, MD
“Colon resections are regarded as major operations in comparison to other GI surgeries, and many surgeons have greeted minimally invasive colon surgery with caution,” says Collin E. Brathwaite, MD, chair of the Department of Surgery at NYU Langone Hospital—Long Island. “There was some initial doubt around oncological colorectal surgery because of early concern regarding higher recurrence rates.”
Another reason for surgeon hesitancy: The learning curve for MIS is steep.
“You have to go through formal, structured training,” Dr. Brathwaite says. “Robotics is easier to learn, but the equipment is expensive. You can’t just go out and start doing it like you can laparoscopy.”
As laparoscopic and robotic procedures increase in academic centers, surgical residents will be more likely to perform colon MIS, Dr. Brathwaite notes. The goal is to make sure as many people are trained in MIS as possible, including practicing surgeons.
“Of course, we’re still teaching laparoscopy; we don’t have robots in every operating room,” he says. “And there are some patients that still require open surgery; for example, someone who is hemodynamically unstable. Residents work with us on these open cases and get simulation training as well.”
Dr. Brathwaite hopes this study and others will shift thinking regarding open colon resection as the gold standard of care.
“To make any sort of change like this, you have to keep showing data,” he says. “Our study shows that patients who have minimally invasive colectomy will have superior outcomes, especially right around the episode of care.”