The robotic approach improves the feasibility of minimally invasive colectomy even where there may be an anatomic challenge with laparoscopy. Whether a failure in completing colectomy with this newer technology is associated with worse consequences needs to be considered when evaluating the relative benefit of robotic colectomy. The aim of this study is to evaluate rates of conversion to open surgery after robotic and laparoscopic colectomy and whether outcomes after conversion vary after the two techniques since this has not been well studied. From the American College of Surgeons (ACS) - National Surgical Quality Improvement Program (NSQIP) (2015-2016), patients who underwent elective minimally invasive colectomy were identified. Converted robotic were compared to laparoscopic procedures for patient demographics, co-morbidities; primary procedure and diagnosis, prolonged operation and postoperative complications. Of 36,046 colectomy procedures, 30,808 (85.5%) were laparoscopic, while 5238 (14.5%) were robotic-assisted. There were 3271 (9.1%) conversions to open surgery (laparoscopic: 2959 [9.6%]; robotic: 312 [6%]). Thirty-day postoperative surgical site infection, anastomotic leak, ileus, sepsis, bleeding requiring transfusion, urinary tract infection, reoperation; pulmonary, renal, cardiac/cerebrovascular complications; readmission, hospital stay, and mortality, were similar between the two groups. However, deep vein thrombosis/pulmonary embolism was higher after robotic conversion (4.5% vs. 2.2%, p = 0.01). Conversion was lower after robotic when compared to laparoscopic colectomy. Converted patients had similar outcomes except for vein thromboembolism which was higher after robotic surgery. Robotic technology seems to improve the feasibility of minimally invasive surgery without negatively affecting safety and efficacy even when conversion is required.

Keywords: Colectomy; Conversion; Laparoscopic; Outcomes; Robotic.

© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

机器人手术方法提高了腹腔镜下解剖结构挑战下的微创结肠切除术的可行性。当评估机器人结肠切除术的相对益处时，需要考虑使用这项新技术未能完成结肠切除是否会导致更严重的后果。本研究旨在评估机器人和腹腔镜结肠切除术后转换为开放手术的比例，并且探讨两种技术在转换后的结果是否存在差异，因为这一方面尚未被充分研究。从美国外科医师学会（ACS）-国家外科质量改进计划（NSQIP）（2015-2016年），识别出接受选择性微创结肠切除术的患者。比较机器人手术与腹腔镜手术在患者的人口统计学特征、合并症；主要手术和诊断，延长操作时间和术后并发症方面的差异。在36,046例结肠切除术中，85.5%（30,808例）为腹腔镜手术，而14.5%（5238例）为机器人辅助手术。有9.1%（3271例）转换为了开放手术（腹腔镜：2959 [9.6%]；机器人：312 [6%]）。术后30天的切口感染、吻合口漏、肠梗阻、败血症、需要输血的出血、尿路感染、再手术；肺部、肾功能、心脏/脑血管并发症；再入院、住院时间和死亡率，在两组中相似。然而，深静脉血栓形成/肺栓塞在机器人转换后更高（4.5% vs. 2.2%，p = 0.01）。与腹腔镜结肠切除术相比，机器人手术后的转换率较低。转换的患者结果相似，除了深静脉血栓形成，在机器人手术后较高。机器人技术似乎提高了微创手术的可行性，即使在需要转换的情况下也不会影响安全性和有效性。

关键词： 结肠切除术；转换；腹腔镜；结果；机器人。

© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.