Duration of surgery and length of stay in patients undergoing robotic versus laparoscopic achalasia surgery

Abstract

Objective: To compare robotic versus laparoscopic Heller’s cardiomyotomy in terms of operative duration and length of hospital stay in a tertiary care setting.

Method: The single-centre, comparative, cohort study was conducted in 2023 at Dr. Ruth K. M. Pfau, Civil Hospital Karachi, and comprised retrospective and prospective data of all patients who presented with classical achalasia on high-resolution manometry between January 2020 and December 2023. All the patients were investigated with upper gastrointestinal endoscopy and high-resolution manometry. Patients who underwent laparoscopic surgery were allocated to group A, and those who underwent robotic surgery were allocated to group B. The duration of surgery and length of hospital stay were recorded. Intraoperative complications, like oesophageal perforation and bleeding, were also noted. Data was analysed using SPSS 23.

Results: Of the 35 patients with mean age 33.40±7.10 years (range: 20-55 years), 20(57.14%) were in group A and 15(42.86%) were in group B. There were 20(57.14%) female and 15(42.86%) male patients. The mean body mass index was 20.74±3.47kg/m2, and it was higher in group A compared to group B (p=0.036). Mean duration of surgery was 132.75±23.64 minutes in group A compared to 92.67±7.52 minutes in group B (p<0.001). There were 2(10%) cases of oesophageal perforation in group A and none in group B (p=0.496). The length of hospital stay was 3.25±0.91 days in group A and 2.87±0.74 days in group B (p=0.383). The cost per procedure in group B was US$4,034 compared to US$53 in group A.

Conclusion: Robotic surgery reduced operative time compared to laparoscopy. While two perforations occurred in the laparoscopic group, the substantially higher cost of robotics remains unjustifiable in resource-limited settings, given its lack of clear clinical superiority.

Key Words: Achalasia, Robotic surgical procedures, Laparoscopy, Length of stay, Postoperative complications.