Trends in operative time and patient outcomes in robotic colostomy reversal: surgeons’ short-term pain for patients’ long-term gain

Introduction: The purpose of this study was to assess robotic console time and total operative time, as well as post-operative outcomes, in patients undergoing robotic-assisted colostomy reversal. Methods: This was a single institution retrospective review of patients undergoing robotic colostomy reversal from January 2020 to February 2024. Demographics, pre-, intra-, and post-operative data were collected and analyzed to evaluate factors associated with prolonged console and operative times, as well as assess post-operative outcomes. Results: 37 patients underwent robotic-assisted colostomy reversal. 21 patients were male. Mean age was 57.1 years and 87.5% were Caucasian. 40.5% had hypertension, 5.4% had DMII, 2.7% had CHF, 5.4% had CKD, and 5.4% had COPD. 24 (64.9%) had colostomies secondary to perforated diverticulitis, 8.1% due to diverticulitis without frank perforation, 8.1% due to perforated or obstructing colon malignancies, and 5.4% following traumatic colon injuries. 97.3% had fully independent functional statuses. Two cases (5.4%) were converted to open. Mean console time for all cases was 174 min. Mean console time in those who did not undergo pre-operative ureteral stenting or ICG instillation was significantly less (161 min) than those who did (203 min) (p = 0.020). Over the study period, there was no statistically significant decrease in robotic console time (p = 0.982) or total operative time (p = 0.977). Two patients (5.4%) had post-operative rectal bleeding, one of which required transfusion. No patients had post-operative anastomotic leaks. Mean return of bowel function was 2.1 days. Mean length of stay was 3.7 days and 85.3% of patients were discharged within 4 days. One (2.7%) patient was readmitted within 90 days. Conclusion: Robotic colostomy reversal appears to be a safe and feasible option with a low incidence of complications. Operative time remains long, primarily due to the need for minimally invasive lysis of adhesions. Use of ureteral stenting also contributes to longer console and operative times.