Water Under the Bridge: Ureteral Injury After Robotic Versus Laparoscopic Rectal Surgery.

Background: Robotic surgery is increasingly utilized for rectal surgery due to its favorable ergonomics and perceived superior outcomes compared with laparoscopic surgery. However, it is unclear whether the rates of ureteral injury are lower with robotic rectal surgery. We hypothesized that the robotic approach would be associated with a lower incidence of ureteral injury. Methods: This retrospective cohort study used the Nationwide Readmissions Database (2017-2022) to identify adults (≥18 years) who underwent all-cause laparoscopic or robotic rectal surgery. The primary outcome was ureteral injury. Secondary outcomes, defined a priori, included in-hospital mortality, major complications, length of stay, nonhome discharge, and hospitalization costs. Entropy balance adjusted for baseline confounders, multivariable regression models were constructed for evaluating the association between surgical approach and outcomes. Results: Of the 33,642 patients included in the study, 18,135 (53.9%) underwent robotic rectal surgery. After entropy balancing and risk adjustment, robotic surgery was not associated with a reduced risk of ureteral injury [adjusted odds ratio: 1.12, 95% confidence interval (CI): 0.76-1.66; Conclusions: This cohort study found that surgical approach does not affect the risk of ureteral injury, yet the robotic approach was associated with better short-term clinical outcomes but significantly higher costs compared with laparoscopic surgery.