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Lai TJ, Heggie R, Kamaruzaman HF, Bouttell J, Boyd K. Economic Evaluations of Robotic-Assisted Surgery: Methods, Challenges and Opportunities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2025; 23:35-49. [PMID: 39333303 DOI: 10.1007/s40258-024-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND The use of robotic-assisted surgery (RAS) is growing rapidly. However, economic evaluation of this technology is challenging. This study aims to identify and discuss the different economic evaluation methods which have been used to evaluate RAS. METHOD This scoping review systematically searched PubMed and Embase from 2015 to 2023. We included economic evaluation studies comparing RAS versus laparoscopic or open surgery. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to aid data extraction and was extended to cover additional features relevant to RAS, including learning curve, organisational impact, incremental innovation and dynamic pricing. RESULTS A total of 50 economic evaluations of RAS were included. Cost-utility analysis (46%) was the most commonly applied economic evaluation method, followed by cost-consequence analysis (32%). The studies focused on the specialties of urology (42%), hepato-pancreato-biliary (20%), colorectal (14%) and gynaecology (6%). Distinctive features related to the assessment of RAS were under-addressed in economic evaluations. Only 40% of the included studies considered learning curve and organisational impact and less than 12% of the included studies reflected on incremental innovation and dynamic pricing. CONCLUSIONS This review found that some studies have incorporated challenges specific to RAS in their evaluations. However, most studies still lack key aspects of importance. In particular, studies rarely considered the ability of RAS platforms to be shared across multiple specialities. Incorporating these distinctive features offers an opportunity for economic evaluation to provide decision-makers with a more realistic assessment of the cost-effectiveness of this technology and to ensure its optimal utilisation in clinical practice.
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Affiliation(s)
- Tzu-Jung Lai
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Robert Heggie
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hanin-Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Janet Bouttell
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Centre for Healthcare Equipment and Technology Adoption, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Song R, Ma M, Yang N, Chen C, Wang H, Li J. A meta-analysis comparing open and minimally invasive cervical tumor surgery wound infection and postoperative complications. BMC Surg 2024; 24:413. [PMID: 39710635 DOI: 10.1186/s12893-024-02713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/09/2024] [Indexed: 12/24/2024] Open
Abstract
To evaluate the impact of open surgical care (OSC) compared to minimally invasive surgery (MIS) on the occurrence of wound infection (WI) and overall postoperative aggregate complications (POACs) in female cervical cancer (CC) patients, we conducted this meta-analysis study. A thorough examination of the literature up to March 2024 was conducted, and 1849 related studies were examined. The 44 studies that were selected included 11,631 females who had CC. The odds ratio (ORs) and the estimation using 95% confidence intervals (CIs) were used to calculate the impact of open surgical management and MIS on WI and POACs in females with CC, using dichotomous methodologies and a random or fixed model. When comparing MIS to open surgical care, there was a substantial decrease in WI (OR, 0.19; 95% CI, 0.13-0.29, p < 0.001) and POACs (OR, 0.49; 95% CI, 0.38-0.62, p < 0.001) in females with CC. On the other hand, among female patients with CC, MIS did not differ significantly from open surgical care in pelvic infection and abscess (PI&A) incidence (OR, 0.59; 95% CI, 0.31-1.16, p = 0.13). When compared to OSC, women with CC who underwent MIS experienced considerably fewer WI and POACs; however, there was no discernible difference in PI&A rates. However, given several of the designated examinations for the meta-analysis had relatively small sample sizes, caution must be used while handling its values.
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Affiliation(s)
- Ran Song
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China
| | - Mingming Ma
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China
| | - Nana Yang
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China
| | - Chunfang Chen
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China
| | - Huan Wang
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China
| | - Juan Li
- Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China.
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Albalawi HIH, Alyoubi RKA, Alsuhaymi NMM, Aldossary FAK, Mohammed G AA, Albishi FM, Aljeddawi J, Najm FAO, Najem NA, Almarhoon MMA. Beyond the Operating Room: A Narrative Review of Enhanced Recovery Strategies in Colorectal Surgery. Cureus 2024; 16:e76123. [PMID: 39840197 PMCID: PMC11745840 DOI: 10.7759/cureus.76123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2024] [Indexed: 01/23/2025] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have significantly transformed the management of patients undergoing colorectal surgery. This comprehensive review explores the key components and benefits of ERAS in colorectal procedures, focusing on preoperative, perioperative, and postoperative strategies aimed at improving patient outcomes. These strategies include preoperative patient education, multimodal analgesia, minimally invasive surgical techniques, and early mobilization. ERAS protocols reduce postoperative complications, shorten hospital stays, and enhance overall recovery, leading to better patient satisfaction and decreased healthcare costs. However, challenges such as patient adherence and managing high-risk patients remain critical areas for further research. Additionally, future research should focus on refining ERAS protocols, integrating novel technologies such as minimally invasive techniques, and evaluating long-term outcomes to further enhance the recovery process.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Neda Ahmed Najem
- General Practice, Fakeeh College of Medical Sciences, Jeddah, SAU
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4
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Gonçalves GF, Villarim PVDO, Marinho VRD, Abreu CA, Pereira LHM, Pereira LHM, Gurgel SE, Rêgo ACM, de Medeiros KS, Araújo-Filho I. Robotic surgery versus conventional laparoscopy in colon cancer patients: a systematic review and meta-analysis. Acta Cir Bras 2024; 39:e397224. [PMID: 39476069 PMCID: PMC11506681 DOI: 10.1590/acb397224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/31/2024] [Indexed: 11/02/2024] Open
Abstract
PURPOSE To compare robotic versus laparoscopic colectomies in colon cancer patients in general complications. METHODS Nine databases were searched for randomized controlled trials (RCT) investigating patients with colon cancer, submitted to robotic surgery (RS) compared to a laparoscopic (LC) approach. The risk of bias was assessed using RoB 2.0 tool, and certainty of the evidence was evaluated by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data synthesis was performed using the software R. The meta-analysis of the included studies was carried out using the fixed-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis. RESULTS A total of four studies were used with 293 patients. Three studies were used in this comparative LC vs. RS when evaluating infection rates on surgical wound sites. The odds ratio (OR) appeared to be slightly favorable to LC (OR = 3.05; 95% confidence interval-95%CI 0.78-11.96). In the hospitalization rates analysis, two randomized controlled trials were used, and the mean differences slightly favored the RS (MD = -0.54; 95%CI -2.28-1.19). GRADE evaluation detected a serious risk of bias due to RCT format and RoB-2 concurred. CONCLUSION Both types of procedures seem to have their own benefits, risks, and limitations. They seem close to equal in terms of postsurgical infection and hospitalization.
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Affiliation(s)
- Giuliana Fulco Gonçalves
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Pedro Vilar de Oliveira Villarim
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | - Vitória Ribeiro Dantas Marinho
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Clarissa Amaral Abreu
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Luiz Henrique Moreira Pereira
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | - Luiz Henrique Moreira Pereira
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | | | - Amália Cínthia Meneses Rêgo
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
| | - Kleyton Santos de Medeiros
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte – Department of Nursing – Natal (RN), Brazil
| | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
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Charland N, Hadaya J, Mallick S, Tran Z, Cho NY, Le N, Kim S, Mukherjee K, Benharash P. National trends and outcomes of robotic emergency general surgery in the United States. Surgery 2024; 176:835-840. [PMID: 38918109 DOI: 10.1016/j.surg.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/22/2024] [Accepted: 05/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been demonstrated, data regarding robotic emergency general surgery remains sparse. METHODS All adults undergoing non-elective appendectomy, cholecystectomy, small or large bowel resection, perforated ulcer repair, or lysis of adhesions were identified in the 2008 to 2020 National Inpatient Sample. Temporal trends were analyzed using a rank-based, non-parametric test developed by Cuzick (nptrend). Using laparoscopy as a reference, multivariable regressions were used to evaluate the association between robotic techniques and in-hospital mortality, major complications, and resource use for each emergency general surgery operation. RESULTS Of an estimated 4,040,555 patients undergoing emergency general surgery, 65,853 (1.6%) were performed using robotic techniques. The robotic proportion of minimally invasive emergency general surgery increased significantly overall, with the largest growth seen in robot-assisted large bowel resections and perforated ulcer repairs. After adjustment for various patient and hospital-level factors, robot-assisted large bowel resection (adjusted odds ratio 0.73, 95% confidence interval 0.58-0.91) and cholecystectomy (adjusted odds ratio 0.66, 95% confidence interval 0.55-0.81) were associated with significantly reduced odds of perioperative blood transfusion compared to traditional laparoscopy. Although robotic techniques were associated with modest reductions in postoperative length of stay, costs were uniformly higher by increments of up to $4,900. CONCLUSION Robotic surgery appears to be a safe and effective adjunct to laparoscopy in minimally invasive emergency general surgery, although comparable cost-effectiveness has yet to be realized. Increasing use of robotic techniques in emergency general surgery may be attributable in part to reduced complications, including blood loss, in certain operative contexts.
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Affiliation(s)
| | - Joseph Hadaya
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Saad Mallick
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Zachary Tran
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, Loma Linda University Health, Loma Linda, CA
| | - Nam Yong Cho
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nguyen Le
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shineui Kim
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Peyman Benharash
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Sohail AH, Martinez KA, Flesner SL, Martinez C, Nguyen H, Jreisat BH, Ye IB, Goyal A, Rohail A, Pacheco TBS, Williams CE, Askeri A, Levine J. Operative Experience of Esophageal Surgery among General Surgery Residents in the United States: An Analysis of ACGME Operative Case Logs. JOURNAL OF SURGICAL EDUCATION 2024; 81:639-646. [PMID: 38556439 DOI: 10.1016/j.jsurg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Esophageal surgery is an essential component of general surgery training and encompasses several types of cases that are logged by general surgery residents. There is a scarcity of data on the quality and volume of esophageal surgery experience during surgical residency in the United States. We analyzed trends for 9 different esophageal procedure categories logged by residents in the United States, with the aim to identify areas for improvement in training. METHODS We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from programs accredited by the ACGME over a fourteen-year period from 2009 to 2023. Data on mean esophageal cases reported by graduates, including mean in each procedure subcategory were retrieved. Cases were categorized as either surgeon chief or surgeon junior for each procedure category. Mann-Kendall trend test was used to obtain tau statistics and p-value for trends in mean operative surgical volume for the total number of cases in each operative category over the study period. Trends in surgeon chief and surgeon junior cases were also investigated for each operative category. RESULTS The mean number of all esophageal procedures performed per resident during their training increased significantly from 10.5 in 2009 to 16 in 2022 (τ = 0.833, p < 0.001). This trend observed among all esophageal procedures during this 14-year study can be largely attributed to the steady increase in the number and proportion of laparoscopic esophageal antireflux procedures performed (τ = 0.950, p < 0.001). Additionally, esophagectomy procedures had a statistically significant, but modest, increase during the study period (τ = 0.505, p = 0.023), from a mean of 1 case during training in 2009 to a peak of 1.3 in 2020. Although the general trend of esophagus procedures increased during the study period, most categories (7 out of 9) either decreased or did not significantly change. Esophagogastrectomy volume decreased significantly by 30%, from 1 per resident during their training in 2009 to 0.7 in 2022 (τ = -0.510, p = 0.018), esophageal diverticulectomy procedures decreased by 50% from 0.2 to 0.1 (τ = -0.609, p = 0.009), and operations for esophageal stenosis decreased by 75% from 0.4 to 0.1 (τ = -0.734, p = 0.001). Mean number of esophageal bypasses (τ = -0.128, p = 0.584), repair of perforated esophageal disease (τ = -0.333, p = 0.156), and other major esophagus procedures (τ = 0.416, p = 0.063) did not significantly change. CONCLUSION The operative volume of esophageal surgery that general surgery residents in the United States are exposed to has significantly risen over the past 14 years, largely driven by the increase in laparoscopic antireflux procedures. However, given the recent advances and the resultant heterogeneity in both esophageal surgery, the increase in resident operative volume is still inadequate to ensure the training of safe and adept esophageal surgeons, necessitating postresidency specialized training for trainees interested in esophageal surgery.
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Affiliation(s)
- Amir Humza Sohail
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Kevin A Martinez
- University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Samuel L Flesner
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christian Martinez
- University of New Mexico, College of Arts and Sciences, Albuquerque, New Mexico
| | - Hoang Nguyen
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Ivan B Ye
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amal Rohail
- Midwestern University, Chicago College of Osteopathic Medicine, Chicago, Illinois
| | - Tulio B S Pacheco
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
| | | | - Aysha Askeri
- Shimoga Institute of Medical Science, Shivamogga, India
| | - Jun Levine
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
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Dashtbozorg A, Heidarian E, Sagheb Ray Shirazi M, Movahednia Z, Jafari M, Abedi Azar R. Emerging Technologies in Hand Orthopedic Surgery: Current Trends and Future Directions. Galen Med J 2024; 13:1-10. [PMID: 39224550 PMCID: PMC11368481 DOI: 10.31661/gmj.v13i.3325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 09/04/2024] Open
Abstract
Emerging technologies are changing hand surgery by improving surgical precision, minimizing tissue disruption, and expediting patient recovery. These advancements have the potential to revolutionize surgical procedures, patient outcomes, and rehabilitation processes. However, there are still challenges that need to be addressed before these technologies can be widely adopted. These challenges include the learning curve for surgeons, high costs, and ethical considerations. Future research should focus on addressing the limitations of these technologies, exploring their long-term effects, and evaluating their cost-effectiveness. To successfully implement them, a collaborative approach involving clinicians, researchers, engineers, and policymakers is necessary. This review provides an overview of current and future trends in emerging technologies for hand orthopedic surgery.
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Affiliation(s)
- Ahmad Dashtbozorg
- Department of Orthopedic Surgery, School of Medicine, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran
| | - Elaheh Heidarian
- Klinik für Unfallchirurgie und Orthopädie, Kinderorthopädie, Agaplesion
Diakonieklinik Rotenburg, Rotenburg (Wümme), Germany
| | - Malihe Sagheb Ray Shirazi
- Depertment of Anatomical Sciences, Faculty of Nursing and Midwifery, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Movahednia
- Department of Operating Room, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Maryam Jafari
- Department of General Surgery for Trauma, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Ramila Abedi Azar
- Laboratory for Robotic Research, Iran University of Science and technology, Tehran,
Iran
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Sibia US, Klune JR, Saiolghalam S, Bilchik A. Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery. Am Surg 2024:31348241241618. [PMID: 38523411 DOI: 10.1177/00031348241241618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. METHODS Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. RESULTS A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). CONCLUSIONS Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.
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Affiliation(s)
- Udai S Sibia
- Providence Health System, Saint John's Cancer Institute, Santa Monica, CA, USA
| | - John R Klune
- Department of Surgery, Anne Arundel Medical Center, Luminis Health, Annapolis, MD, USA
| | - Said Saiolghalam
- Business Intelligence Analytics, Providence Health System, Renton, WA, USA
| | - Anton Bilchik
- Providence Health System, Saint John's Cancer Institute, Santa Monica, CA, USA
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Sujka J, Ahmed A, Kang R, Grimsley EA, Weche M, Janjua H, Mi Z, English D, Martinez C, Velanovich V, Bennett RD, Docimo S, Saad AR, DuCoin C, Kuo PC. Examining surgeon stress in robotic and laparoscopic surgery. J Robot Surg 2024; 18:82. [PMID: 38367193 DOI: 10.1007/s11701-024-01834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Abstract
Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Surgical faculty (n = 7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical "effort"), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using 7-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student's t test used for statistical analysis; p values < 0.05 were significant. Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4 ± 4.5 (p < 0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4 ± 11.5 and 22.2 ± 13.4; raw maximum cortisol change was 44.21 ± 46.57 and 53.21 ± 50.36, respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095 ± 0.12, vs laparoscopic: 0.164 ± 0.16 (p < 0.02). Normalized change in cortisol was: laparoscopic 0.30 ± 0.44, robotic 0.22 ± 0.4 (p = NS). On linear regression (p < 0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p < 0.01); comfort with complex robotic was not significant. Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA.
| | - Abrahim Ahmed
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Richard Kang
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Mcwayne Weche
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Zhiyong Mi
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana English
- Department of Gynecologic Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Carolina Martinez
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Robert D Bennett
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Adham R Saad
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
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Kossenas K, Karamatzanis I, Moutzouri O, Catalli B, Biris AI, Dimaki D, Kokkofiti I, Georgopoulos F. Precision Versus Practicality: A Comprehensive Analysis of Robotic Right Colectomy Versus Laparoscopic Right Colectomy, Future Directions, Biases, Research Gaps, and Their Implications. Cureus 2024; 16:e52904. [PMID: 38406010 PMCID: PMC10892367 DOI: 10.7759/cureus.52904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Colorectal cancer is the third most commonly diagnosed cancer in the world and second in cancer-related mortality. It is most prevalent in the developed world and is often associated with lifestyle factors along with age and genetics. The inclusion criteria comprised high-level evidence, such as randomized clinical trials, meta-analyses, and systematic reviews, conducted between 2012 and 2023, that directly compared the two approaches. The review reveals mixed outcomes between robotic right colectomy (RRC) and laparoscopic right colectomy (LRC). The robotic approach was associated with longer operative duration and higher costs but with decreased blood loss and quicker recovery compared to laparoscopy. On the other hand, no major differences were observed regarding lymph node retrieval, duration of hospitalization, and surgical complications. Regarding future directions, it is evident that the focus needs to shift beyond the operative parameters and to patient-centered outcomes, which are underreported. Also, more randomized clinical trials are required, focusing on safety, efficacy, and long-term quality of life. Costs-benefit analyses are required to weigh the benefits of robotic surgery against the implementation and practice costs. Additionally, improvements in surgeons' training may be necessary to reduce the operative duration and potentially decrease operational costs. Finally, standardization of research protocols may be necessary to reduce biases.
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Affiliation(s)
| | | | - Olga Moutzouri
- Medicine, University of Nicosia Medical School, Nicosia, CYP
| | | | | | - Dimitra Dimaki
- Medicine, University of Nicosia Medical School, Nicosia, CYP
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11
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Arang H, El Boghdady M. Robotic Appendicectomy: A review of feasibility. Sultan Qaboos Univ Med J 2023; 23:440-446. [PMID: 38090254 PMCID: PMC10712383 DOI: 10.18295/squmj.7.2023.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/02/2023] [Accepted: 05/16/2023] [Indexed: 12/18/2023] Open
Abstract
Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing use of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery's major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended.
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Affiliation(s)
| | - Michael El Boghdady
- Department of General Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
- University of Edinburgh, Scotland, UK
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12
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Baracy MG, Kerl A, Hagglund K, Fennell B, Corey L, Aslam MF. Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020. J Robot Surg 2023; 17:2211-2220. [PMID: 37280406 DOI: 10.1007/s11701-023-01631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/21/2023] [Indexed: 06/08/2023]
Abstract
The objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approach to hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI - 2.3 to - 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI - 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.
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Affiliation(s)
- Michael G Baracy
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA.
| | - Alexis Kerl
- Department of Family Medicine, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Karen Hagglund
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Brian Fennell
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48202, USA
| | - Logan Corey
- Department of Gynecologic Oncology, Wayne State University, Detroit, MI, 48202, USA
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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13
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McCarthy A, Samarakoon D, Gray J, Mcmeekin P, McCarthy S, Newton C, Nobbenhuis M, Lippiatt J, Twigg J. Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England. BMJ Open 2023; 13:e073990. [PMID: 37770262 PMCID: PMC10546163 DOI: 10.1136/bmjopen-2023-073990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy. DESIGN Multicentre prospective observational cohort study. SETTING Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 National Health Service (NHS) cancer units and centres in England between August 2017 and February 2020. PARTICIPANTS 275 patients recruited with 159 RALS, 73 CLS eligible for analysis. OUTCOME MEASURES Primary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS. RESULTS No difference identified between RALS and CLS for EORTC, EQ-5D-5L utility and 6MWT. RALS had unadjusted mean cost difference of £556 (95% CI -£314 to £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 to £827) and QALY difference of 0.0024 (95% CI -0.0008 to 0.0057). CONCLUSIONS Findings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost-effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority randomised controlled trial would be of benefit to decision-makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.
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Affiliation(s)
- Andrew McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Dilupa Samarakoon
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Peter Mcmeekin
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Stephen McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Claire Newton
- Department of Gynaecology Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Marielle Nobbenhuis
- Department of Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Jonathan Lippiatt
- Department of Gynaecological Oncology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Jeremy Twigg
- Department of Gynaecological Oncology, Coventry and Warwickshire Hospital, Coventry, UK
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14
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Vörös V, De Smet J, Ourak M, Poliakov V, Deprest J, Kimpe T, Vander Poorten E. Comparison of 2D and autostereoscopic 3D visualization during mixed reality simulation. Int J Comput Assist Radiol Surg 2023; 18:1679-1686. [PMID: 36995512 DOI: 10.1007/s11548-023-02876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE In general minimally invasive surgical procedures, surgeons are tied to 2D visualization, leading to the loss of depth perception. This can lead to large mental load for the surgeons and may be responsible for the long learning curve. To restore the sense of depth, this study investigated the use and benefits of an autostereoscopic (3D) display during a simulated laparoscopic task. METHODS A mixed reality simulator was developed for comparing the performance of participants while using 2D and autostereoscopic 3D visualization. An electromagnetic sensor was mounted on a physical instrument, and its pose was mapped to the virtual instrument. The virtual scene was developed using Simulation Open Framework Architecture (SOFA). Finite element modeling was used to calculate interaction forces, which were then mapped to visual soft tissue deformation. RESULTS Ten non-expert participants completed a virtual laparoscopic task, where the subjects were asked to contact eighteen target areas distributed on the surface of the vagina, both in 2D and 3D. Results showed an improvement with 3D vision in task completion time (-16%), total traveled distance (-25%) and errors made (-14%). There was no difference in the average contact forces between the vagina and the instrument. Only the difference in time and forces were shown to be statistically significant. CONCLUSION Overall, autostereoscopic 3D showed superiority over conventional 2D visualization. The traveled trajectory increased in 2D as the instrument was retracted more between the targets to avoid contact. The 2D and 3D deformation upon contact seems not to contribute differently to force perception. However, the participants only had visual feedback, but no haptic feedback. Therefore, it could be interesting to include haptic feedback in a future study.
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Affiliation(s)
- Viktor Vörös
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium.
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium.
| | - Jef De Smet
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Vladimir Poliakov
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3000, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tom Kimpe
- Healthcare Division, Barco NV, Beneluxpark 21, 8500, Kortrijk, Belgium
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15
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Kawka M, Fong Y, Gall TMH. Laparoscopic versus robotic abdominal and pelvic surgery: a systematic review of randomised controlled trials. Surg Endosc 2023; 37:6672-6681. [PMID: 37442833 PMCID: PMC10462573 DOI: 10.1007/s00464-023-10275-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The current evidence is inconclusive on whether robotic or laparoscopic surgery is the optimal platform for minimally invasive surgery. Existing comparisons techniques focus on short-term outcomes only, while potentially being confounded by a lack of standardisation in robotic procedures. There is a pertinent need for an up-to-date comparison between minimally invasive surgical techniques. We aimed to systematically review randomised controlled trials comparing robotic and laparoscopic techniques in major surgery. METHODS Embase, Medline and Cochrane Library were searched from their inception to 13th September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic techniques in abdominal and pelvic surgery. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Short-term, health-related quality of life, and long-term, outcomes were analysed. RESULTS Forty-five studies, across thirteen procedures, involving 7364 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In majority of studies, there was no significant difference in complication rate (n = 31/35, 85.6%), length of postoperative stay (n = 27/32, 84.4%), and conversion rate (n = 15/18, 83.3%). Laparoscopic surgery was associated with shorter operative time (n = 16/31, 51.6%) and lower total cost (n = 11/13, 84.6%). Twenty three studies reported on quality of life outcomes; majority (n = 14/23, 60.9%) found no significant differences. CONCLUSION There were no significant differences between robotic surgery and laparoscopic surgery with regards to mortality and morbidity outcomes in the majority of studies. Robotic surgery was frequently associated with longer operative times and higher overall cost. Selected studies found potential benefits in post-operative recovery time, and patient-reported outcomes; however, these were not consistent across procedures and trials, with most studies being underpowered to detect differences in secondary outcomes. Future research should focus on assessing quality of life, and long-term outcomes to further elucidate where the robotic platform could lead to patient benefits, as the technology evolves.
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Affiliation(s)
- Michal Kawka
- Department of Medicine, Imperial College London, London, UK
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Tamara M H Gall
- Department of HPB Surgery, The Mater Misericordiae Hospital, Dublin, Ireland.
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16
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Lee J, Hong DG. Comparative study of supracervical hysterectomy between da Vinci SP ® surgical system and conventional single-site laparoscopy for uterine fibroid: single center experiences. J Robot Surg 2023; 17:1421-1427. [PMID: 36715965 PMCID: PMC10374849 DOI: 10.1007/s11701-023-01527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
This study aimed to review the surgical outcomes of supracervical hysterectomy using the da Vinci SP® surgical system and conventional single-site laparoscopic surgery for uterine fibroids. This study included 79 patients who underwent supracervical hysterectomy with the da Vinci SP® surgical system and conventional single-site laparoscopy for uterine fibroid between June 2018 and April 2021. All the surgeries were performed by an experienced surgeon. Surgical outcomes and complications were reviewed in both groups. No significant difference was found between the two groups with regards to the patients' preoperative surgical conditions such as weight of the uterus, history of pelvic surgery, and pelvic adhesion. A significantly longer operation time (p < 0.01) and higher levels of C-reactive protein (p < 0.01) were found in the robotic surgery group; in particular, the uterus-out time was significantly longer (p < 0.01). No significant differences were found in other surgical outcomes such as complication rates and hospital stays. Supracervical hysterectomy using the da Vinci® SP surgical system is comparable to conventional single-site laparoscopy in uncomplicated cases. However, it requires a significantly longer operative time and has a higher inflammatory response.
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Affiliation(s)
- Juhun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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17
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Silva JP, Putnam LR, Wu J, Ding L, Samakar K, Abel S, Nguyen JD, Dobrowolsky AB, Bildzukewicz NA, Lipham JC. Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer. Am Surg 2023; 89:2583-2594. [PMID: 35611934 DOI: 10.1177/00031348221104249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minimally invasive approaches to esophagectomy have gained popularity worldwide; however, unplanned conversion to an open approach is not uncommon. This study sought to investigate risk factors associated with converting to an open approach and to evaluate outcomes following conversion. METHODS Patients undergoing minimally invasive esophagectomy (MIE) for cancer were identified using the 2016-2019 Procedure Targeted NSQIP Database. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with unplanned conversion to open esophagectomy. Propensity-matched comparison of robotic (RAMIE) to traditional MIE was performed. RESULTS A total of 1347 patients were included; 140 patients (10%) underwent conversion to open. Morbid obesity, diabetes, hypertension, American Society of Anesthesiologists class, and squamous cell carcinoma were associated with a higher likelihood of conversion. A robotic approach was associated with a lower likelihood of conversion to open (OR .57, 95% CI 0.32-.99). On multivariable analysis, squamous cell carcinoma pathology was the only variable independently associated with higher odds of conversion (OR 2.66, 95% CI 1.02-6.98). Propensity-matched comparison of RAMIE vs MIE showed no significant difference in conversion rate (6.5% vs 9.1%, P = .298), morbidity, or mortality. DISCUSSION A robotic approach to esophagectomy was associated with a lower likelihood of unplanned conversion to open, and patients who were converted to open experienced worse outcomes. Future studies should aim to determine why a robotic esophagectomy approach may lead to fewer open conversions as it may be an underappreciated benefit of this newest operative approach.
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Affiliation(s)
- Jack P Silva
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Luke R Putnam
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jessica Wu
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Li Ding
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Stuart Abel
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - James D Nguyen
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Adrian B Dobrowolsky
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - Nikolai A Bildzukewicz
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
| | - John C Lipham
- Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA
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18
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Villarim PVO, Marinho VRD, Abreu CA, Moura ACMA, Silva TCL, Alves HPM, Rêgo ACM, Medeiros KS, Araújo-Filho I. Incidence of colonic fistulas in patients with colon cancer submitted to robotic surgery versus laparoscopic colorectal surgery: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e065011. [PMID: 37173111 DOI: 10.1136/bmjopen-2022-065011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Up to the present time, the laparoscopic approach for colon cancer is considered the gold standard. However, robotic surgery has been appraised in modern medicine. It is essential to evaluate the differences between laparoscopic and robotic surgery, owing to the significant impact they cause in postoperative morbidity and mortality. This article aims to perform a systematic review and meta-analysis of the literature to compare robotic versus laparoscopic colectomies in patients with colon cancer in terms of the incidence of colonic fistulas. METHODS AND ANALYSIS PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, LILACS and Clinical trials databases will be searched for randomised clinical trials investigating the incidence of colonic fistulas in patients with colonic cancer, submitted to robotic surgery compared with a laparoscopic approach. No language or publication period restrictions will be imposed. The primary outcome will be the incidence of colonic fistulas in patients with colon cancer in different surgical approaches. The secondary outcomes will be the incidence of infection, sepsis, mortality, length of hospitalisation and malnutrition. Three independent reviewers will select the studies and extract data from the original publications. The risk of bias will be assessed using The Risk of Bias 2 tool, and the evidence's certainty will be made using the Grading of Recommendations Assessment, Development and Evaluation. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity. We will compute the I2 statistics. In addition, a quantitative synthesis will be performed if the included studies are sufficiently homogeneous. ETHICS AND DISSEMINATION This study will review the published data; thus, it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021295313.
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Affiliation(s)
| | | | | | | | | | - Higor Paiva Mendonça Alves
- Department of Nutrition and Dietetics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Kleyton Santos Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Irami Araújo-Filho
- Department of Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
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19
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Turgut F, Somfai GM, Heussen FM, Eberle A, de Smet MD, Becker MD. Robot-Assisted Epiretinal Membrane Peeling: A Prospective Assessment of Pre- and Intra-Operative Times and of Surgeons' Subjective Perceptions. J Clin Med 2023; 12:jcm12082768. [PMID: 37109104 PMCID: PMC10141075 DOI: 10.3390/jcm12082768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons' perceptions of robot-assisted epiretinal membrane peeling (RA-MP). METHODS We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. RESULTS RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36-65) min. Task III had a mean time of 72.4 (range of 57-100) min. A mean time of 27.9 (range of 9-46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. CONCLUSIONS A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP.
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Affiliation(s)
- Ferhat Turgut
- Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland
- Werner H. Spross Foundation for the Advancement of Research and Teaching in Ophthalmology, 8063 Zurich, Switzerland
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Gábor Márk Somfai
- Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland
- Werner H. Spross Foundation for the Advancement of Research and Teaching in Ophthalmology, 8063 Zurich, Switzerland
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Florian M Heussen
- Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland
- Werner H. Spross Foundation for the Advancement of Research and Teaching in Ophthalmology, 8063 Zurich, Switzerland
- Department of Ophthalmology, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | - Alexander Eberle
- Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland
- Werner H. Spross Foundation for the Advancement of Research and Teaching in Ophthalmology, 8063 Zurich, Switzerland
| | - Marc D de Smet
- Helvetia Retina Associates, 1005 Lausanne, Switzerland
- New York Eye and Ear Infirmary of Mt Sinai, Icahn School of Medicine, New York, NY 10029, USA
| | - Matthias D Becker
- Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland
- Werner H. Spross Foundation for the Advancement of Research and Teaching in Ophthalmology, 8063 Zurich, Switzerland
- Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany
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20
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Ferrari A, Giannini A, Seghieri C, Simoncini T, Vainieri M. Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data. BMJ Open 2023; 13:e068145. [PMID: 36882257 PMCID: PMC10008403 DOI: 10.1136/bmjopen-2022-068145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES To explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP). DESIGN AND SETTING A retrospective cohort study employing administrative health data from the Tuscany region, Italy. PARTICIPANTS All women over 40 years hospitalised for apical/multicompartmental POP reconstructive surgery (excluding anterior/posterior colporrhaphy without concomitant hysterectomy) from January 2017 to December 2019. OUTCOMES We first computed treatment rates just for women residing in Tuscany (n=2819) and calculated the Systematic Component of Variation (SCV) to explore variation in access to care among health districts. Then, using the full cohort (n=2959), we ran multilevel models for the average length of stay and reoperations, readmissions and complications, and computed the intraclass correlation coefficient to assess the individual and hospital determinants of efficiency and quality of care provided by hospitals. RESULTS The 5.4-fold variation between the lowest-rate (56/100 000 inhabitants) and the highest-rate (302/100 000) districts and the SCV over 10% confirmed high systematic variation in the access to care. Higher treatment rates were driven by greater provisions of robotic and/or laparoscopic interventions, which showed highly variable usage rates. Both individual and hospital factors influenced quality and efficiency provided by hospitals, but just low proportions of variation were explained by hospital and patient characteristics. CONCLUSIONS We found high and systematic variation in the access to POP surgical care in Tuscany and in quality and efficiency provided by hospitals. Such a variation may be mainly explained by user and provider preferences, which should be further explored. Also, supply-side factors may be involved, suggesting that wider and more uniform dissemination of robotic/laparoscopic procedures may reduce variation.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Chiara Seghieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
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21
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Costa TN, Abdalla RZ, Tustumi F, Junior UR, Cecconello I. Robotic-assisted compared with laparoscopic incisional hernia repair following oncologic surgery: short- and long-term outcomes of a randomized controlled trial. J Robot Surg 2023; 17:99-107. [PMID: 35355200 DOI: 10.1007/s11701-022-01403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with abdominal site cancer are at risk for incisional hernia after open surgery. This study aimed to compare the short- and long-term outcomes of robotic-assisted (RVIHR) with the laparoscopic incisional hernia repair (LVIHR) in an oncologic institute. METHODS This is a single-blinded randomized controlled pilot trial. Patients were randomized into two groups: RVIHR and LVIHR. RESULTS Groups have similar baseline characteristics (LVIHR: N = 19; RVIHR: N = 18). No difference was noted in the length of hospital stay (RVIHR: 3.67 ± 1.78 days; LVIHR: 3.95 ± 2.66 days) and postoperative complications (16.7 versus 10.5%; p = 0.94). The mean operating time for RVIHR was significantly longer than LVIHR (RVIHR was 355.6 versus 293.5 min for LVIHR; p = 0.04). Recurrence was seen in three patients in LVIHR and two in RVIHR at 24-month follow-up, with no significant difference. (p > 0.99). CONCLUSION Laparoscopic and robotic-assisted incisional hernia repair show similar short- and long-term outcomes for cancer patients.
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Affiliation(s)
- Thiago Nogueira Costa
- Department of Gastroenterology. Digestive Surgery Division, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Ricardo Zugaib Abdalla
- Department of Gastroenterology. Digestive Surgery Division, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology. Digestive Surgery Division, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil.
| | - Ulysses Ribeiro Junior
- Department of Gastroenterology. Digestive Surgery Division, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology. Digestive Surgery Division, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
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22
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Schnittka E, Lanpher NW, Cushing-Murray J, Decker T, Patel PG. Surgical Outcomes Following Robotic Single-Site Versus Multiport Hysterectomy for Treatment of Endometrial Cancer: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e34702. [PMID: 36909114 PMCID: PMC9998109 DOI: 10.7759/cureus.34702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches of robotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's d = 1.05 and Z = 18.62), operating time (Cohen's d = 0.29 and Z = 4.38), and length of hospital stay (Cohen's d = 1.06 and Z = 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.
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Affiliation(s)
- Emma Schnittka
- Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Nick W Lanpher
- Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | | | - Trevor Decker
- Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Praful G Patel
- Obstetrics and Gynecology, Southeast Health Medical Center, Dothan, USA.,Obstetrics and Gynecology, Alabama College of Osteopathic Medicine, Dothan, USA
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23
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Querleu D, Scambia G, Rychlik A. Reappraisal of Robotic Assistance in Gynecologic Oncology: The Lessons of ROBOGYN-1004. Ann Surg Oncol 2023; 30:672-674. [PMID: 36109413 DOI: 10.1245/s10434-022-12558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Denis Querleu
- Department of Gynecologic Oncology, Policlinico Gemelli IRCCS, Rome, Italy. .,University Hospital, Strasbourg, France.
| | - Giovanni Scambia
- Department of Gynecologic Oncology, Policlinico Gemelli IRCCS, Rome, Italy
| | - Agnieszka Rychlik
- Department of Gynecologic Oncology, Sklodowska National Cancer Center, Warsaw, Poland
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24
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Del Conte F, Montalva L, Ali L, Langeron M, Colas AE, Bonnard A. Scarless laparoscopic incisions in Pfannenstiel (slip): the first 50 cases using an innovative approach in pediatric robotic surgery. J Robot Surg 2023; 17:215-221. [PMID: 35622191 DOI: 10.1007/s11701-022-01419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
Incisions in the supra-pubic region have been described robotic-assisted surgery to improve cosmetic results in adults, but seldom in children. We aimed to present an innovative trocar placement in the Pfannenstiel line, named Scarless Laparoscopic Incisions in Pfannenstiel (SLIP), and evaluate its feasibility for various intra-abdominal procedures and its cosmetic results in pediatric robotic surgery. We performed a monocentric prospective study, including children undergoing robotic-assisted surgeries using a SLIP approach (July 2019-September 2021). Data regarding demographics, surgery, and outcome were collected and reported as median (range), or number (percentage). Cosmetic results were evaluated with a questionnaire. A SLIP approach was performed in 50 children (24 cholecystectomies, 12 splenectomies, 2 cholecystectomies and splenectomies, 9 colonic resections, 2 choledochal cyst resections, and 1 pancreatic pseudocyst resection). Median age was 11 years (2-18) and median weight 35 kg (10.5-80). Conversion to laparoscopy occurred in two cases. Post-operative complications occurred in 5 patients (10%), after colectomies [intrabdominal abscess (n = 3), stoma dysfunction (n = 1), parietal abscess (n = 1)], of which 3 (6%) required reintervention (intrabdominal abscess n = 2, stoma dysfunction n = 1). Regarding scars, 68% (n = 28) of parents and patients reported the maximal score of 5/5 for global satisfaction and 63% (n = 26) had all scars hidden by underwear. SLIP approach is versatile and can be used in supra- and infra-mesocolic robotic-assisted procedures. The low complication rate shows its safety in both young children and teenagers and does not increase operative difficulties. It results in high patient satisfaction regarding scars, and a scarless abdomen.
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Affiliation(s)
- Fulvia Del Conte
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France.,Department of Pediatric General Surgery and Urology, University Hospital, Federico II, Naples, Italy
| | - Louise Montalva
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France.,Paris Cité University, Paris, France
| | - Liza Ali
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France
| | - Margaux Langeron
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France
| | - Anne-Emmanuelle Colas
- Department of Pediatric Anesthesiology, Robert-Debré Children University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France. .,Paris Cité University, Paris, France.
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25
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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26
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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27
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Popescu M, Olita MR, Stefan MO, Mihaila M, Sima RM, Tomescu D. Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery. BMC Anesthesiol 2022; 22:356. [PMID: 36411445 PMCID: PMC9677621 DOI: 10.1186/s12871-022-01900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. METHODS Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO2) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO2 values were noted and arterial to end-tidal CO2 gradient was calculated. RESULTS We observed a statistically significant difference in plateau pressure between RAS and LAS at one-hour (26.2 ± 4.5 cmH2O vs. 20.2 ± 3.5 cmH2O, p = 0.05) and two-hour intervals (25.2 ± 5.7 cmH2O vs. 17.9 ± 3.1 cmH2O, p = 0.01) during surgery and at the end of surgery (19.9 ± 5.0 cmH2O vs. 17.0 ± 2.7 cmH2O, p = 0.02). Significant changes in lung compliance were also observed between groups at one-hour (28.2 ± 8.5 mL/cmH2O vs. 40.5 ± 13.9 mL/cmH2O, p = 0.01) and two-hour intervals (26.2 ± 7.8 mL/cmH2O vs. 54.6 ± 16.9 mL/cmH2O, p = 0.01) and at the end of surgery (36.3 ± 9.9 mL/cmH2O vs. 58.2 ± 21.3 mL/cmH2O, p = 0.01). At the end of surgery, plateau pressures remained higher than preoperative values in both groups, but lung compliance remained significantly lower than preoperative values only in patients undergoing RAS with a mean 24% change compared to 1.7% change in the LAS group (p = 0.01). We also noted a more significant arterial to end-tidal CO2 gradient in the RAS group compared to LAS group at one-hour (12.9 ± 4.5 mmHg vs. 7.4 ± 4.4 mmHg, p = 0.02) and two-hours interval (15.2 ± 4.5 mmHg vs. 7.7 ± 4.9 mmHg, p = 0.02), as well as at the end of surgery (11.0 ± 6.6 mmHg vs. 7.0 ± 4.6 mmHg, p = 0.03). CONCLUSION Video-assisted surgery is associated with significant changes in lung mechanics after induction of pneumoperitoneum. The observed changes are more severe and longer-lasting in patients undergoing robotic-assisted surgery compared to classic laparoscopy.
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Affiliation(s)
- Mihai Popescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Roxana Olita
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mara Oana Stefan
- grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mariana Mihaila
- grid.415180.90000 0004 0540 9980Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Romina-Marina Sima
- grid.8194.40000 0000 9828 7548Department of Obstetrics and Gynecology, Bucur Maternity, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dana Tomescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
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28
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Siu KC, Schlottmann F. Editorial: Robotic surgery: Human learning, simulation and training on surgical education. Front Surg 2022; 9:1061691. [PMID: 36439537 PMCID: PMC9692118 DOI: 10.3389/fsurg.2022.1061691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ka-Chun Siu
- Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, NE United States
- Correspondence: Ka-Chun Siu
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois at Chicago, Chicago, ILUnited States
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29
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Boekestijn I, van Oosterom MN, Dell'Oglio P, van Velden FHP, Pool M, Maurer T, Rietbergen DDD, Buckle T, van Leeuwen FWB. The current status and future prospects for molecular imaging-guided precision surgery. Cancer Imaging 2022; 22:48. [PMID: 36068619 PMCID: PMC9446692 DOI: 10.1186/s40644-022-00482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/21/2022] [Indexed: 01/19/2023] Open
Abstract
Molecular imaging technologies are increasingly used to diagnose, monitor, and guide treatment of i.e., cancer. In this review, the current status and future prospects of the use of molecular imaging as an instrument to help realize precision surgery is addressed with focus on the main components that form the conceptual basis of intraoperative molecular imaging. Paramount for successful interventions is the relevance and accessibility of surgical targets. In addition, selection of the correct combination of imaging agents and modalities is critical to visualize both microscopic and bulk disease sites with high affinity and specificity. In this context developments within engineering/imaging physics continue to drive the growth of image-guided surgery. Particularly important herein is enhancement of sensitivity through improved contrast and spatial resolution, features that are critical if sites of cancer involvement are not to be overlooked during surgery. By facilitating the connection between surgical planning and surgical execution, digital surgery technologies such as computer-aided visualization nicely complement these technologies. The complexity of image guidance, combined with the plurality of technologies that are becoming available, also drives the need for evaluation mechanisms that can objectively score the impact that technologies exert on the performance of healthcare professionals and outcome improvement for patients.
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Affiliation(s)
- Imke Boekestijn
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Floris H P van Velden
- Medical Physics, Department of Radiology , Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Pool
- Department of Clinical Farmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre Hamburg, Hamburg, Germany
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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30
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Munshower E, Ren E, Bauerle WB, Ruland J, Stoltzfus J, McDonald M, Baillie DR, Chaar ME. Cost analysis of robotic assisted general surgery cases in a single academic institution. J Robot Surg 2022; 17:557-564. [PMID: 35939166 DOI: 10.1007/s11701-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
Laparoscopy is currently the standard approach for minimally invasive general surgery procedures. However, robotic surgery is now increasingly being used in general surgery. Robotic surgery provides several advantages such as 3D-visualization, articulated instruments, improved ergonomics, and increased dexterity, but is also associated with an increased overall cost which limits its widespread use. In our institution, the robotic assisted approach is frequently used for the performance of general surgery cases including inguinal hernias, cholecystectomies and paraesophageal hernia (PEH) repairs. The primary aim of the study was to evaluate the differences in cost between a robotic and laparoscopic approach for the above-mentioned cases. With IRB approval, we conducted a retrospective cost analysis of patients undergoing inguinal hernia repairs, cholecystectomies and PEH repairs between June 2018 and November 2020. Patients who had a concomitant procedure, a revisional surgery, or bilateral inguinal hernia repair were excluded from the study. Cost analysis was performed using a micro-costing approach. Statistical significance was denoted by p < 0.05. There were no differences among the different groups in relation to age, gender, ethnicity, and BMI. The overall cost of the robotic (R-) approach compared to a laparoscopic (L-) approach was significantly lower for cholecystectomy ($3,199.96 vs $4019.89, p < 0.05). For inguinal hernia repairs and PEH repairs without mesh, we found no significant difference in overall costs between the R- and L- approach (R- $3835.06 vs L- $3783.50, p = 0.69) and (R- $6852.41 vs L- $6819.69, p = 0.97), respectively. However, the overall cost of PEH with mesh was significantly higher for the R- group compared to the L- group (R- $7,511.09 vs L- $6,443.32, p < 0.05). Based on our institutional cost data, use of a robotic approach when performing certain general surgery cases does not seem to be cost prohibitive.
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Affiliation(s)
- Eva Munshower
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Emily Ren
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Wayne B Bauerle
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Janice Ruland
- Cost Accounting Department, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Marian McDonald
- Department of Surgery, Division of Minimally Invasive Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Daniel R Baillie
- Department of Surgery, Division of Minimally Invasive Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke's University Hospital and Health Network, Allentown, PA, USA.
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Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes. J Am Coll Surg 2022; 235:149-156. [PMID: 35839388 DOI: 10.1097/xcs.0000000000000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration. STUDY DESIGN This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest. RESULTS A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001). CONCLUSIONS Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.
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Salehjawich A, Günther V, Ruchay Z, Al Zoubi MS, Dhanawat J, Maass N, Ackermann J, Pape J, Alkatout I. Robot-Assisted Tubal Reanastomosis after Sterilization: A Choice for Family Planning. J Clin Med 2022; 11:4385. [PMID: 35956002 PMCID: PMC9369034 DOI: 10.3390/jcm11154385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
A variety of procedures have been used for family planning. One of these is sterilization surgery, which can be reversed by a tubal reanastomosis. In the present report, we compare Robot-assisted tubal reanastomosis sterilization with other methods of family planning and discuss factors related to the choice of the approach. The keywords used for the electronic search in PubMed were family planning, sterilization, Robot-assisted, tubal reanastomosis, depression, and regret. The decision in favor of or against sterilization surgery has been a sensitive issue for several years. Robot-assisted technology is a modern and precise approach. It has contributed to the flexibility of the decision between sterilization and its reversal through tubal reanastomosis, as well as enhanced the success rate of the surgery. Based on our analysis of the published literature, we believe that Robot-assisted tubal anastomosis is the optimum approach. However, to ensure the quality of health care, the surgeon must be well trained, well versed with the anatomy of the fallopian tubes, and thoroughly informed on the psychological impact of family planning.
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Affiliation(s)
- Arwa Salehjawich
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Zino Ruchay
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Mazhar Salim Al Zoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 211-63, Jordan;
| | - Juhi Dhanawat
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Julian Pape
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
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Terho AM, Mäkelä-Kaikkonen J, Ohtonen P, Uimari O, Puhto T, Rautio T, Koivurova S. Robotic versus laparoscopic surgery for severe deep endometriosis: protocol for a randomised controlled trial (ROBEndo trial). BMJ Open 2022; 12:e063572. [PMID: 35851028 PMCID: PMC9297206 DOI: 10.1136/bmjopen-2022-063572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Endometriosis is a common gynaecological disease affecting around 10% of fertile-aged women, causing severe pain symptoms. Deep endometriosis is defined as endometriotic implants that infiltrate the underlying organs more than 5 mm in depth. Surgery for deep endometriosis requires advanced multidisciplinary surgical technique, often in very difficult surgical conditions, with increased risks of complications. Robotic surgery offers a high-definition three-dimensional view and articulating instruments that may allow more precise dissection than conventional laparoscopy in the pelvic area. The superiority of robotic surgery has not, however, been provedin randomised controlled studies, and there is a lack of long-term outcome data. Advanced endometriosis surgery offers an excellent platform to study the feasibility and long-term outcomes of robotic surgery compared with conventional laparoscopy. METHODS AND ANALYSIS ROBEndo is a prospective, randomised, controlled clinical trial in a single-centre setting. Patients with deep endometriosis verified by MRI needing surgery at Oulu University Hospital (Oulu, Finland) will be considered eligible. 70 patients will be allocated 1:1 to receive either robotic-assisted or conventional laparoscopic surgery in two strata: radical surgery (with the removal of the uterus and adnexae) and gynaecological organ-sparing surgery. The primary outcome will be the surgical outcome as regards to pain symptoms measured on numeric rating scale (NRS) questionnaires at 24 hours and 6, 12 and 24 months postoperatively. As secondary outcomes, intraoperative measures, enhanced recovery after surgery factors, complications, cost and long-term quality of life measured with Endometriosis Health Profile-30 (EHP-30), Female Sexual Function Index (FSFI) and 15-dimensional (15D) questionnaires will be compared. ETHICS AND DISSEMINATION This study has been approved by the Northern Ostrobothnian Hospital District Ethical Committee at Oulu University Hospital (212/2021). Informed consent will be obtained during the preoperative check-up by the operating gynaecologist. The results will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER NCT05179109.
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Affiliation(s)
- Anna Maria Terho
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit and Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Johanna Mäkelä-Kaikkonen
- Department of Surgery, Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Department of Surgery, Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Outi Uimari
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit and Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Terhi Puhto
- Department of Surgery, Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit and Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Nechay TV, Panin SI, Sazhin AV, Bykov AV, Kuznetsov AA, Tyagunov AE, Melnikov-Makarchuk KY. [Comparison of robot-assisted and conventional endoscopic surgeries in the Russian Federation. (A systematic review and meta-analysis)]. Khirurgiia (Mosk) 2022:88-101. [PMID: 35658141 DOI: 10.17116/hirurgia202206188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation. MATERIAL AND METHODS Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis. RESULTS We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors. CONCLUSION Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.
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Affiliation(s)
- T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Bykov
- Volgograd State Medical University, Volgograd, Russia
| | - A A Kuznetsov
- Volgograd State Medical University, Volgograd, Russia
| | - A E Tyagunov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Ielpo B, Podda M, Burdio F, Sanchez-Velazquez P, Guerrero MA, Nuñez J, Toledano M, Morales-Conde S, Mayol J, Lopez-Cano M, Espín-Basany E, Pellino G. Cost-Effectiveness of Robotic vs. Laparoscopic Surgery for Different Surgical Procedures: Protocol for a Prospective, Multicentric Study (ROBOCOSTES). Front Surg 2022; 9:866041. [PMID: 36227017 PMCID: PMC9549953 DOI: 10.3389/fsurg.2022.866041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery. Methods The Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure). Discussion The results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.
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Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
- *Correspondence: Benedetto Ielpo
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Maria-Alejandra Guerrero
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Miguel Toledano
- General Surgery Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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Hahn SJ, Sylla P. Technological Advances in the Surgical Treatment of Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:183-218. [DOI: 10.1016/j.soc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Accurate Mandible Reconstruction by Mixed Reality, 3D Printing, and Robotic-Assisted Navigation Integration. J Craniofac Surg 2022; 33:1720-1724. [DOI: 10.1097/scs.0000000000008586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/25/2022] Open
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Maier-Hein L, Eisenmann M, Sarikaya D, März K, Collins T, Malpani A, Fallert J, Feussner H, Giannarou S, Mascagni P, Nakawala H, Park A, Pugh C, Stoyanov D, Vedula SS, Cleary K, Fichtinger G, Forestier G, Gibaud B, Grantcharov T, Hashizume M, Heckmann-Nötzel D, Kenngott HG, Kikinis R, Mündermann L, Navab N, Onogur S, Roß T, Sznitman R, Taylor RH, Tizabi MD, Wagner M, Hager GD, Neumuth T, Padoy N, Collins J, Gockel I, Goedeke J, Hashimoto DA, Joyeux L, Lam K, Leff DR, Madani A, Marcus HJ, Meireles O, Seitel A, Teber D, Ückert F, Müller-Stich BP, Jannin P, Speidel S. Surgical data science - from concepts toward clinical translation. Med Image Anal 2022; 76:102306. [PMID: 34879287 PMCID: PMC9135051 DOI: 10.1016/j.media.2021.102306] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
Abstract
Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.
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Affiliation(s)
- Lena Maier-Hein
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany.
| | - Matthias Eisenmann
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Duygu Sarikaya
- Department of Computer Engineering, Faculty of Engineering, Gazi University, Ankara, Turkey; LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Keno März
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anand Malpani
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Pietro Mascagni
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | | | - Adrian Park
- Department of Surgery, Anne Arundel Health System, Annapolis, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Swaroop S Vedula
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Cleary
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, D.C., USA
| | | | - Germain Forestier
- L'Institut de Recherche en Informatique, Mathématiques, Automatique et Signal (IRIMAS), University of Haute-Alsace, Mulhouse, France; Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Bernard Gibaud
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Teodor Grantcharov
- University of Toronto, Toronto, Ontario, Canada; The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Makoto Hashizume
- Kyushu University, Fukuoka, Japan; Kitakyushu Koga Hospital, Fukuoka, Japan
| | - Doreen Heckmann-Nötzel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hannes G Kenngott
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sinan Onogur
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Roß
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Russell H Taylor
- Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Minu D Tizabi
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Jan Goedeke
- Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel A Hashimoto
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA; Surgical AI and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luc Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium; Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium; Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Kyle Lam
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Daniel R Leff
- Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Breast Unit, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, and UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Ozanan Meireles
- Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, City Hospital Karlsruhe, Karlsruhe, Germany
| | - Frank Ückert
- Institute for Applied Medical Informatics, Hamburg University Hospital, Hamburg, Germany
| | - Beat P Müller-Stich
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pierre Jannin
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
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Minimally invasive hysterectomy for benign indications-surgical volume matters: a retrospective cohort study comparing complications of robotic-assisted and conventional laparoscopic hysterectomies. J Robot Surg 2022; 16:1199-1207. [PMID: 34981444 DOI: 10.1007/s11701-021-01340-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the incidence of perioperative complications in robotic-assisted hysterectomies performed by high-volume robotic surgeons compared to conventional laparoscopic hysterectomies performed by all gynecologic surgeons. This retrospective cohort study was performed at a single-center community based hospital and medical center. A total of 332 patients who underwent hysterectomy for benign indications were included in this study. Half of these patients (n = 166) underwent conventional laparoscopic hysterectomy and the other half underwent a robotic-assisted laparoscopic hysterectomy. The main outcome measures included composite complication rate, estimated blood loss (EBL), and hospital length of stay (LOS). Median (IQR) EBL was significantly lower for robotic hysterectomy [22.5 (30) mL] compared to laparoscopic hysterectomy [100 (150) mL, p < 0.0001]. LOS was significantly shorter for robotic hysterectomy (1.0 ± 0.2 day) compared to laparoscopic hysterectomy (1.2 ± 0.7 days, p = 0.04). Despite averaging 3.0 (IQR 1.0) concomitant procedures compared to 0 (IQR 1.0) for the conventional laparoscopic hysterectomies, the incidence of any type of complication was lower in the robotic hysterectomy group (2 vs. 6%, p = 0.05). Finally, in a logistic regression model controlling for multiple confounders, robotic-assisted hysterectomy was less likely to result in a perioperative complication compared to traditional laparoscopic hysterectomy [odds ratio (95% CI) = 0.2 (0.1, 0.90), p = 0.04]. In conclusion, robotic-assisted hysterectomy may reduce complications compared with conventional laparoscopic hysterectomy when performed by high volume surgeons, especially in the setting of other concomitant gynecologic surgeries.
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Application of Design Structure Matrix to Simulate Surgical Procedures and Predict Surgery Duration. Minim Invasive Surg 2021; 2021:6340754. [PMID: 34912579 PMCID: PMC8668307 DOI: 10.1155/2021/6340754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background The complexities of surgery require an efficient and explicit method to evaluate and standardize surgical procedures. A reliable surgical evaluation tool will be able to serve various purposes such as development of surgery training programs and improvement of surgical skills. Objectives (a) To develop a modeling framework based on integration of dexterity analysis and design structure matrix (DSM), to be generally applicable to predict total duration of a surgical procedure, and (b) to validate the model by comparing its results with laparoscopic cholecystectomy surgery protocol. Method A modeling framework is developed through DSM, a tool used in engineering design, systems engineering and management, to hierarchically decompose and describe relationships among individual surgical activities. Individual decomposed activities are assumed to have uncertain parameters so that a rework probability is introduced. The simulation produces a distribution of the duration of the modeled procedure. A statistical approach is then taken to evaluate surgery duration through integrated numerical parameters. The modeling framework is applied for the first time to analyze a surgery; laparoscopic cholecystectomy, a common surgical procedure, is selected for the analysis. Results The present simulation model is validated by comparing its results of predicted surgery duration with the standard laparoscopic cholecystectomy protocols from the Atlas of Minimally Invasive Surgery with 2.5% error and that from the Atlas of Pediatric Laparoscopy and Thoracoscopy with 4% error. Conclusion The present model, developed based on dexterity analysis and DSM, demonstrates a validated capability of predicting laparoscopic cholecystectomy surgery duration. Future studies will explore its potential applications to other surgery procedures and in improving surgeons' performance and training novices.
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Madison A, Alamri L, Schwartz A, Brolinson M, DeCherney A. Conventional Laparoscopy Is the Better Option for Tubal Sterilization Reversal: A Closer Look at Tubal Reanastomosis. WOMEN'S HEALTH REPORTS 2021; 2:375-380. [PMID: 34671757 PMCID: PMC8524733 DOI: 10.1089/whr.2021.0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
Background: Permanent sterilization is one of the most common methods of birth control in the United States and around the world. A small subset of women will regret their decision and desire future fertility. For these women, the options include in vitro fertilization (IVF) or surgical reversal. Surgical reversal, specifically via tubal reanastamosis, is an important choice to consider. Surgical reversal can be accomplished via three different general approaches including laparotomy, conventional laparoscopy, and robot-assisted approaches. Unfortunately, surgical reversal is becoming a lost art. Objective: To compare and contrast pregnancy success rates, ectopic pregnancy rates, and cost between the surgical methods and IVF. Methods: We conducted a literature review via Pubmed with keywords as listed below. Conclusion: Laparoscopic tubal reanastomosis is the best approach for women <40 years of age due to pregnancy outcomes that are comparable to other methods, cost effectiveness, and favorable safety profile of minimally invasive surgery.
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Affiliation(s)
- Anita Madison
- The Department of Obstetrics and Gynecology, Woman's Hospital Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - Lamia Alamri
- The Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adina Schwartz
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Marja Brolinson
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan DeCherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Glasgow RE, Mulvihill SJ, Pettit JC, Young J, Smith BK, Vargo DJ, Ray DM, Finlayson SRG. Value Analysis of Methods of Inguinal Hernia Repair. Ann Surg 2021; 274:572-580. [PMID: 34506312 DOI: 10.1097/sla.0000000000005063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Value is defined as health outcomes important to patients relative to cost of achieving those outcomes: Value = Quality/Cost. For inguinal hernia repair, Level 1 evidence shows no differences in long-term functional status or recurrence rates when comparing surgical approaches. Differences in value reside within differences in cost. The aim of this study is to compare the value of different surgical approaches to inguinal hernia repair: Open (Open-IH), Laparoscopic (Lap-IH), and Robotic (R-TAPP). METHODS Variable and fixed hospital costs were compared among consecutive Open-IH, Lap-IH, and R-TAPP repairs (100 each) performed in a university hospital. Variable costs (VC) including direct materials, labor, and variable overhead ($/min operating room [OR] time) were evaluated using Value Driven Outcomes, an internal activity-based costing methodology. Variable and fixed costs were allocated using full absorption costing to evaluate the impact of surgical approach on value. As cost data is proprietary, differences in cost were normalized to Open-IH cost. RESULTS Compared to Open-IH, VC for Lap-IH were 1.02X higher (including a 0.81X reduction in cost for operating room [OR] time). For R-TAPP, VC were 2.11X higher (including 1.36X increased costs for OR time). With allocation of fixed cost, a Lap-IH was 1.03X more costly, whereas R-TAPP was 3.18X more costly than Open-IH. Using equivalent recurrence as the quality metric in the value equation, Lap-IH decreases value by 3% and R-TAPP by 69% compared to Open-IH. CONCLUSIONS Use of higher cost technology to repair inguinal hernias reduces value. Incremental health benefits must be realized to justify increased costs. We expect payors and patients will incorporate value into payment decisions.
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Affiliation(s)
| | | | - Jacob C Pettit
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | - Jeffrey Young
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | | | - Daniel J Vargo
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - David M Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
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Valadão M, Cesar D, Véo CAR, Araújo RO, do Espirito Santo GF, Oliveira de Souza R, Aguiar S, Ribeiro R, de Castro Ribeiro HS, de Souza Fernandes PH, Oliveira AF. Brazilian society of surgical oncology: Guidelines for the surgical treatment of mid-low rectal cancer. J Surg Oncol 2021; 125:194-216. [PMID: 34585390 DOI: 10.1002/jso.26676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. OBJECTIVES The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. METHODS Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. RESULTS The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. CONCLUSION These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.
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Affiliation(s)
- Marcus Valadão
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Daniel Cesar
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | - Rodrigo Otávio Araújo
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | - Samuel Aguiar
- Department of Surgical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Reitan Ribeiro
- Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
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Isono W, Maruyama M. Utility of a minimal skin incision technique for abdominal hysterectomy at a regional core hospital: a retrospective study. J Med Case Rep 2021; 15:128. [PMID: 33752748 PMCID: PMC7986041 DOI: 10.1186/s13256-021-02715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We present a minimal skin wound abdominal hysterectomy for patients with leiomyomas and describe the characteristics of this technique. The skin wound was made as small as possible, with a maximum length of 6 cm. METHODS In addition to introducing minimal skin wound abdominal hysterectomy, we retrospectively analyzed the medical records of 82 patients treated with minimal skin wound abdominal hysterectomy exclusively by two experts at Maruyama Memorial General Hospital between January 2013 and December 2016. Relationships between the leiomyoma characteristics and the difficulty of this operation, as estimated by operation time and blood loss, were statistically investigated. RESULTS First, we introduce a case in which we performed minimal skin wound abdominal hysterectomy on a 46-year-old Japanese patient with multiple leiomyomas (maximum 8 cm in diameter). Then, we assessed the impacts of the leiomyoma characteristics on the difficulty of this operation. On multivariate analysis, the number of leiomyomas significantly affected operation difficulty. Other characteristics of the target leiomyoma showed no effect. Additionally, higher body mass index also made the operation more difficult. CONCLUSIONS Although multiple leiomyomas can make this procedure difficult, minimal skin wound abdominal hysterectomy is safe and effective for use in many cases.
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Affiliation(s)
- Wataru Isono
- Department of Obstetrics and Gynaecology, Maruyama Memorial General Hospital, 2-10-5, Motomachi, Iwatsuki-ku, Saitama-shi, Saitama, 339-8521 Japan
| | - Masanori Maruyama
- Department of Obstetrics and Gynaecology, Maruyama Memorial General Hospital, 2-10-5, Motomachi, Iwatsuki-ku, Saitama-shi, Saitama, 339-8521 Japan
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Lee SR, Lee ES, Eum HR, Lee YJ, Lee SW, Park JY, Suh DS, Kim DY, Kim SH, Kim YM, Kim YT. New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique. J Clin Med 2021; 10:654. [PMID: 33567699 PMCID: PMC7914728 DOI: 10.3390/jcm10040654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a "locking suture on myoma (LSOM)" technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.
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Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea;
| | - Hye Rim Eum
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
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De Smet J, Page A, Deprest J, Housmans S, Niu K, Vander Poorten E. A uniaxial force and stiffness model of the vagina during laparoscopic sacrocolpopexy. Clin Biomech (Bristol, Avon) 2021; 81:105204. [PMID: 33189455 DOI: 10.1016/j.clinbiomech.2020.105204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/03/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sacrocolpopexy is the preferred procedure for restoring vaginal vault prolapse. An assistant uses a vaginal manipulator to position and tension the vault such that the surgeon can dissect the bladder, rectum and vault to eventually suture a synthetic mesh used to suspend the vagina to the longitudinal anterior vertebral ligament. Vaginal vault manipulation requires application of high forces for long periods of time. METHODS This work quantifies the task by measuring and analyzing the interaction forces and the workspace during vaginal vault manipulation. From the measurements we developed a uniaxial model, expressing the increase in interaction force and stiffness of the vagina. By adapting the model parameters, the difference in interaction force and stiffness between moderate and severe prolapse is predicted. FINDINGS For moderate prolapse the average interaction force and stiffness start at 2.56 N and 0.11 N mm-1 in the tensionfree state, and go up to 20.14 N and 0.53 N mm-1 after complete insertion of the instrument. For severe degrees of prolapse, tissue interaction is much lower starting at 1.68 N and 0.06 N mm-1 while staying limited to 12.20 N and 0.30 N mm-1 at full extension. INTERPRETATION Population data shows that the stage of prolapse and total vaginal length increase with age and parity. The interaction force and stiffness of the vagina are correlated with this degree of prolapse. By adapting the model parameters a good estimation of the tissue interaction is found for patients with mild and severe prolapse.
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Affiliation(s)
- J De Smet
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium.
| | - A Page
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium
| | - J Deprest
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, Herestraat 49, Leuven, Belgium
| | - S Housmans
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium
| | - K Niu
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium
| | - E Vander Poorten
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium
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Richards HW, Kulaylat AN, Cooper JN, McLeod DJ, Diefenbach KA, Michalsky MP. Trends in robotic surgery utilization across tertiary children’s hospitals in the United States. Surg Endosc 2020; 35:6066-6072. [DOI: 10.1007/s00464-020-08098-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
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Li LY, Wen LY, Park SH, Nam EJ, Lee JY, Kim S, Kim YT, Kim SW. Impact of the Learning Curve on the Survival of Abdominal or Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. Cancer Res Treat 2020; 53:243-251. [PMID: 33070554 PMCID: PMC7811999 DOI: 10.4143/crt.2020.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/25/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose The objective of this study was to define the learning curve required to attain satisfactory oncologic outcomes of cervical cancer patients who were undergoing open or minimally invasive surgery for radical hysterectomy, and to analyze the correlation between the learning curve and tumor size. Materials and Methods Cervical cancer patients (stage IA–IIA) who underwent open radical hysterectomy (n=280) or minimal invasive radical hysterectomy (n=282) were retrospectively reviewed. The learning curve was evaluated using cumulative sum of 5-year recurrence rates. Survival outcomes were analyzed based on the operation period (“learning period,” P1 vs. “skilled period,” P2), operation mode, and tumor size. Results The 5-year disease-free and overall survival rates between open and minimally invasive groups were 91.8% and 89.0% (p=0.098) and 96.1% and 97.2% (p=0.944), respectively. The number of surgeries for learning period was 30 and 60 in open and minimally invasive group, respectively. P2 had better 5-year disease-free survival than P1 after adjusting for risk factors (hazard ratio, 0.392; 95% confidence interval, 0.210 to 0.734; p=0.003). All patients with tumors < 2 cm had similar 5-year disease-free survival regardless of operation mode or learning curve. Minimally invasive group presented lower survival rates than open group when tumors ≥ 2 cm in P2. Preoperative conization improved disease-free survival in patients with tumors ≥ 2 cm, especially in minimally invasive group. Conclusion Minimally invasive radical hysterectomy required more cases than open group to achieve acceptable 5-year disease-free survival. When tumors ≥ 2 cm, the surgeon’s proficiency affected survival outcomes in both groups.
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Affiliation(s)
- Lan Ying Li
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Lan Ying Wen
- Department of Obstetrics and Gynecology, Yanbian University Hospital, Yanji, China
| | - Sun Hee Park
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum 2020; 63:1191-1222. [PMID: 33216491 DOI: 10.1097/dcr.0000000000001762] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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