1
|
Bai F, Li M, Han J, Qin Y, Yao L, Yan W, Liu Y, He G, Zhou Y, Ma X, Aboudou T, Guan L, Lu M, Wei Z, Li X, Yang K. More work is needed on cost-utility analyses of robotic-assisted surgery. J Evid Based Med 2022; 15:77-96. [PMID: 35715999 DOI: 10.1111/jebm.12475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To comprehensively analyze the cost-utility of robotic surgery in clinical practice and to investigate the reporting and methodological quality of the related evidence. METHODS Data on cost-utility analyses (CUAs) of robotic surgery were collected in seven electronic databases from the inception to July 2021. The quality of the included studies was assessed using the CHEERs and QHES checklists. A systematic review was performed with the incremental cost-effectiveness ratio as the outcome of interest. RESULTS Thirty-one CUAs of robotic surgery were eligible. Overall, the identified CUAs were fair to high quality, and 63% of the CUAs ranked the cost-utility of robotic surgery as "favored," 32% categorized as "reject," and the remaining 5% ranked as "unclear." Although a high heterogeneity was present in terms of the study design among the included CUAs, most studies (81.25%) consistently found that robotic surgery was more cost-utility than open surgery for prostatectomy (ICER: $6905.31/QALY to $26240.75/QALY; time horizon: 10 years or lifetime), colectomy (dominated by robotic surgery; time horizon: 1 year), knee arthroplasty (ICER: $1134.22/QALY to $1232.27/QALY; time horizon: lifetime), gastrectomy (dominated by robotic surgery; time horizon: 1 year), spine surgery (ICER: $17707.27/QALY; time horizon: 1 year), and cystectomy (ICER: $3154.46/QALY; time horizon: 3 months). However, inconsistent evidence was found for the cost-utility of robotic surgery versus laparoscopic surgery and (chemo)radiotherapy. CONCLUSIONS Fair or high-quality evidence indicated that robotic surgery is more cost-utility than open surgery, while it remains inconclusive whether robotic surgery is more cost-utility than laparoscopic surgery and (chemo)radiotherapy. Thus, an additional evaluation is required.
Collapse
Affiliation(s)
- Fei Bai
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jiani Han
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yu Qin
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Wenlong Yan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yujun Liu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Gege He
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yinjuan Zhou
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Xiaoya Ma
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Taslim Aboudou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ling Guan
- School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Mengying Lu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Zhipeng Wei
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| |
Collapse
|
2
|
Silva JB, Busnello CV, Cesarino MR, Xavier LF, Cavazzola LT. Existe espaço para a microcirurgia na cirurgia robótica? Rev Bras Ortop 2022; 57:709-717. [PMID: 36226217 PMCID: PMC9550381 DOI: 10.1055/s-0042-1744496] [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: 02/14/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms '
robotic surgery
' AND
microsurgery
, with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.
Collapse
Affiliation(s)
- Jefferson Braga Silva
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
- Departamento de Cirurgia da Mão e Microcirurgia Reconstrutiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Catarina Vellinho Busnello
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Matheus Ribeiro Cesarino
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Luiza Fernandes Xavier
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Leandro Totti Cavazzola
- Departamento de Cirurgia da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
3
|
Parimbelli E, Soldati F, Duchoud L, Armas GL, de Almeida J, Broglie M, Quaglini S, Simon C. Cost-utility of two minimally-invasive surgical techniques for operable oropharyngeal cancer: transoral robotic surgery versus transoral laser microsurgery. BMC Health Serv Res 2021; 21:1173. [PMID: 34711226 PMCID: PMC8555235 DOI: 10.1186/s12913-021-07149-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In the past few decades, a re-evaluation of treatment paradigms of head and neck cancers with a desire to spare patients the treatment-related toxicities of open surgery, has led to the development of new minimally invasive surgical techniques to improve outcomes. Besides Transoral Laser Microsurgery (TLM), a new robotic surgical technique namely Transoral Robotic Surgery (TORS) emerged for the first time as one of the two most prominent and widely used minimally invasive surgical approaches particularly for the treatment of oropharyngeal cancer, a sub-entity of head and neck cancers. Recent population-level data suggest equivalent tumor control, but different total costs, and need for adjuvant chemoradiation. A comparative analysis of these two techniques is therefore warranted from the cost-utility (C/U) point of view. METHODS A cost-utility analysis for comparing TORS and TLM was performed using a decision-analytical model. The analyses adopted the perspective of a Swiss hospital. Two tertiary referral centers in Lausanne and Zurich provided data for model quantificantion. RESULTS In the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55 and 62% cost effectiveness of TORS is sensitive to the prescription of adjuvant chemoradiation therapy (CRT). Exceeding 29% of TLM patients requiring a revision of surgical margins renders TORS more cost-effective. CONCLUSION Non-robotic endoscopic surgery (TLM) is more cost-effective than robotic endoscopic surgery (TORS) for the treatment of oropharyngeal cancers. However, this advantage is sensitive to various parameters, i.e.to the number of re-operations and adjuvant treatment.
Collapse
Affiliation(s)
- Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Federico Soldati
- Department of Otolaryngology - Head and Neck Surgery, Centre Universitaire Hospitalier Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lorry Duchoud
- Department of Otolaryngology - Head and Neck Surgery, Centre Universitaire Hospitalier Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gian Luca Armas
- Department of Otolaryngology - Head and Neck Surgery, Centre Universitaire Hospitalier Vaudois, University of Lausanne, Lausanne, Switzerland
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre- University Health Network, University of Toronto, Toronto, Canada
| | - Martina Broglie
- Department of Otolaryngology - Head and Neck Surgery, Universitätsspital Zürich, University Hospital Zurich, Zürich, Switzerland
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, Centre Universitaire Hospitalier Vaudois, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Thankappan K, Battoo AJ, Vidhyadharan S, Kudpaje A, Balasubramanian D, Iyer S. Economic evaluations comparing Tran-oral robotic surgery and radiotherapy in oropharyngeal squamous cell carcinoma: A systematic review. Eur J Surg Oncol 2021; 47:2961-2970. [PMID: 34253425 DOI: 10.1016/j.ejso.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Trans-oral robotic surgery (TORS) and primary radiotherapy are the two modalities used to treat early T stage oropharyngeal squamous cell carcinoma(OPSCC). Prior literature including a recent randomized controlled trial have not shown the superiority of one modality over the other. When the modalities have similar outcomes, cost-effectiveness have an important role in deciding on the appropriate treatment. There are economic evaluations comparing the two modality with contradicting conclusions. The purpose of this review is to synthesise the evidence. METHODS This is a systematic review of economic evaluations on the treatment modalities for OPSCC, namely TORS versus radiotherapy. The main outcome measures were the Cost-utility results reported as the effectiveness and costs separately and as part of the Incremental Cost-Effectiveness Ratio. RESULTS Literature search identified five articles reporting cost-utility analysis, eligible for the review. A strategy is considered to be dominant when the effectiveness achieved was more at a lower cost, compared to the comparator. At the willingness to pay (WTP) threshold of 50,000 to 100,000 USD per Quality Adjusted Life-Year (QALY), three studies showed dominance of strategies in the base case analysis (TORS in two and Primary Chemoradiotherapy in one). Two of the articles studied node negative patients, one of them favored TORS. Three articles had node positive patients and two of them favored TORS and one favored chemoradiotherapy in the base case analysis. On sensitivity analysis, adjuvant treatment was found to be the detrimental factor affecting the cost-effectiveness. CONCLUSIONS TORS can be considered a cost-effective strategy in early T stage OPSCC, if the addition of adjuvant therapy involving radiotherapy can be avoided. Literature have shown that around 70% of the early cancers would require adjuvant treatment. This implies the importance of case selection while considering TORS as the initial treatment modality.
Collapse
Affiliation(s)
- Krishnakumar Thankappan
- Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
| | - Azhar Jan Battoo
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akshay Kudpaje
- Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| |
Collapse
|
5
|
Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
Collapse
|
6
|
Abstract
Transoral robotic surgery (TORS) is a rapidly growing diagnostic and therapeutic modality in otolaryngology-head and neck surgery, having already made a large impact in the short time since its inception. Cost-effectiveness analysis is complex, and a thorough cost-effectiveness inquiry should analyze not only financial consequences but also impact on the health state of the patient. The cost-effectiveness of TORS is still under scrutiny, but the early data suggest that TORS is a cost-effective method compared with other available options when used in appropriately selected patients.
Collapse
Affiliation(s)
- James Kenneth Byrd
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA.
| | - Rebecca Paquin
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA
| |
Collapse
|
7
|
Caulley L, Hunink MG, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology, Part XI: Modeling and Analysis to Support Decisions. Otolaryngol Head Neck Surg 2020; 164:462-472. [PMID: 32838658 DOI: 10.1177/0194599820948827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide a resource to educate clinical decision makers about the analyses and models that can be employed to support data-driven choices. DATA SOURCES Published studies and literature regarding decision analysis, decision trees, and models used to support clinical decisions. REVIEW METHODS Decision models provide insights into the evidence and its implications for those who make choices about clinical care and resource allocation. Decision models are designed to further our understanding and allow exploration of the common problems that we face, with parameters derived from the best available evidence. Analysis of these models demonstrates critical insights and uncertainties surrounding key problems via a readily interpretable yet quantitative format. This 11th installment of the Evidence-Based Medicine in Otolaryngology series thus provides a step-by-step introduction to decision models, their typical framework, and favored approaches to inform data-driven practice for patient-level decisions, as well as comparative assessments of proposed health interventions for larger populations. CONCLUSIONS Information to support decisions may arise from tools such as decision trees, Markov models, microsimulation models, and dynamic transmission models. These data can help guide choices about competing or alternative approaches to health care. IMPLICATIONS FOR PRACTICE Methods have been developed to support decisions based on data. Understanding the related techniques may help promote an evidence-based approach to clinical management and policy.
Collapse
Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Myriam G Hunink
- Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, the Netherlands.,Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Kundrat D, Graesslin R, Schoob A, Friedrich DT, Scheithauer MO, Hoffmann TK, Ortmaier T, Kahrs LA, Schuler PJ. Preclinical Performance Evaluation of a Robotic Endoscope for Non-Contact Laser Surgery. Ann Biomed Eng 2020; 49:585-600. [PMID: 32785862 PMCID: PMC7851027 DOI: 10.1007/s10439-020-02577-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Despite great efforts, transoral robotic laser surgery has not been established clinically. Patient benefits are yet to be proven to accept shortcomings of robotic systems. In particular, laryngeal reachability and transition from microscope to accurate endoscopic laser ablation have not been achieved. We have addressed those challenges with a highly integrated robotic endoscope for non-contact endolaryngeal laser surgery. The current performance status has been assessed in multi-level user studies. In addition, the system was deployed to an ex vivo porcine larynx. The robotic design comprises an extensible continuum manipulator with multifunctional tip. The latter features laser optics, stereo vision, and illumination. Vision-based performance assessment is derived from depth estimation and scene tracking. Novices and experts (n = 20) conducted teleoperated delineation tasks to mimic laser ablation of delicate anatomy. Delineation with motion-compensated and raw endoscopic visualisation was carried out on planar and non-planar nominal patterns. Root mean square tracing errors of less than 0.75 mm were feasible with task completion times below 45 s. Relevant anatomy in the porcine larynx was exposed successfully. Accuracy and usability of the integrated platform bear potential for dexterous laser manipulation in clinical settings. Cadaver and in vivo animal studies may translate ex vivo findings.
Collapse
Affiliation(s)
- D. Kundrat
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ UK
| | - R. Graesslin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - A. Schoob
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
| | - D. T. Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Augsburg University Medical Center, Stenglinstr. 2, 86156 Augsburg, Germany
| | - M. O. Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - T. K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - T. Ortmaier
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
| | - L. A. Kahrs
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
- Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, ON L5L 1C6 Canada
| | - P. J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| |
Collapse
|
9
|
kalantari F, Rajaeih S, Daneshvar A, Karbasi Z, Mahdi Salem M. Robotic surgery of head and neck cancers, a narrative review. Eur J Transl Myol 2020; 30:8727. [PMID: 32782756 PMCID: PMC7385690 DOI: 10.4081/ejtm.2019.8727] [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: 12/02/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023] Open
Abstract
Head and neck cancers are the most common cancers in the body. Treatments are determined on the basis of the location and stage of the primary tumor. The goal of treatment is to eliminate the tumor, prevent recurrence or metastasis, and maintain the quality of life. There are several treatments available for the management of head and neck cancers, including surgery, radiation therapy, chemotherapy, new molecular agents, and a combination of them. Transoral robotic technique is a short-time operation using a type of robotic machine in which the patient undergoes anesthesia for a shorter time and the side effects of this operation and the time of hospitalization are less than open surgery. Due to the importance of speed and accuracy in head and neck cancer surgery and the importance of application of robotics in surgery, the present study was designed and implemented to review the application of robotics in the management of head and neck cancers. In this review study, the keywords: application, robotic, surgical, head cancer, transoral robotic surgery (TORS), and neck cancer, were searched in ISI, PubMed, Scopus, Google scholar databases. Related articles written domestically or abroad that have covered areas such as the background of transoral robotic surgery, maintaining organ function and approaches, the advantages and disadvantages of TORS, the affordability of TORS, the combination of TORS with other therapeutic approaches published from 2003 to 2019 were reviewed. The use of robotic surgery for precise operations such as head and neck cancers seems to be essential. More advanced robotic devices are expected to expand the surgery treatment for head and neck cancers as well as the results of using TORS for oncologic optimization and acceptability of results while maintaining organ function and patient's quality of life.
Collapse
Affiliation(s)
- Farbood kalantari
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Rajaeih
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Daneshvar
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Karbasi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salem
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Shetty KR, Wong K, Hashemi S, Shetty A, Levi JR. Transoral robotic surgery: Differences between online information and academic literature. Am J Otolaryngol 2020; 41:102395. [PMID: 32008838 DOI: 10.1016/j.amjoto.2020.102395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Evaluate the authorship, content, quality, and readability of information on Transoral Robotic Surgery (TORS) available to patients online. METHODS The technical search term "TORS Surgery" and layperson's term "robotic surgery of the mouth" were utilized to conduct a search of the top 50 websites on Google, Bing, and Yahoo. Websites were evaluated according to the HONcode evaluation of content and quality, and readability was assessed using the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level Formula, SMOG readability formula, Coleman Liau Index formula, and Gunning Fog Index. Statistical analysis was conducted using the Fisher Freeman- Halton test to compare differences in authorship, quality, and content between the three search engines and the Fisher exact test was used to determine if there was a difference in these variables between the two search terms. RESULTS Overall, websites were predominantly from academic institutions with 97% mentioning benefits of TORS with 24% mentioning risks. 45% of TORS websites had no description of the TORS procedure, while 62% allowed individuals to make appointments. There was a significant difference in authorship with the layperson's terms yielding more news sources, but there were no significant differences in quality and content of information elicited through the technical and layperson search terms. The mean readability scores were Flesch Kincaid Grade Level 13.81(±3.32), Gunning-Fog Index 16.51(±3.39), SMOG 12.53(±2.40), and Automated Readability Index 14.05 (±4.17). CONCLUSIONS Current online information on TORS surgery may not provide balanced information for patients to make informed healthcare decisions. The current readability of online information regarding TORS far exceeds the average literacy level of average American adults.
Collapse
Affiliation(s)
- Kunal Ramanand Shetty
- Department of Otolaryngology, Boston University Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA, USA.
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA
| | - Sean Hashemi
- Department of Otolaryngology, Boston University Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA, USA
| | - Anisha Shetty
- Department of School of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica R Levi
- Department of Otolaryngology, Boston University Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA, USA
| |
Collapse
|
11
|
Comparative cost of transoral robotic surgery and radiotherapy (IMRT) in early stage tonsil cancer. Am J Otolaryngol 2020; 41:102409. [PMID: 32057489 DOI: 10.1016/j.amjoto.2020.102409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare treatment costs and cost-effectiveness for transoral robotic surgery (TORS) and definitive intensity-modulated radiotherapy (IMRT) in managing early stage tonsil cancer. MATERIALS AND METHODS Direct treatment costs for surgery and IMRT were calculated from SEER-Medicare data for a cohort with clinically early stage (cT1/2N0) p16+ tonsillar squamous cell carcinoma from Kaiser Permanente Southern California Health Plan between 2012 and 2017. A Markov decision tree model with a 5-year time horizon was then applied to the cohort which incorporated costs associated with treatment, surveillance, and recurrence. RESULTS IMRT cost up to $19,000 more (35%) than TORS in direct treatment costs. When input into the Markov model, TORS dominated IMRT with lower cost and better effectiveness over a range of values. CONCLUSION TORS is a more cost-effective treatment method than IMRT in early stage (cT1/2N0) tonsil cancer.
Collapse
|
12
|
Mazul AL, Colditz GA, Zevallos JP. Factors associated with HPV testing in oropharyngeal cancer in the National Cancer Data Base from 2013 to 2015. Oral Oncol 2020; 104:104609. [PMID: 32143112 DOI: 10.1016/j.oraloncology.2020.104609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/07/2019] [Accepted: 02/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Given the recent treatment deintensification clinical trials for Human Papillomavirus (HPV)-associated oropharyngeal cancer, College of American Pathologists recommendation for HPV-testing of all oropharyngeal cancers and treatment disparities in head and neck cancer, determining factors related to HPV testing are exceedingly pertinent. MATERIALS AND METHODS We used the National Cancer Data Base, accounting for 70% of new cancer diagnoses. To reduce the heterogeneity due to the recent recommendation of HPV-testing, we used squamous cell oropharyngeal cancer patients from 2013 to 2015. We only used patients that have either reported HPV testing and non-testing (30.5% of the sample). We used a chi-square test to compare the factors among tested and untested patients and calculated the prevalence ratio for not tested to those tested with Poisson regression. As a sensitivity analysis, we used a fully Conditional Specification implemented by the MICE algorithm to impute missing variables. RESULTS Of the 24,241 oropharyngeal cancer patients with HPV testing data, 12% were not been tested for HPV. Across the study period, integrated network and low-volume hospitals had the lowest proportion of HPV testing from 2013 to 2015. In a multivariable analysis, compared to patients with private insurance, Medicaid (PR: 1.82; 95% Confidence Interval (CI): 1.63-2.02) and uninsured (PR: 1.75; 95% CI: 1.52-2.01) patients were more likely not to be tested for HPV. We saw similar results in the imputed dataset, in which 12.5% of patients were not tested. CONCLUSIONS This heterogeneity in testing is significant, given potential de-intensification of treatment for HPV-positive cancer. Future research should examine interventions in non-academic low-volume to ensure equitable treatment for all.
Collapse
Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, United States.
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| |
Collapse
|
13
|
Kalantari F, Rajaeih S, Daneshvar A, Karbasi Z, Mahdi Salem M. Robotic surgery of head and neck cancers, a narrative review. Eur J Transl Myol 2020. [DOI: 10.4081/ejtm.2020.8727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Head and neck cancers are the most common cancers in the body. Treatments are determined on the basis of the location and stage of the primary tumor. The goal of treatment is to eliminate the tumor, prevent recurrence or metastasis, and maintain the quality of life. There are several treatments available for the management of head and neck cancers, including surgery, radiation therapy, chemotherapy, new molecular agents, and a combination of them. Transoral robotic technique is a short-time operation using a type of robotic machine in which the patient undergoes anesthesia for a shorter time and the side effects of this operation and the time of hospitalization are less than open surgery. Due to the importance of speed and accuracy in head and neck cancer surgery and the importance of application of robotics in surgery, the present study was designed and implemented to review the application of robotics in the management of head and neck cancers. In this review study, the keywords: application, robotic, surgical, head cancer, transoral robotic surgery (TORS), and neck cancer, were searched in ISI, PubMed, Scopus, Google scholar databases. Related articles written domestically or abroad that have covered areas such as the background of transoral robotic surgery, maintaining organ function and approaches, the advantages and disadvantages of TORS, the affordability of TORS, the combination of TORS with other therapeutic approaches published from 2003 to 2019 were reviewed. The use of robotic surgery for precise operations such as head and neck cancers seems to be essential. More advanced robotic devices are expected to expand the surgery treatment for head and neck cancers as well as the results of using TORS for oncologic optimization and acceptability of results while maintaining organ function and patient's quality of life.
Collapse
|
14
|
Meccariello G, Montevecchi F, D'Agostino G, Iannella G, Calpona S, Parisi E, Costantini M, Cammaroto G, Gobbi R, Firinu E, Sgarzani R, Nestola D, Bellini C, De Vito A, Amadori E, Vicini C. Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. ACTA ACUST UNITED AC 2019; 39:75-83. [PMID: 31097824 PMCID: PMC6522856 DOI: 10.14639/0392-100x-2199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022]
Abstract
Trans-oral robotic surgery (TORS) has changed surgical management
of patients with oropharyngeal squamous cell carcinomas (OPSCC). In
this study we present surgical and oncologic outcomes of patients with
oropharyngeal squamous cell carcinomas, treated using TORS, with and
without an adjuvant therapy. Sixty patients with oropharyngeal
squamous cell carcinomas treated with TORS between January 2008 and
December 2017 have been retrospectively evaluated considering
clinicopathologic features, disease characteristics, adjuvant
treatments and oncological outcomes. TORS was performed for OPSCC to
the base of tongue in 41.7%, tonsils in 46.7%, soft palate and
posterior pharyngeal wall in 3.3% and 5%, respectively. Neck
dissection was performed in 43.3% of patients. Management strategies
included surgery alone in 30%, TORS and adjuvant radiotherapy in
33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year
overall survival of the total group was 77.6%, the 5-year disease-free
survival rate was 85.2%, and the 5-year local recurrence-free survival
rate was 90.6%. Finally, in selected patients TORS appears to yield
similar oncologic outcomes and functional outcomes to traditional
techniques and non-operative treatment with a possible benefit on
long-term quality of life. The future offers exciting opportunities to
combine TORS and radiotherapy in unique ways. However, further
research is urgently needed to clarify the indications for adjuvant
therapy following TORS resections.
Collapse
Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Iannella
- Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome "La Sapienza," Italy
| | - S Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - E Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - M Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - D Nestola
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - C Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| |
Collapse
|
15
|
Caulley L, Rodin D, Kilty S, Randolph G, Hunink MG, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 10: Cost-Effectiveness Analyses in Otolaryngology. Otolaryngol Head Neck Surg 2019; 161:375-387. [DOI: 10.1177/0194599819852104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clinicians seek to pursue the most clinically effective treatment strategies, but costs have also become a key determinant in contemporary health care. Economic analyses have thus emerged as a valuable resource to both quantify and qualify the value of existing and emerging interventions and programs. Cost-effectiveness analyses estimate the benefits gained per monetary unit, providing insights to guide resource allocation. Herein, we delineate the related concepts and considerations to facilitate understanding and appraisal of these analyses, so as to better inform the stakeholders in our otolaryngology community.
Collapse
Affiliation(s)
- Lisa Caulley
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shaun Kilty
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Myriam G. Hunink
- Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Center for Health Decision Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer J. Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Golusiński W. Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond. Front Oncol 2019; 9:293. [PMID: 31058091 PMCID: PMC6479210 DOI: 10.3389/fonc.2019.00293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
In recent years, interest in functional organ preservation surgery (FOPS) in the treatment of head and neck cancer has increased dramatically as clinicians seek to minimize the adverse effects of treatment while maximizing survival and quality of life. In this context, the use of transoral robotic surgery (TORS) is becoming increasingly common. TORS is a relatively new and rapidly-evolving technique, with a growing range of treatment indications. A wide range of novel, flexible surgical robots are now in development and their commercialization is expected to significantly expand the current indications for TORS. In the present review, we discuss the current and future role of this organ-preserving modality as the central element in the multimodal treatment of head and neck cancer.
Collapse
Affiliation(s)
- Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
17
|
Mäkitie AA, Keski-Säntti H, Markkanen-Leppänen M, Bäck L, Koivunen P, Ekberg T, Sandström K, Laurell G, von Beckerath M, Nilsson JS, Wahlberg P, Greiff L, Norberg Spaak L, Kjærgaard T, Godballe C, Rikardsen O, Channir HI, Rubek N, von Buchwald C. Transoral Robotic Surgery in the Nordic Countries: Current Status and Perspectives. Front Oncol 2018; 8:289. [PMID: 30101130 PMCID: PMC6072842 DOI: 10.3389/fonc.2018.00289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/09/2018] [Indexed: 01/25/2023] Open
Abstract
Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology—Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5–60). The observed number of annually operated cases remained fairly low (<25) at most of the centers. Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.
Collapse
Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology - Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - Tomas Ekberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Karl Sandström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mathias von Beckerath
- Department of Otorhinolaryngology - Head and Neck Surgery, Örebro University Hospital, Örebro, Sweden
| | - Johan S Nilsson
- Department of Otorhinolaryngology - Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Peter Wahlberg
- Department of Otorhinolaryngology - Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Lennart Greiff
- Department of Otorhinolaryngology - Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Lena Norberg Spaak
- Department of Otorhinolaryngology - Head and Neck Surgery, Umeå University Hospital, Umeå, Sweden
| | - Thomas Kjærgaard
- Department of Otorhinolaryngology - Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology - Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Oddveig Rikardsen
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital North Norway, Tromsoe, Norway
| | - Hani Ibrahim Channir
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Rock K, O’Sullivan B, Chen ZJ, Xu ZY, Li JS, Huang SH. Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0214-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
19
|
Financial outcomes of transoral robotic surgery: A narrative review. Am J Otolaryngol 2018; 39:448-452. [PMID: 29650421 DOI: 10.1016/j.amjoto.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/01/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the current cost impact and financial outcomes of transoral robotic surgery in Otolaryngology. DATA SOURCES A narrative review of the literature with a defined search strategy using Pubmed, MEDLINE, CINAHL, and Web of Science. REVIEW METHODS Using keywords ENT or otolaryngology, cost or economic, transoral robotic surgery or TORs, searches were performed in Pubmed, MEDLINE, CINAHL, and Web of Science and reviewed by the authors for inclusion and analysis. RESULTS Six total papers were deemed appropriate for analysis. All addressed cost impact of transoral robotic surgery (TORs) as compared to open surgical methods in treating oropharyngeal cancer and/or the identification of the primary tumor within unknown primary squamous cell carcinoma. Results showed TORs to be cost-effective. CONCLUSION Transoral robotic surgery is currently largely cost effective for both treatment and diagnostic procedures. However, further studies are needed to qualify long-term data.
Collapse
|
20
|
Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
Collapse
Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
| |
Collapse
|
21
|
Dobbs TD, Cundy O, Samarendra H, Khan K, Whitaker IS. A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery-From Inception to the Future. Front Surg 2017; 4:66. [PMID: 29188219 PMCID: PMC5694772 DOI: 10.3389/fsurg.2017.00066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background The use of robots in surgery has become commonplace in many specialties. In this systematic review, we report on the current uses of robotics in plastic and reconstructive surgery and looks to future roles for robotics in this arena. Methods A systematic literature search of Medline, EMBASE, and Scopus was performed using appropriate search terms in order to identify all applications of robot-assistance in plastic and reconstructive surgery. All articles were reviewed by two authors and a qualitative synthesis performed of those articles that met the inclusion criteria. The systematic review and results were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Results A total of 7,904 articles were identified for title and abstract review. Sixty-eight studies met the inclusion criteria. Robotic assistance in plastic and reconstructive surgery is still in its infancy, with areas such as trans-oral robotic surgery and microvascular procedures the dominant areas of interest currently. A number of benefits have been shown over conventional open surgery, such as improved access and greater dexterity; however, these must be balanced against disadvantages such as the lack of haptic feedback and cost implications. Conclusion The feasibility of robotic plastic surgery has been demonstrated in several specific indications. As technology, knowledge, and skills in this area improve, these techniques have the potential to contribute positively to patient and provider experience and outcomes.
Collapse
Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Olivia Cundy
- Oxford University Medical School, Oxford, United Kingdom
| | | | - Khurram Khan
- Department of Plastic Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Iain Stuart Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| |
Collapse
|
22
|
Rodin D, Caulley L, Burger E, Kim J, Johnson-Obaseki S, Palma D, Louie AV, Hansen A, O'Sullivan B. Cost-Effectiveness Analysis of Radiation Therapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2017; 97:709-717. [DOI: 10.1016/j.ijrobp.2016.11.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 11/09/2016] [Accepted: 11/19/2016] [Indexed: 12/31/2022]
|
23
|
Rubek N, Channir HI, Charabi BW, Lajer CB, Kiss K, Nielsen HU, Bentzen J, Friborg J, von Buchwald C. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. Eur Arch Otorhinolaryngol 2017; 274:2229-2237. [DOI: 10.1007/s00405-016-4433-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/16/2016] [Indexed: 12/18/2022]
|
24
|
Frenkel CH, Yang J, Zhang M, Regenbogen E, Telem DA, Samara GJ. Trends and the utilization of transoral robotic surgery with neck dissection in New York State. Laryngoscope 2016; 127:1571-1576. [PMID: 27882552 DOI: 10.1002/lary.26345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/26/2016] [Accepted: 09/02/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS. STUDY DESIGN We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence. METHODS Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts. RESULTS Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02). CONCLUSION Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:1571-1576, 2017.
Collapse
Affiliation(s)
- Catherine H Frenkel
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Mengru Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Elliot Regenbogen
- Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Dana A Telem
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Ghassan J Samara
- Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| |
Collapse
|
25
|
Ward MC, Koyfman SA. Transoral robotic surgery: The radiation oncologist’s perspective. Oral Oncol 2016; 60:96-102. [DOI: 10.1016/j.oraloncology.2016.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
|
26
|
Naunheim MR, Song PC, Franco RA, Alkire BC, Shrime MG. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments. Laryngoscope 2016; 127:691-697. [DOI: 10.1002/lary.26253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/24/2016] [Accepted: 07/20/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Phillip C. Song
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Blake C. Alkire
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Mark G. Shrime
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Global Health and Population; Harvard School of Public Health; Boston Massachusetts U.S.A
| |
Collapse
|
27
|
Cracchiolo JR, Roman BR, Kutler DI, Kuhel WI, Cohen MA. Adoption of transoral robotic surgery compared with other surgical modalities for treatment of oropharyngeal squamous cell carcinoma. J Surg Oncol 2016; 114:405-11. [PMID: 27392812 DOI: 10.1002/jso.24353] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Transoral robotic surgery (TORS) has increased for treatment of oropharyngeal squamous cell carcinoma (OPSCC). To define the adoption of TORS, we analyzed patterns of surgical treatment for OPSCC in the US. METHODS Cases of T1-T3 OPSCC treated with surgery between 2010 and 2013 from the National Cancer Database were queried. RESULTS Of 3,071 patients who underwent primary surgical management for T1-T3 OPSCC, 846 (28%) underwent TORS. On multivariable analysis, low tumor stage (T2 vs. T1: OR 0.75, CI 0.37-0.51, P < 0.0001; T3 vs. T1: O.R. 0.33, CI 0.28-0.38, P < 0.0001), treatment at an academic cancer center (O.R. 2.23, C.I. 1.29-3.88, P = 0.004) and treatment at a high volume hospital (34-155 cases vs. 1-4 cases: O.R. 9.07, C.I. 3.19-25.79, P < 0.0001) were associated with increased TORS approach. Significant geographic variation was observed, with high adoption in the Middle Atlantic. Positive margin rates were lower when TORS was performed at a high volume versus low volume hospital (8.2% vs. 16.7% respectively, P = 0.001). CONCLUSIONS Tumor and non-tumor factors are associated with TORS adoption. This analysis suggests uneven diffusion of this technology in the treatment of OPSCC. J. Surg. Oncol. 2016;114:405-411. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | | | | | - Marc A Cohen
- Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
28
|
Zhou JY, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, Lu C, Chen RG. Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes. PLoS One 2016; 11:e0151189. [PMID: 26974961 PMCID: PMC4790929 DOI: 10.1371/journal.pone.0151189] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/24/2016] [Indexed: 01/26/2023] Open
Abstract
AIM To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP). METHODS A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups. CONCLUSION RADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required. Core tip To date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.
Collapse
Affiliation(s)
- Jia-Yu Zhou
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Chang Xin
- Department Of Hepatobiliary Surgery, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
- * E-mail:
| | - Xiao-Wu Xu
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
| | - Miao-Zun Zhang
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People Hospital, Hangzhou 310016, Zhejiang Province, China
| | - Chao Lu
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Rong-Gao Chen
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| |
Collapse
|