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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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2
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Travis J, Wilgus S. Order Online or Call it in? Conceptualization and Measurement of Preferences for Computer versus Human Interaction. Psychol Rep 2023; 126:3028-3051. [PMID: 35476030 DOI: 10.1177/00332941221097952] [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] [Indexed: 11/16/2022]
Abstract
Technology is increasingly integrated into everyday life and consequently, traditional social exchanges between human agents have evolved to include human-computer interaction, providing scientists new directions for understanding and predicting consumer behavior. Despite progress, there are conceptual and empirical limitations in current measures applied to consumer/user preferences. This paper documents the development and validation of the 10-item preference for computer versus human interaction (PCHI) scale across three distinct samples and incorporating items that (a) include direct comparisons between computers and humans, (b) are independent of specific contexts or technologies, and (c) capture major theoretical domains of social, consumer, and human factors psychology. Results support the hypothesized three-factor structure (efficiency, ease of use, and trust) and demonstrate the utility of this measure to predict everyday consumer decisions beyond extant measures. Additionally, the PCHI offers marketing, user experience, and other practitioners a brief instrument for developing interventions, training protocols, and modeling attitudes.
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Affiliation(s)
- Justin Travis
- Department of Psychology, University of South Carolina Upstate, Spartanburg, SC, USA
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McNair AGK, Hoffmann C, Macefield RC, Elliott D, Blazeby JM, Avery KLN, Potter S. A standardized measurement instrument was recommended for evaluating operator experience in complex healthcare interventions. J Clin Epidemiol 2023; 153:55-65. [PMID: 36228972 DOI: 10.1016/j.jclinepi.2022.10.006] [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: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators' experiences (how professionals feel undertaking the innovation) drive this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators' experience of surgical innovation. STUDY DESIGN AND SETTING There were three phases: (1) Literature reviews identified measures of operators' experience and concepts measured were extracted and grouped into domains. (2) Quality appraisal was conducted to assess content validity of identified instruments and was supported by COnsensus-based Standards for the selection of health Measurement Instruments methodology. Self-reported measurement instruments that had underdone formal development were eligible. Content validity was assessed using COnsensus-based Standards for the selection of health Measurement Instruments criteria for good content validity (rated sufficient/insufficient/indeterminate/inconsistent), informed by standards for measurement development and domains identified in phase 1. (3) Instruments determined suitable and of sufficient quality underwent supplemental appraisal in interviews with international multidisciplinary professionals and a focus group. RESULTS Literature reviews identified 16 measurement instruments from 243 studies. Most assessed 'psychological' experiences and 'usability'. No instrument was specifically validated for innovative surgery. Three instruments were rated 'sufficient' (Surgery Task Load Index [SURG-TLX]) or 'indeterminate' (Spielberger State-Trait Anxiety Inventory, Imperial Stress Assessment Tool). Twenty professionals were interviewed (seven female; 15 specialties; six countries) and the focus group included 10 participants (four professionals, six researchers). The SURG-TLX was considered the most relevant, comprehensive, and comprehensible instrument. CONCLUSION The SURG-TLX is preliminarily recommended to measure operators' experiences of innovation. Further work exploring its role and impact on surgical innovation is required.
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Affiliation(s)
- Angus G K McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK; Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK.
| | - Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Rhiannon C Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Daisy Elliott
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane M Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Kerry L N Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Shelley Potter
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK; Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
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Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [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: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
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Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Navarrete-Arellano M. Robotic-Assisted Minimally Invasive Surgery in Children. LATEST DEVELOPMENTS IN MEDICAL ROBOTICS SYSTEMS 2021. [DOI: 10.5772/intechopen.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.
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Alfred MC, Cohen TN, Cohen KA, Kanji FF, Choi E, Del Gaizo J, Nemeth LS, Alekseyenko AV, Shouhed D, Savage SJ, Anger JT, Catchpole K. Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design. JMIR Res Protoc 2021; 10:e25284. [PMID: 33560239 PMCID: PMC7902184 DOI: 10.2196/25284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. OBJECTIVE This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals. METHODS The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention (including through direct observation of a sample of surgeries in each observational phase), operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis. RESULTS The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 (CSMC and MDRH: Pro00056245; VCMC: STUDY 270; MUSC: Pro00088741). After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites. CONCLUSIONS This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25284.
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Affiliation(s)
- Myrtede C Alfred
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC, United States
| | - Tara N Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Kate A Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Falisha F Kanji
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Eunice Choi
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - John Del Gaizo
- Medical University of South Carolina, Biomedical Informatics Center, Charleston, SC, United States
| | - Lynne S Nemeth
- Medical University of South Carolina, College of Nursing, Charleston, SC, United States
| | - Alexander V Alekseyenko
- Medical University of South Carolina, Biomedical Informatics Center, Charleston, SC, United States
| | - Daniel Shouhed
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Carleston, SC, United States
| | - Jennifer T Anger
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Ken Catchpole
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC, United States
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Francavilla S, Veccia A, Dobbs RW, Zattoni F, Vigneswaran HT, Antonelli A, Dal Moro F, Autorino R, Simeone C, Crivellaro S. Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port-a single surgeon pathway. J Robot Surg 2021; 16:21-27. [PMID: 33554284 PMCID: PMC8863749 DOI: 10.1007/s11701-021-01194-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022]
Abstract
To describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.
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Affiliation(s)
- Simone Francavilla
- Department of Urology, College of Medicine, University of Illinois at Chicago, 820 S Wood Street, Chicago, IL, 60612, USA.
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
| | - Alessandro Veccia
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA
| | - Ryan W Dobbs
- Department of Urology, College of Medicine, University of Illinois at Chicago, 820 S Wood Street, Chicago, IL, 60612, USA
| | - Fabio Zattoni
- Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Hari T Vigneswaran
- Department of Urology, College of Medicine, University of Illinois at Chicago, 820 S Wood Street, Chicago, IL, 60612, USA
| | - Alessandro Antonelli
- Urology Unit Azienda Ospedaliero Universitaria Integrata di Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Fabrizio Dal Moro
- Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Simone Crivellaro
- Department of Urology, College of Medicine, University of Illinois at Chicago, 820 S Wood Street, Chicago, IL, 60612, USA
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Lungu DA, Pennucci F, De Rosis S, Romano G, Melfi F. Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians. Int J Health Plann Manage 2019; 35:773-787. [PMID: 31793689 DOI: 10.1002/hpm.2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023] Open
Abstract
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
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Affiliation(s)
- Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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Kaouk J, Garisto J, Eltemamy M, Bertolo R. Step-by-step technique for single-port robot-assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci ® SP™ surgical system. BJU Int 2019; 124:707-712. [PMID: 30868722 DOI: 10.1111/bju.14744] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe a step-by-step technique for robot-assisted radical cystectomy (RARC) with pelvic lymph node dissection (PLND) performed using the da Vinci® SP™ surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). PATIENTS AND METHODS Four consecutive patients diagnosed with urothelial carcinoma of the bladder were counselled for RARC with PLND and ileal conduit urinary diversion performed using the da Vinci SP surgical system. A 3-cm midline incision was made 5-cm above the umbilicus. Dissection was performed to access the abdominal cavity. Insertion of the GelPOINT® advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) with the SP Cannula was performed through the incision made. A 12-mm AirSeal® (SurgiQuest Inc., Milfort, CT, USA) port for the assistant was placed on the pre-marked stoma site, where an ileal conduit urinary diversion was desired. Demographics and perioperative outcomes were collected under Institutional Review Board approval (IRB 13-780). The surgeries were performed by reproducing the steps of the institutional approach for RARC performed with the multi-arm robotic platform. RESULTS The surgeries were successfully completed. There was neither conversion to standard multi-arm robotic or open approaches nor the need for additional port placement. The mean (range) operative time was 454 (420-496) min. Blood loss averaged 312 mL. No transfusions were required and no intraoperative complications occurred. All patients had negative surgical margins. All patients were discharged on postoperative day 5. CONCLUSION From our preliminary experience, RARC with PLND and ileal conduit urinary diversion is feasible and safe using the da Vinci SP surgical system. Further comparative studies with open and multi-arm robotic approaches are warranted.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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McCulloch P, Feinberg J, Philippou Y, Kolias A, Kehoe S, Lancaster G, Donovan J, Petrinic T, Agha R, Pennell C. Progress in clinical research in surgery and IDEAL. Lancet 2018; 392:88-94. [PMID: 29361334 DOI: 10.1016/s0140-6736(18)30102-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement decisions, lead to slow adoption of innovations, and permit widespread adoption of procedures that offer no benefit, or cause harm. Improvement in the quality of surgical evidence would therefore be valuable. The Idea, Development, Exploration, Assessment, and Long-term Follow-up (IDEAL) Framework and Recommendations specify desirable qualities for surgical studies, and outline an integrated evaluation pathway for surgery, and similar complex interventions. We used the IDEAL Recommendations to assess methodological progress in surgical research over time, assessed the uptake and influence of IDEAL, and identified the challenges to further methodological progress. Comparing studies from the periods 2000-04 and 2010-14, we noted apparent improvement in the use of standard outcome measures, adoption of Consolidated Standards of Reporting Trials (CONSORT) standards, and assessment of the quality of surgery and of learning curves, but no progress in the use of qualitative research or reporting of modifications during procedure development. Better education about research, integration of rigorous evaluation into routine practice and training, and linkage of such work to awards systems could foster further improvements in surgical evidence. IDEAL has probably contributed only slightly to the improvements described to date, but its uptake is accelerating rapidly. The need for the integrated evaluation template IDEAL offers for surgery and other complex treatments is becoming more widely accepted.
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Affiliation(s)
- Peter McCulloch
- Nuffiled Department of Surgical Science, University of Oxford, Oxford, UK.
| | - Joshua Feinberg
- Department of Surgery, Maimonides Hospital, Brooklyn, NY, USA
| | - Yiannis Philippou
- Nuffiled Department of Surgical Science, University of Oxford, Oxford, UK
| | - Angelos Kolias
- Division of Neurosurgery, School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Gillian Lancaster
- Institute of Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tatjana Petrinic
- Cairns Library, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Riaz Agha
- Plastic Surgery Department, Guys and St Thomas' NHS Foundation Trust, London, UK
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Morelli L, Palmeri M, Simoncini T, Cela V, Perutelli A, Selli C, Buccianti P, Francesca F, Cecchi M, Zirafa C, Bastiani L, Cuschieri A, Melfi F. A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table. Surg Endosc 2018; 32:4165-4172. [PMID: 29603010 DOI: 10.1007/s00464-018-6161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 03/21/2018] [Indexed: 02/08/2023]
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12
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Blended shared control utilizing online identification. Int J Comput Assist Radiol Surg 2018; 13:769-776. [DOI: 10.1007/s11548-018-1745-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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13
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Van Bruwaene S, Namdarian B, Challacombe B, Eddy B, Billiet I. Introducing new technology safely into urological practice. World J Urol 2018; 36:543-548. [PMID: 29327248 DOI: 10.1007/s00345-018-2173-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Surgical innovation is necessary to ensure continued improvement in patient care. However, several challenges unique to the surgical craft are encountered during the development and validation of such new technology. This article highlights some of these challenges and gives an overview of existing solutions. METHODS A Pubmed review was performed about the "introduction of new technology" to identify challenges. Cross-referencing was used to explore the possible solutions per challenge. RESULTS Several characteristics of the surgical craft itself limit our ability to establish randomised controlled trials and hence provide clear categorical evidence. Existing certification bodies for new technology often use unstructured regulations and allow fast-track bypassing systems. Consequently the IDEAL framework (innovation, development, exploration, assessment, long-term follow-up) proposes an objective scientific approach whilst defining stakeholder responsibilities. The selection of which new modality to implement is heavily influenced by third parties unrelated to the best patient outcomes and thus professional organisations can aid in this decision-making. Appropriate training of surgeons and their teams until proficiency is achieved is essential prior to credentialling. Finally long-term surveillance of outcomes in the form of registries is an increasing responsibility of the urological community to maintain our role in directing the adoption or rejection of these innovations. CONCLUSION Urological innovation is a dynamic and challenging process. Increasing efforts are identified within the urological community to render the process more reliable and transparent.
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Affiliation(s)
| | | | - Ben Challacombe
- Guy's Hospital, Guy's and St Thomas' Trust (GSTT), London, UK
| | - Ben Eddy
- Kent and Canterbury Hospital, East Kent Hospital Trust (EKHUFT), Canterbury, UK
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15
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Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc 2017; 32:1405-1413. [DOI: 10.1007/s00464-017-5822-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022]
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Simmons MN, Fitts M, Krigbaum T, Neeb AD. Outcomes and Complications of Robotic-assisted Laparoscopic Prostatectomy in a Community Hospital Setting. Urology 2016; 96:136-141. [DOI: 10.1016/j.urology.2016.05.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 11/27/2022]
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Borgmann H, Woelm J, Nelson K, Gust K, Mager R, Reiter M, Schilling D, Bartsch G, Blaheta R, Haferkamp A, Tsaur I. Strategy of robotic surgeons to exert public influence through Twitter. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Hendrik Borgmann
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Jan Woelm
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Karen Nelson
- Department of Vascular and Endovascular Surgery; University Hospital Frankfurt; Frankfurt Germany
| | - Kilian Gust
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Michael Reiter
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - David Schilling
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Georg Bartsch
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Roman Blaheta
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology; University Hospital Frankfurt; Frankfurt Germany
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Adapting the robotic platform to small operating theaters: our experience with the side-docking technique for robotic-assisted laparoscopic prostatectomy. Surg Endosc 2016; 30:4464-8. [PMID: 26850025 DOI: 10.1007/s00464-016-4777-1] [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: 11/03/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Conventionally, in robotic-assisted laparoscopic prostatectomy (RALP), the robot is entered between the abducted legs of the patient. This approach may present drawbacks, including the limited access to the perineum, the inevitable abduction of the patient's legs, and the limited space available in small operating theaters. To overcome these problems, in our center, we use, from over 5 years, a side-docking technique. We herein describe our technique and a series of patients who underwent RALP using such side-docking procedure. METHODS In our department, we have applied the side-docking technique for over 5 years, mainly in RALP procedures. The series reported includes 268 men undergoing RALP ± extended lymph node dissection (ePLND) between mid-2010 and 2014. After trocart positioning, the robot is entered at a 45° angle compared to the patient's main axis, coming in from the right side. Patient's legs are minimally abducted to <10°. RESULTS Mean docking time, from skin incision to full docking was 13 min. 41 % (109/268) of patients underwent simultaneous ePLND, dissecting nodes up till at least the iliac bifurcation. No conversion to open surgery was required. External collisions are infrequent with this configuration: No re-docking was necessary in this cohort. CONCLUSIONS Side-docking of the da Vinci robot is a safe alternative for RALP. In our department, this technique has faced the proof of time and is routinely used.
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Lavoué V, Gotlieb W. Benefits of Minimal Access Surgery in Elderly Patients with Pelvic Cancer. Cancers (Basel) 2016; 8:cancers8010012. [PMID: 26771641 PMCID: PMC4728459 DOI: 10.3390/cancers8010012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 12/12/2022] Open
Abstract
An increasing proportion of patients requiring treatment for malignancy are elderly, which has created new challenges for oncologic surgeons. Aging is associated with an increasing prevalence of frailty and comorbidities that may affect the outcome of surgical procedures. By decreasing complications and shortening length of hospital stay without affecting oncologic safety, surgery performed using the robot, rather than traditional laparotomy, improves the chances of a better outcome in our growing elderly populations. In addition to age, surgeons should take into account factors, such as frailty and comorbidities that correlate with outcome.
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Affiliation(s)
- Vincent Lavoué
- Service de chirurgie gynécologique, Centre Hospitalo-Universitaire de Rennes, Hôpital Sud, 16 Bd de Bulgarie, 35000 Rennes, France.
- Inserm, ER440-OSS, CRLCC Eugène Marquis, Avenue Bataille Flandre-Dunkerque, 35000 Rennes, France.
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
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Gandaglia G, Montorsi F, Karakiewicz PI, Sun M. Robot-assisted radical prostatectomy in prostate cancer. Future Oncol 2015; 11:2767-73. [DOI: 10.2217/fon.15.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
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Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Francesco Montorsi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Maxine Sun
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
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Parsons JK, Rangarajan SS, Palazzi K, Chang D. A National, Comparative Analysis of Perioperative Outcomes of Open and Minimally Invasive Simple Prostatectomy. J Endourol 2015; 29:919-24. [DOI: 10.1089/end.2014.0879] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- J. Kellogg Parsons
- Department of Urology, UC San Diego Health System, La Jolla, California
- Urologic Cancer, UC San Diego Moores Cancer Center, La Jolla, California
- Section of Surgery, VA San Diego Healthcare System, San Diego, California
- Department of Surgery, UC San Diego Health System, San Diego, California
| | | | - Kerrin Palazzi
- Department of Urology, UC San Diego Health System, La Jolla, California
| | - David Chang
- Department of Surgery, UC San Diego Health System, San Diego, California
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Lee JK, Oh JJ, Lee S, Lee SB, Byun SS, Lee SE, Jeong CW. A New Sliding-Loop Technique in Renorrhaphy for Partial Nephrectomy: A Feasibility Study in a Porcine Model. Surg Innov 2015; 23:130-3. [PMID: 26169258 DOI: 10.1177/1553350615595321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We developed a sliding-loop technique that narrowed both sides of the parenchyma in a porcine model and compared it with the conventional sliding-clip technique. METHODS Three pigs (30-40 kg) were reused following another experiment conducted by the same researchers. Bilateral kidneys were harvested within 30 minutes after euthanasia. Two partial nephrectomies per kidney were performed on opposite surfaces. All kidney defects were of the same size (diameter of 2.5-3 cm with a depth of 1.0-1.5 cm). The sliding-clip technique and sliding-loop technique were performed separately. In the sliding-loop technique, we created a 1-cm loop at the end of a Vicryl and placed a tetrafluoroethylene polymer pledget in front of the knots passing through the needle. The needle then crossed the loop after passing through the renal parenchyma. A Weck clip was placed and slid on one side to tighten the suture. Tightening was controlled with an equivalent force using a digital push-pull gauge. Three stitches were placed at each renorrhaphy site. The distance between repaired renal surfaces was measured at 5 different points (3 suture sites and 2 middle sites between sutures). RESULTS The results of the 2 techniques were compared by using the independent t test. The mean distance between renal surfaces was significantly narrower in the sliding-loop technique than in the conventional technique (1.80 ± 1.08 mm vs 5.28 ± 2.46 mm, P < .001). CONCLUSION In the porcine model, the sliding-loop technique more effectively closed the partial nephrectomy defects compared with the conventional sliding-clip technique.
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Affiliation(s)
- Jung Keun Lee
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Jin Oh
- Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
| | - Sangchul Lee
- Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
| | - Seung Bae Lee
- College of Medicine, Seoul National University, Seoul, Korea SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seok-Soo Byun
- Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
| | - Sang Eun Lee
- Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
| | - Chang Wook Jeong
- College of Medicine, Seoul National University, Seoul, Korea Seoul National University Hospital, Seoul, Korea
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Virtual reality suturing task as an objective test for robotic experience assessment. BMC Urol 2015; 15:63. [PMID: 26137869 PMCID: PMC4490698 DOI: 10.1186/s12894-015-0051-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/09/2015] [Indexed: 01/22/2023] Open
Abstract
Background We performed a pilot study using a single virtual-simulation suturing module as an objective measurement to determine functional use of the robotic system. This study will assist in designing a study for an objective, adjunctive test for use by a surgical proctor. Methods After IRB approval, subjects were recruited at a robotic renal surgery course to perform two attempts of the “Tubes” module without warm-up using the Da Vinci® Surgical Skills Simulator™. The overall MScore (%) from the simulator was compared among various skill levels to provide construct validity. Correlation with MScore and number of robotic cases was performed and pre-determined skill groups were tested. Nine metrics that make up the overall score were also tested via paired t test and subsequent logistic regression to determine which skills differed among experienced and novice robotic surgeons. Results We enrolled 38 subjects with experience ranging from 0- < 200 robotic cases. Median time to complete both tasks was less than 10 min. The MScore on the first attempt was correlated to the number of previous robotic cases (R2 = 0.465; p = 0.003). MScore was different between novice and more experienced robotic surgeons on the first (44.7 vs. 63.9; p = 0.005) and second attempt (56.0 vs. 69.9; p = 0.037). Conclusion A single virtual simulator exercise can provide objective information in determining proficient use of the robotic surgical system.
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Sgarbura O, Tomulescu V, Popescu I. Robotic oncologic complexity score - a new tool for predicting complications in computer-enhanced oncologic surgery. Int J Med Robot 2015; 12:296-302. [PMID: 25943703 DOI: 10.1002/rcs.1664] [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: 09/17/2014] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND While there is little doubt that robotic interventions have already opened new horizons in surgery due to its inherent complexity, there is still an unmet need for tools allowing center-to-center performance comparisons. A complexity score could be a valuable instrument for further research. METHODS The items of the robotic oncologic complexity score (ROCS) were based on risk factors identified in previous studies. We attempt to build the score and validate it on 400 consecutive cases of robotic oncologic surgery. The primary endpoint is to assess the value of ROCS in predicting major complications. RESULTS The mean ROCS in the group was 3.3(+/-1.4). Different correlations were calculated: the score and the complications (r=0.38), the major complications (r=0.42), Clavien grade (r=0.5), the operating time (r=0.35), and the length of stay (r=0.47). On the ROC-curve a score >4 has the best specificity and sensibility for predicting major complications (P<0.05). CONCLUSION ROCS has potential in predicting complications and hospital length of stay, as well as a role in classifying oncologic robotic surgical interventions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Olivia Sgarbura
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Institut Régional du Cancer, Montpellier, France
| | - Victor Tomulescu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Mano R, Russo P. Reply: To PMID 25586475. Urology 2015; 85:603-4. [PMID: 25586474 DOI: 10.1016/j.urology.2014.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Roy Mano
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.
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Shimbo M. Editorial comment to Prediction of biochemical recurrence after robot-assisted radical prostatectomy: analysis of 784 Japanese patients. Int J Urol 2014; 22:193-4. [PMID: 25424133 DOI: 10.1111/iju.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan.
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Stolzenburg JU, Kallidonis P, Qazi H, Ho Thi P, Dietel A, Liatsikos EN, Do M. Extraperitoneal Approach for Robotic-assisted Simple Prostatectomy. Urology 2014; 84:1099-105. [DOI: 10.1016/j.urology.2014.06.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 06/27/2014] [Indexed: 12/18/2022]
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Robotic-Assisted Simple Prostatectomy: Is there Evidence to go Beyond the Experimental Stage? Curr Urol Rep 2014; 15:443. [DOI: 10.1007/s11934-014-0443-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
In the current health care system, high costs without proportional improvements in quality or outcome have prompted widespread calls for change in how we deliver and pay for care. Value-based health care delivery models have been proposed. Multiple impediments exist to achieving value, including misaligned patient and provider incentives, information asymmetries, convoluted and opaque cost structures, and cultural attitudes toward cancer treatment. Radiation oncology as a specialty has recently become a focus of the value discussion. Escalating costs secondary to rapidly evolving technologies, safety breaches, and variable, nonstandardized structures and processes of delivering care have garnered attention. In response, we present a framework for the value discussion in radiation oncology and identify approaches for attaining value, including economic and structural models, process improvements, outcome measurement, and cost assessment.
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Affiliation(s)
- Sewit Teckie
- Sewit Teckie, Memorial Sloan-Kettering Cancer Center, New York, NY; and Susan A. McCloskey and Michael L. Steinberg, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Susan A McCloskey
- Sewit Teckie, Memorial Sloan-Kettering Cancer Center, New York, NY; and Susan A. McCloskey and Michael L. Steinberg, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Michael L Steinberg
- Sewit Teckie, Memorial Sloan-Kettering Cancer Center, New York, NY; and Susan A. McCloskey and Michael L. Steinberg, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
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31
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Parsons JK. Editorial comment. J Urol 2014; 191:912; discussion 912-3. [PMID: 24440510 DOI: 10.1016/j.juro.2013.10.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Kellogg Parsons
- Moores Comprehensive Cancer Center, University of California-San Diego, San Diego, California
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Revenig LM, Canter DJ, Master VA, Maithel SK, Kooby DA, Pattaras JG, Tai C, Ogan K. A prospective study examining the association between preoperative frailty and postoperative complications in patients undergoing minimally invasive surgery. J Endourol 2014; 28:476-80. [PMID: 24308497 DOI: 10.1089/end.2013.0496] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Current surgical decision-making is overly subjective and often misjudges a patient's physiologic state. The concept of frailty has gained recent recognition and potentially represents a measureable phenotype, which can quantify a patient's physiologic reserve and risk of an adverse surgical outcome. We sought to investigate the relationship between preoperative markers of frailty and postoperative complications in patients undergoing minimally invasive surgery (MIS). METHODS Frailty, using the methodology described by Fried and coworkers, was prospectively measured in patients who presented to urology, general surgery, and surgical oncology clinics where major MIS (endoscopic, laparoscopic, or robotic) was planned. The relationship between preoperative markers of frailty and 30-day postoperative complications was our primary outcome measure. RESULTS Our cohort includes 80 patients. Mean age and body mass index were 60.0 (range 19-87) years and 29.2 (range 18.4-53.1) kg/m(2), respectively. The majority of patients were male (57.5%) and Caucasian (65.0%). Thirteen patients were deemed "intermediately frail" or "frail," and the remaining 67 were classified as "not frail." Thirteen (16.25%) patients experienced any postoperative complication. Five (38.5%) of the intermediately frail and frail patients experienced a complication, compared with eight (11.9%) of the not frail patients (odds ratio=5.914; 95% confidence interval=1.25-27.96; P=0.025). CONCLUSION The advent of MIS has potentially lured surgeons into thinking older and patients with comorbidities may more easily tolerate this surgical approach compared with traditional open techniques. Our data suggest, however, that intermediately frail or frail patients are at increased risk of experiencing postoperative complications compared with not frail patients.
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Affiliation(s)
- Louis M Revenig
- 1 Department of Urology, Emory University School of Medicine , Atlanta, Georgia
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Good DW, Stewart GD, Stolzenburg JU, McNeill SA. Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. World J Urol 2013; 32:1225-33. [PMID: 24326782 DOI: 10.1007/s00345-013-1198-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/19/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Laparoscopic radical prostatectomy (LRP) has a long learning curve; however, little is known about the pentafecta learning curve for LRP. We analysed the learning curve for a fellowship trained surgeon with regard to the pentafecta with up to 6-year follow-up. METHODS A retrospective review was performed in 550 cases, by dividing these cases into 11 groups of 50 patients. Outcomes analysed were the following: (1) the pentafecta (complication rate, positive surgical margin (PSM) rate, continence, potency and biochemical recurrence); (2) operative time and blood loss; and (3) overall pentafecta attainment. RESULTS The mean complication rate for the entire series was 9 %; this plateaued after 150 cases. The overall PSM rate for the series was 23.5 %, 16.3 % for pT2 and 40.5 % for pT3. PSM plateaued after 200 cases. Excluding the first 100 cases, the overall PSM rate for pT2 was 10.9 % and 37.8 % for pT3. The continence rate stabilised after approximately 250 cases. The rate of male sling/artificial urinary sphincter plateaued after 200 cases. The potency learning curve continues to improve after 250 cases of nerve-sparing (ns) endoscopic extraperitoneal radical prostatectomy (EERPE) as does the pentafecta learning curve which closely follows the pattern of the potency learning curve. The last group of nsEERPE achieved pentafecta in 63 %. CONCLUSION This study shows multiple learning curves: an initial for peri-operative outcomes, then stabilisation of oncologic outcomes and the final for stabilisation of functional outcomes. In this series over 250 cases were required to achieve the learning curve.
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Affiliation(s)
- D W Good
- Department of Urology, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh, EH2 4XU, UK,
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Peterson CY, Palazzi K, Parsons JK, Chang DC, Ramamoorthy SL. The prevalence of laparoscopy and patient safety outcomes: an analysis of colorectal resections. Surg Endosc 2013; 28:608-16. [PMID: 24091552 DOI: 10.1007/s00464-013-3216-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although laparoscopic colorectal surgery is associated with faster postoperative recovery and shorter hospital stays than open surgery, perioperative patient safety analyses using process-focused, validated measures have yet to be performed. METHODS This study analyzed the U.S. Nationwide Inpatient Sample, a 20 % weighted sample of inpatient hospital discharges, from 1998 to 2009. The study included patients who underwent open or laparoscopic colorectal resections and excluded those younger than 18 years and those who underwent emergent or multiple colorectal operations. The primary outcome measure was surgery-specific patient safety indicators (PSIs). Uni- and multivariate regression methods were used to estimate associations of surgery type with PSIs. RESULTS A total of 2,936,641 patients were identified, and 177,547 (6 %) of these patients underwent laparoscopic colorectal resections. The laparoscopic patients were younger (p < 0.001) and more likely to be Caucasian (p = 0.005) and male (p < 0.001), to have lower Charlson scores (p < 0.001), and to undergo surgery in teaching hospitals (p < 0.001) located in urban areas (p < 0.001). The prevalence of laparoscopic surgery has increased rapidly in recent years, from 5 to 29 % of all colorectal procedures performed in 2007 and 2009, respectively. The prevalence of any PSI was lower in the laparoscopic group (4.2 vs. 8.3 %; p < 0.001). Multivariate analyses showed that the likelihood of any PSI for laparoscopic colorectal resection was 57 % lower than for open resections (odds ratio, 0.43; 95 % confidence interval, 0.40-0.46; p < 0.001). CONCLUSION Laparoscopic colorectal surgery was associated with a lower risk of adverse patient safety events, a difference that became more pronounced as the prevalence of laparoscopy increased. Future studies should focus on factors that promote the safe adoption of innovative surgical techniques and optimize surgical outcomes.
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Affiliation(s)
- Carrie Y Peterson
- Department of Surgery, University of California, San Diego, 3855 Health Sciences Dr., Suite 2073, La Jolla, CA, 92093, USA,
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Robotic partial nephrectomy shortens warm ischemia time, reducing suturing time kinetics even for an experienced laparoscopic surgeon: a comparative analysis. World J Urol 2013; 32:265-71. [PMID: 23783881 DOI: 10.1007/s00345-013-1115-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/06/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Laparoscopic and robotic partial nephrectomy (LPN and RPN) are strongly related to influence of tumor complexity and learning curve. We analyzed a consecutive experience between RPN and LPN to discern if warm ischemia time (WIT) is in fact improved while accounting for these two confounding variables and if so by which particular aspect of WIT. METHODS This is a retrospective analysis of consecutive procedures performed by a single surgeon between 2002-2008 (LPN) and 2008-2012 (RPN). Specifically, individual steps, including tumor excision, suturing of intrarenal defect, and parenchyma, were recorded at the time of surgery. Multivariate and univariate analyzes were used to evaluate influence of learning curve, tumor complexity, and time kinetics of individual steps during WIT, to determine their influence in WIT. Additionally, we considered the effect of RPN on the learning curve. RESULTS A total of 146 LPNs and 137 RPNs were included. Considering renal function, WIT, suturing time, renorrhaphy time were found statistically significant differences in favor of RPN (p < 0.05). In the univariate analysis, surgical procedure, learning curve, clinical tumor size, and RENAL nephrometry score were statistically significant predictors for WIT (p < 0.05). RPN decreased the WIT on average by approximately 7 min compared to LPN even when adjusting for learning curve, tumor complexity, and both together (p < 0.001). CONCLUSIONS We found RPN was associated with a shorter WIT when controlling for influence of the learning curve and tumor complexity. The time required for tumor excision was not shortened but the time required for suturing steps was significantly shortened.
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