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Myla K, Bou-Ayash N, Kim WC, Bugaev N, Bawazeer M. Is implementation of robotic-assisted procedures in acute care general surgery cost-effective? J Robot Surg 2024; 18:223. [PMID: 38801638 DOI: 10.1007/s11701-024-01912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/16/2024] [Indexed: 05/29/2024]
Abstract
Over the past 2 decades, the use and importance of robotic surgery in minimally invasive surgery has increased. Across various surgical specialties, robotic technology has gained popularity through its use of 3D visualization, optimal ergonomic positioning, and precise instrument manipulation. This growing interest has also been seen in acute care surgery, where laparoscopic procedures are used more frequently. Despite the growing popularity of robotic surgery in the acute care surgical realm, there is very little research on the utility of robotics regarding its effects on health outcomes and cost-effectiveness. The current literature indicates some value in utilizing robotic technology in specific urgent procedures, such as cholecystectomies and incarcerated hernia repairs; however, the high cost of robotic surgery was found to be a potential barrier to its widespread use in acute care surgery. This narrative literature review aims to determine the cost-effectiveness of robotic-assisted surgery (RAS) in surgical procedures that are often done in urgent settings: cholecystectomies, inguinal hernia repair, ventral hernia repair, and appendectomies.
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Affiliation(s)
- Kumudini Myla
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Woon Cho Kim
- Tufts University School of Medicine, Boston, MA, USA
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Nikolay Bugaev
- Tufts University School of Medicine, Boston, MA, USA
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Mohammed Bawazeer
- Tufts University School of Medicine, Boston, MA, USA.
- Tufts Medical Center, Department of Surgery, Boston, MA, USA.
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Mikhail AR, Daniels L, Cobb D, Kawji Y, Issa C, Danos DM, LeBlanc K. Robotic hernia repair: the trainee "Drag" factor-a single-surgeon 9-year experience. Hernia 2024; 28:241-247. [PMID: 38123830 DOI: 10.1007/s10029-023-02935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The use of robotic assisted surgery is increasing but training residents in its use may be associated with increased operative time and cost. The objective of this study is to compare the operative time of robotic incisional/ventral hernia repair (RIVHR) and robotic inguinal hernia repair (RIHR) when performed with and without a resident or fellow trainee. METHODS A review of prospectively collected data was performed on all patients who underwent RIVHR and RIHR by a single surgeon over a 9-year period (2014-2023). Study variables included presence of trainee (resident or fellow), procedure time, console time, and recurrent hernia. Primary outcomes include procedure time and console time. RESULTS A total of 402 surgeries were included for analysis. Residents assisted in 190 (47%) of the procedures, while fellows assisted in 97 (24%), and 115 (29%) were performed without a trainee. Median (IQR) console times in RIVHR assisted by fellows was 102 (72-145) minutes, compared to 90 (71-129) minutes among surgeries assisted by residents and 65 (52-82) minutes among surgeries performed without a trainee (p < 0.0001), a similar trend was observed for RIHR. The duration of hernia repair assisted by trainees was significantly longer than surgeries performed without a trainee. CONCLUSION Operative time for RIVHR and RIHR is significantly lower when performed without a trainee. However, RIHR assisted by residents showed a consistent decrease in operative time over the 9-year period.
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Affiliation(s)
- A R Mikhail
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA.
| | - L Daniels
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
| | - D Cobb
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
| | - Y Kawji
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
| | - C Issa
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
| | - D M Danos
- School of Public, Health Louisiana State University, 3rd Floor, 2020 Gravier St, New Orleans, LA, 70112, USA
| | - K LeBlanc
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
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Stewart CL, Green C, Meara MP, Awad MM, Nelson M, Coker AM, Porterfield J. Common Components of General Surgery Robotic Educational Programs. JOURNAL OF SURGICAL EDUCATION 2023; 80:1717-1722. [PMID: 37596106 DOI: 10.1016/j.jsurg.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Robotically assisted surgery has become more common in general surgery, but there is limited guidance from the Accreditation Council for Graduate Medical Education (ACGME) regarding this type of training. We sought to determine common elements and differences in the robotic educational curricula developed by general surgery residency programs. DESIGN Robotic educational curricula were obtained from the 7 individuals who presented at the workshop, "Robotic Education in General Surgery" at the 2023 Association of Program Directors in Surgery annual meeting. RESULTS All 7 general surgery programs had training beginning intern year, required online robotic modules, had at least 1 dedicated simulation training console not used for clinical purposes, and ran dry and wet (tissue) robotic labs at least annually. All programs had bedside and console surgeon case minimums and had administrative support to run the educational programs. Differences existed regarding how training intern year was executed, the simulations required, clinical practice minimum requirements, how progress was monitored over time, and how case numbers were tracked. Some programs had salary support for a director of robotic education. CONCLUSIONS There are several common elements to robotic educational curricula in general surgery, however significant variation does exist between programs. Given the frequency of robotic use in general surgery and current lack of standardization, formal guidance from the ACGME specifically regarding robotic education in general surgery residency is warranted.
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Affiliation(s)
- Camille L Stewart
- Department of Surgery, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado.
| | - Courtney Green
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Michael P Meara
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Michael M Awad
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Megan Nelson
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Alisa M Coker
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Porterfield
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Meara M, Pieper H, Shields M, Woelfel I, Wang T, Renton D, Chen X. What influences general surgery residents' prospective entrustment and operative time in robotic inguinal hernia repairs. Surg Endosc 2023; 37:7908-7913. [PMID: 37430122 DOI: 10.1007/s00464-023-10242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Teaching residents robotic-assisted inguinal hernia repair (RIHR) is an increasingly common extension of contemporary surgical training. This study sought to investigate what variables would influence operative time (OT) and resident prospective entrustment in RIHR cases. METHODS We prospectively collected 68 resident RIHR operative performance evaluations with a validated instrument. Outpatient RIHR cases performed by 11 general surgery residents during 2020-2022 were included. The overall OT of matched cases was extracted from hospital billing; matched procedural step-specific OT was obtained from Intuitive Data Recorder (IDR). Statistical analysis was performed using Pearson correlation and one-way ANOVA. RESULTS The evaluation instrument reliably assessed residents' RIHR performance (Cronbach's α = 0.93); residents' prospective entrustment strongly correlated with overall guidance provided by attending surgeon (r = 0.86, p < 0.0001) and operative plan and judgment (r = 0.85, p < 0.0001). The overall OT was significantly associated with resident's team management (r = - 0.35, p = 0.011). Procedural step-specific OT was significantly associated with residents' step-specific skill (r = - 0.32, p = 0.014). On average, RIHR cases with the highest level of prospective entrustment (Resident can teach junior) showed the shortest step-specific OT. Entrustment level 3 (Reactive guidance needed) was the turning point of all four RIHR procedural step-specific OT. CONCLUSIONS Our findings suggest that in RIHR, attending guidance, resident operative plan and judgment, and resident technical skill contribute to resident prospective entrustment; resident team management, technical skill, and attending guidance influence operative time, which in turn impacts attendings' determination of resident prospective entrustment. Future studies with a larger sample size are needed to further validate the findings.
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Affiliation(s)
- Michael Meara
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Heidi Pieper
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Mallory Shields
- Research Division, Intuitive Surgical Inc, Norcross, GA, 30092, USA
| | - Ingrid Woelfel
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Theresa Wang
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - David Renton
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Xiaodong Chen
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA.
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