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Subramaniam S, Piozzi GN, Kim SH, Khan JS. Robotic approach to colonic resection: For some or for all patients? Colorectal Dis 2024; 26:1447-1455. [PMID: 38812078 DOI: 10.1111/codi.17046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
The robotic approach is rapidly gaining momentum in colorectal surgery. Its benefits in pelvic surgery have been extensively discussed and are well established amongst those who perform minimally invasive surgery. However, the same cannot be said for the robotic approach for colonic resection, where its role is still debated. Here we aim to provide an extensive debate between selective and absolute use of the robotic approach for colonic resection by combining the thoughts of experts in the field of robotic and minimally invasive colorectal surgery, dissecting all key aspects for a critical view on this exciting new paradigm in colorectal surgery.
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Affiliation(s)
- Sentilnathan Subramaniam
- Colorectal Surgery Unit, Department of General Surgery, Hospital Selayang, Selangor, Malaysia
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Seon-Hahn Kim
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jim S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
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2
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Presl J, Ehgartner M, Schabl L, Singhartinger F, Gantschnigg A, Wallner E, Jäger T, Emmanuel K, Kessler H, Koch OO. Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis. Langenbecks Arch Surg 2024; 409:200. [PMID: 38935194 PMCID: PMC11211106 DOI: 10.1007/s00423-024-03382-0] [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: 03/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Robotic assisted surgery is an alternative, fast evolving technique for performing colorectal surgery. The primary aim of this single center analysis is to compare elective laparoscopic and robotic sigmoid colectomies for diverticular disease on the extent of operative trauma and the costs. METHODS Retrospective analysis from our prospective clinical database to identify all consecutive patients aged ≥ 18 years who underwent elective minimally invasive left sided colectomy for diverticular disease from January 2016 until December 2020 at our tertiary referral institution. RESULTS In total, 83 patients (31 female and 52 male) with sigmoid diverticulitis underwent elective minimally invasive sigmoid colectomy, of which 42 underwent conventional laparoscopic surgery (LS) and 41 robotic assisted surgery (RS). The mean C-reactive protein difference between the preoperative and postoperative value was significantly lower in the robotic assisted group (4,03 mg/dL) than in the laparoscopic group (7.32 mg/dL) (p = 0.030). Similarly, the robotic´s hemoglobin difference was significantly lower (p = 0.039). The first postoperative bowel movement in the LS group occurred after a mean of 2.19 days, later than after a mean of 1.63 days in the RS group (p = 0.011). An overview of overall charge revealed significantly lower total costs per operation and postoperative hospital stay for the robotic approach, 6058 € vs. 6142 € (p = 0,014) not including the acquisition and maintenance costs for both systems. CONCLUSION Robotic colon resection for diverticular disease is cost-effective and delivers reduced intraoperative trauma with significantly lower postoperative C-reactive protein and hemoglobin drift compared to conventional laparoscopy.
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Affiliation(s)
- Jaroslav Presl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - M Ehgartner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - L Schabl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - F Singhartinger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - A Gantschnigg
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Wallner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - T Jäger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - H Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - O O Koch
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
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Larach JT, Flynn J, Tew M, Fernando D, Apte S, Mohan H, Kong J, McCormick JJ, Warrier SK, Heriot AG. Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes. Int J Colorectal Dis 2023; 38:161. [PMID: 37284889 PMCID: PMC10247549 DOI: 10.1007/s00384-023-04446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform. METHODS Consecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs. RESULTS During the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 ± 83.4 versus 243 ± 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 ± 8235 versus A$15,525 ± 6382; P < 0.001) and overall costs (A$34,350 ± 14,770 versus A$26,083 ± 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA ≥ 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1). CONCLUSION Robotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Michelle Tew
- Health Economics, Department of Health Services Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Diharah Fernando
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Sameer Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.
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Bastawrous AL, Shih IF, Li Y, Khalil M, Almaz B, Cleary RK. Health-care expenditures are less for minimally invasive than open colectomy for colon cancer: A US commercial claims database analysis. Surg Endosc 2023:10.1007/s00464-023-10104-y. [PMID: 37193891 PMCID: PMC10338385 DOI: 10.1007/s00464-023-10104-y] [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: 11/14/2022] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Most studies comparing surgical platforms focus on short-term outcomes. In this study, we compare the expanding societal penetration of minimally invasive surgery (MIS) with open colectomy by assessing payer and patient expenditures up to one year for patients undergoing surgery for colon cancer. METHODS We analyzed the IBM MarketScan Database for patients who underwent left or right colectomy for colon cancer between 2013 and 2020. Outcomes included perioperative complications and total health-care expenditures up to 1 year following colectomy. We compared results for patients who had open colectomy (OS) to those with MIS operations. Subgroup analyses were performed for adjuvant chemotherapy (AC+) versus no adjuvant chemotherapy (AC-) groups and for laparoscopic (LS) versus robotic (RS) approaches. RESULTS Of 7,063 patients, 4,417 cases did not receive adjuvant chemotherapy (OS: 20.1%, LS: 67.1%, RS: 12.7%) and 2646 cases had adjuvant chemotherapy (OS: 28.4%, LS: 58.7%, RS: 12.9%) after discharge. MIS colectomy was associated with lower mean expenditure at index surgery and post-discharge periods for AC- patients (index surgery: $34,588 vs $36,975; 365-day post-discharge $20,051 vs $24,309) and for AC+ patients (index surgery: $37,884 vs $42,160; 365-day post-discharge $103,341vs $135,113; p < 0.001 for all comparisons). LS had similar index surgery expenditures but significantly higher expenditures at post-discharge 30 days (AC-: $2,834 vs $2276, p = 0.005; AC+: $9100 vs $7698, p = 0.020) than RS. The overall complication rate was significantly lower in the MIS group than the open group for AC- patients (20.5% vs 31.2%) and AC+ patients (22.6% vs 39.1%, both p < 0.001). CONCLUSION MIS colectomy is associated with better value at lower expenditure than open colectomy for colon cancer at the index operation and up to one year after surgery. RS expenditure is less than LS in the first 30 postoperative days regardless of chemotherapy status and may extend to 1 year for AC- patients.
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Affiliation(s)
| | - I-Fan Shih
- Global Health Economics and Outcomes Research, Intuitive Surgical, Inc, Sunnyvale, CA, USA
| | - Yanli Li
- Global Health Economics and Outcomes Research, Intuitive Surgical, Inc, Sunnyvale, CA, USA
| | - Marissa Khalil
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Biruk Almaz
- Swedish Cancer Institute, Swedish Health System, Seattle, WA, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite 104, Ann Arbor, MI, 48106, USA.
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Jung J, Bae GH, Kim JH, Kim J. Outcomes of prostate cancer patients after robot-assisted radical prostatectomy compared with open radical prostatectomy in Korea. Sci Rep 2023; 13:7851. [PMID: 37188739 DOI: 10.1038/s41598-023-34864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
Limited evidence exists regarding the value of robot-assisted radical prostatectomy (RARP) in promoting health outcomes in patients with prostate cancer (PCa) in Korea, prompting a study to determine its clinical impact. The study included 15,501 patients with PCa who underwent RARP (n = 12,268) or radical prostatectomy (RP) (n = 3,233) between 2009 and 2017. The outcomes were compared using a Cox proportional hazards model after propensity score matching. Hazard ratios of all-cause overall mortality after RARP compared to that after RP within 3 and 12 months were (6.72, 2.00-22.63, p = 0.002) and (5.55, 3.31-9.31, p < 0.0001), respectively. The RARP group in four hospitals with the largest PCa surgery volume during the study period had worse percentile deaths than the total RARP patients within 3- (1.6% vs. 0.63%) and 12-month post-op (6.76% vs. 2.92%). The RARP group showed specific surgical complications, like pneumonia and renal failure, more than the RP group. A significantly higher short-term mortality and only modestly lower surgical complications occurred in RARP than RP group. RARP performance status may not be superior to that of RP as previously reported and perceived, possibly due to increased robotic surgery in the elderly. More meticulous measures are needed for robotic surgery in the elderly.
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Affiliation(s)
- Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Gi Hwan Bae
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University Medical College, Seoul, South Korea
- Urological Biomedicine Research Institute, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jaehong Kim
- Department of Biochemistry, College of Medicine, Gachon University, Incheon, 21999, Republic of Korea.
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Lekarczyk A, Sinha H, Dvir D, Goyert J, Airhart A, Reddy RM. Similar hospital profits with robotic-assisted paraesophageal hiatal hernia repair, despite higher or supply costs. Surg Endosc 2022; 37:3952-3955. [PMID: 35999312 DOI: 10.1007/s00464-022-09513-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Robotic-assisted laparoscopic surgery has emerged as an alternative to traditional laparoscopy and may offer some clinical benefits when performing complex hiatal hernia repairs. Many institutions may choose to not invest in robotic surgery because of perceived higher costs, and when they already have proficient laparoscopic surgeons. We hypothesized that the robotic approach would yield lower profits overall due to higher supply costs, while offering comparable outcomes to the traditional laparoscopic approach. METHODS Financial and outcomes data from a single quaternary academic center was retrospectively reviewed from a prospectively collected database from July 2020 to May 2021. Laparoscopic hiatal hernia repairs and robotic-assisted repairs were compared for metrics including length of stay, operative time, hospital and supply cost, payments, and profits. Metrics of these two groups were compared using t-test analyses with significance set to p < 0.05. RESULTS Seventy-three patients were included with 31 in the robotic group (42.5%) and 42 in the laparoscopic group (57.5%). There were no significant differences in length of stay (robotic mean 2.0 days, laparoscopic 2.55 days, p = 0.09) or operative time (257.6 min vs 256.7 min, p = 0.48) between the two approaches. The robotic approach was associated with higher supply costs ($2,655 vs $2,028, p < 0.001) and patient charges ($63,997 vs $56,276, p < 0.05). Despite higher costs associated with robotics, hospital profits were not different between the two groups ($7,462 vs $7,939, p = 0.42). CONCLUSION Despite higher supply costs and charges for robotic-assisted hiatal hernia repair, hospital profits were similar when comparing robotic and laparoscopic approaches. Short-term clinical outcomes were also similar. Programs should do their own analysis to understand their individual cost issues.
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Affiliation(s)
- Andrew Lekarczyk
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Hana Sinha
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Danielle Dvir
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Joshua Goyert
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Austin Airhart
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Rishindra M Reddy
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
- Section of Thoracic Surgery, Department of Surgery, University of Michigan-Comprehensive Robotic Surgery Program, Jose Jose Alvarez Research Professor in Thoracic Surgery, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Status of robotic assisted surgery (RAS) and the effects of Coronavirus (COVID-19) on RAS in the Department of Defense (DoD). J Robot Surg 2022; 17:413-417. [PMID: 35739435 PMCID: PMC9225798 DOI: 10.1007/s11701-022-01432-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/28/2022] [Indexed: 11/19/2022]
Abstract
The purpose of this study is to update the available literature with information on the current use of robotic assisted surgery (RAS) in the Department of Defense (DoD) compared to the civilian world, and how the coronavirus disease 2019 (COVID-19) pandemic impacted RAS in the DoD. A total of 9,979 RAS cases between 01st October 2017 and 31st December 2020 were reviewed from every DoD Military Treatment Facility (MTF) that meets our inclusion criteria and employs various models of da Vinci robotic surgical systems (Intuitive Surgical). Specialty, number, and facility were recorded for each case. These data were then compared to previously known trends about RAS use in the DoD as well as with civilian trends. Before COVID-19, the use of RAS had increased over time, but not at the same rate as in the civilian sector. General surgery cases constituted most RAS cases in both the DoD and the civilian sector. The arrival of COVID-19 in the United States significantly decreased the use of RAS in the DoD as well as in the civilian sector in all surgical specialties because it led to postponement or cancellation of many non-emergent surgical procedures. In conclusion, the use of RAS has continued to increase, and general surgery cases continue to constitute most of these cases. However, since the COVID-19 pandemic began, there was a significant decline in both DoD and civilian RAS cases, with a more pronounced decline in the DoD.
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Gass JM, Daume D, Schneider R, Steinemann D, Mongelli F, Scheiwiller A, Fourie L, Kern B, von Flüe M, Metzger J, Angehrn F, Bolli M. Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients. Surg Endosc 2022; 36:6235-6242. [PMID: 35024933 PMCID: PMC9283164 DOI: 10.1007/s00464-021-09003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
Background Robotic-assisted colorectal surgery has gained more and more popularity over the last years. It seems to be advantageous to laparoscopic surgery in selected situations, especially in confined regions like a narrow male pelvis in rectal surgery. Whether robotic-assisted, left-sided colectomies can serve as safe training operations for less frequent, low anterior resections for rectal cancer is still under debate. Therefore, the aim of this study was to evaluate intra- and postoperative results of robotic-assisted laparoscopy (RAL) compared to laparoscopic (LSC) surgery in left-sided colectomies. Methods Between June 2015 and December 2019, 683 patients undergoing minimally invasive left-sided colectomies in two Swiss, high-volume colorectal centers were included. Intra- and postoperative outcome parameters were collected and analyzed.
Results A total of 179 patients undergoing RAL and 504 patients undergoing LSC were analyzed. Baseline characteristics showed similar results. Intraoperative complications occurred in 0.6% of RAL and 2.0% of LSC patients (p = 0.193). Differences in postoperative complications graded Dindo ≥ 3 were not statistically significant (RAL 3.9% vs. LSC 6.3%, p = 0.227). Occurrence of anastomotic leakages showed no statistically significant difference [RAL n = 2 (1.1%), LSC n = 8 (1.6%), p = 0.653]. Length of hospital stay was similar in both groups. Conversions to open surgery were significantly higher in the LSC group (6.2% vs.1.7%, p = 0.018), while stoma formation was similar in both groups [RAL n = 1 (0.6%), LSC n = 5 (1.0%), p = 0.594]. Operative time was longer in the RAL group (300 vs. 210.0 min, p < 0.001). Conclusion Robotic-assisted, left-sided colectomies are safe and feasible compared to laparoscopic resections. Intra- and postoperative complications are similar in both groups. Most notably, the rate of anastomotic leakages is similar. Compared to laparoscopic resections, the analyzed robotic-assisted resections have longer operative times but less conversion rates. Further prospective studies are needed to confirm the safety of robotic-assisted, left-sided colectomies as training procedures for low anterior resections.
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Affiliation(s)
- Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Diana Daume
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Daniel Steinemann
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Regional Hospital of Lugano, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Lana Fourie
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Beatrice Kern
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Markus von Flüe
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Fiorenzo Angehrn
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Martin Bolli
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
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Diaz SE, Lee YF, Bastawrous AL, Shih IF, Lee SH, Li Y, Cleary RK. Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease. Surg Endosc 2022; 36:7250-7258. [PMID: 35194661 PMCID: PMC9485164 DOI: 10.1007/s00464-022-09097-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. METHODS This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. RESULTS Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, - 1.71, p < 0.001) and lower average total expenditures (mean difference, - $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, - 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, - 0.31, p = 0.001) at 365 days than LS. CONCLUSION MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.
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Affiliation(s)
- Sarah E. Diaz
- grid.416444.70000 0004 0370 2980Department of Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite 104, Ann Arbor, MI 48106 USA
| | - Yongjin F. Lee
- grid.281044.b0000 0004 0463 5388Swedish Cancer Institute, Seattle, WA USA
| | - Amir L. Bastawrous
- grid.281044.b0000 0004 0463 5388Swedish Cancer Institute, Seattle, WA USA
| | - I.-Fan Shih
- grid.420371.30000 0004 0417 4585Global Health Economics and Outcomes Research, Intuitive Surgical, Inc., Sunnyvale, CA USA
| | - Shih-Hao Lee
- grid.420371.30000 0004 0417 4585Global Health Economics and Outcomes Research, Intuitive Surgical, Inc., Sunnyvale, CA USA
| | - Yanli Li
- grid.420371.30000 0004 0417 4585Global Health Economics and Outcomes Research, Intuitive Surgical, Inc., Sunnyvale, CA USA
| | - Robert K. Cleary
- grid.416444.70000 0004 0370 2980Department of Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite 104, Ann Arbor, MI 48106 USA
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Mueller AN, Vossler JD, Yim NH, Harbison GJ, Murayama KM. Predictors and Consequences of Unplanned Conversion to Open During Robotic Colectomy: An ACS-NSQIP Database Analysis. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:3-9. [PMID: 34820629 PMCID: PMC8609196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Robotic-assisted surgery has become a desired modality for performing colectomy; however, unplanned conversion to an open procedure may be associated with worse outcomes. The purpose of this study is to examine predictors and consequences of unplanned conversion to open in a large, high fidelity data set. A retrospective analysis of 11 061 robotic colectomies was conducted using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) 2012-2017 database. Predictors of conversion and the effect of conversion on outcomes were analyzed by multivariate logistic regression resulting in risk-adjusted odds ratios of conversion and morbidity/mortality. Overall, 10 372 (93.8%) patients underwent successful robotic colectomy, and 689 (6.2%) had an unplanned conversion. Predictors of conversion included age ≥ 65 years, male gender, obesity, functional status not independent, American Society of Anesthesia (ASA) classification IV-V, non-oncologic indication, emergency case, smoking, recent weight loss, bleeding disorder, and preoperative organ space infection. Conversion is an independent risk factor for mortality, overall morbidity, cardiac morbidity, pulmonary morbidity, renal morbidity, venous thromboembolism morbidity, wound morbidity, sepsis, bleeding, readmission, return to the operating room, and extended length of stay (LOS). Unplanned conversion to open during robotic colectomy is an independent predictor of morbidity and mortality.
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Affiliation(s)
- Andrew N. Mueller
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
| | - John D. Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
| | - Nicholas H. Yim
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (NHY, GJH)
| | - Gregory J. Harbison
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (NHY, GJH)
| | - Kenric M. Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
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Unruh KR, Bastawrous AL, Bernier GV, Flum DR, Kumar AS, Moonka R, Thirlby RC, Simianu VV. Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program. J Gastrointest Surg 2021; 25:2387-2397. [PMID: 33206328 DOI: 10.1007/s11605-020-04875-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) for colorectal disease has well-known benefits, but many patients undergo open operations. When choosing an MIS approach, robotic technology may have benefits over traditional laparoscopy and is increasingly used. However, the broad adoption of MIS, and specifically robotics, across colorectal operations has not been well described. Our primary hypothesis is that rates of MIS in colorectal surgery are increasing, with different contributions of robotics to abdominal and pelvic colorectal operations. METHODS Rates of MIS colorectal operations are described using a prospective cohort of elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP) from 2011 to 2018. The main outcome was proportion of cases approached using open, laparoscopic, and robotic surgery. Factors associated with increased use of MIS approaches were described. RESULTS Across 21,423 elective colorectal operations, rates for MIS (laparoscopic or robotic surgery) increased from 44% in 2011 to 75% in 2018 (p < 0.001). Approaches for abdominal operations (n = 12,493) changed from 2 to 11% robotic, 43 to 63% laparoscopic, and 56 to 26% open (p < 0.001). Approaches for pelvic operations (n = 8930) changed from 3 to 33% robotic, 40 to 42% laparoscopic, and 57 to 24% open(p < 0.001). These trends were similar for high-(100 + operations/year) and low-volume hospitals and surgeons. CONCLUSIONS At SCOAP hospitals, the majority of elective colorectal operations is now performed minimally invasively. The increase in the MIS approach is primarily driven by laparoscopy in abdominal procedures and robotics in pelvic procedures.
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Affiliation(s)
- Kenley R Unruh
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | | | - Greta V Bernier
- Colon and Rectal Surgery Clinic, University of Washington Medicine-Valley Medical Center, Renton, WA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Anjali S Kumar
- Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | - Richard C Thirlby
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA.
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12
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Simianu VV, Curran T, Gaertner WB, Sklow B, Kuntz KM, Kwaan MR, Madoff RD, Jensen CC. A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy. J Gastrointest Surg 2021; 25:1512-1523. [PMID: 32394122 DOI: 10.1007/s11605-020-04615-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic surgery is increasingly used for proctectomy, but the cost-effectiveness of this approach is uncertain. Robotic surgery is considered more expensive than open or laparoscopic approaches, but in certain situations has been demonstrated to be cost-effective. We examined the cost-effectiveness of open, laparoscopic, and robotic approaches to proctectomy from societal and healthcare system perspectives. METHODS We developed a decision-analytic model to evaluate one-year costs and outcomes of robotic, laparoscopic, and open proctectomy based on data from the available literature. The robustness of our results was tested with one-way and multi-way sensitivity analyses. RESULTS Open proctectomy had increased cost and lower quality of life (QOL) compared with laparoscopy and robotic approaches. In the societal perspective, robotic proctectomy costs $497/case more than laparoscopy, with minimal QOL improvements, resulting in an incremental cost-effectiveness ratio (ICER) of $751,056 per quality-adjusted life year (QALY). In the healthcare sector perspective, robotic proctectomy resulted in $983/case more and an ICER of $1,485,139/QALY. One-way sensitivity analyses demonstrated factors influencing cost-effectiveness primarily pertained to the operative cost and the postoperative length of stay (LOS). In a probabilistic sensitivity analysis, the cost-effective approach to proctectomy was laparoscopic in 42% of cases, robotic in 39%, and open in 19% at a willingness-to-pay (WTP) of $100,000/QALY. CONCLUSIONS Laparoscopic and robotic proctectomy cost less and have higher QALY than the open approach. Based on current data, laparoscopy is the most cost-effective approach. Robotic proctectomy can be cost-effective if modest differences in costs or postoperative LOS can be achieved.
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Affiliation(s)
- Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
| | - Thomas Curran
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bradford Sklow
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Karen M Kuntz
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Mary R Kwaan
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert D Madoff
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Christine C Jensen
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
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13
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Quilici PJ, Wolberg H, McConnell N. Operating costs, fiscal impact, value analysis and guidance for the routine use of robotic technology in abdominal surgical procedures. Surg Endosc 2021; 36:1433-1443. [PMID: 33835252 DOI: 10.1007/s00464-021-08428-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was designed to define the value, cost, and fiscal impact of robotic-assisted procedures in abdominal surgery and provide clinical guidance for its routine use. METHODS 34,984 patients who underwent an elective cholecystectomy, colectomy, inguinal hernia repair, hysterectomy, or appendectomy over a 24-month period were analyzed by age, BMI, risk class, operating time, LOS and readmission rate. Average Direct and Total Cost per Case (ADC, TCC) and Net Margin per Case (NM) were produced for each surgical technique, i.e., open, laparoscopic, and robotic assisted (RA). RESULTS All techniques were shown to have similar clinical outcomes. 9412 inguinal herniorrhaphy were performed (48% open with $2138 ADC, 29% laparoscopy with $3468 ADC, 23% RA with $6880 ADC); 8316 cholecystectomies (94% laparoscopy with $2846 ADC, 4.4% RA with a $7139 ADC, 16% open with a $3931 ADC); 3432 colectomies (42% open with a $12,849 ADC, 38% laparoscopy with a $10,714, 20% RA with a $15,133); 12,614 hysterectomies [42% RA with a $8213 Outpatient (OP) ADC, 39% laparoscopy $5181 OP ADC, 19% open $4894 OP ADC]. Average Global NM is - 1% for RA procedures and only positive with commercial payors. CONCLUSION RA techniques do not produce significant clinical enhancements than similar surgical techniques with identical outcomes while their costs are much higher. The produced value analysis does not support the routine use of RA techniques for inguinal hernia repair and cholecystectomy. RA techniques for hysterectomies and colectomies are also performed at much higher cost than open and laparoscopic techniques, should only be routinely used with appropriate clinical justification and by cost efficient surgical providers.
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Affiliation(s)
- Philippe J Quilici
- PSJH System Digestive Health Institute, Renton, WA, USA. .,PSJMC MIS-Ba Service, Burbank, CA, USA.
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Ready for the robot? A cross-sectional survey of OB/GYN fellowship directors' experience and expectations of their incoming fellow's robotic surgical skills. J Robot Surg 2020; 15:723-729. [PMID: 33141409 DOI: 10.1007/s11701-020-01160-w] [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: 03/17/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
To describe OB/GYN fellowship directors' (FDs) observations, expectations, and preferences of incoming fellow's robotic surgery preparedness. Cross-sectional study. OB/GYN FDs in gynecologic oncology, minimally invasive gynecologic surgery, female pelvic medicine and reconstructive surgery, and reproductive endocrinology and infertility in the United States. 60 FDs answered the questionnaire. Participants completed an online questionnaire about their preferences and expectations of robotic surgery experience for incoming fellows. FDs observed that many incoming first-year fellows had a baseline understanding of robotic technology (60%) and robotic bedside assist experience (53%). However, few could perform more advanced robotic tasks; with FDs indicating fellows could infrequently robotically suture (18%), or perform the entire hysterectomy (15%). FDs reported higher composite observation than expectation scores (34.3 versus 22.2, p < 0.0001), and higher preference than expectation scores (34.0 versus 22.2, p < 0.0001). The composite expectation score of high-volume divisions was greater than of low-volume divisions (23.7 versus 14.0, p = 0.04). Among the domains identified, FDs most strongly preferred their fellows be able to bedside assist, have a basic understanding of robotic technology, and have basic robotic operative skills. While incoming fellows have more robotic skill than their FDs expect, few are deemed competent to independently operate the robot. Higher volume robotic surgery divisions have higher expectations of the robotic skills of their incoming fellows compared to low-volume divisions; however, FDs neither expected nor preferred their incoming fellows to be fully competent in all aspects of robotic surgery.
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Abstract
OBJECTIVE Evaluate the cost-effectiveness of open, laparoscopic, and robotic colectomy. BACKGROUND The use of robotic-assisted colon surgery is increasing. Robotic technology is more expensive and whether a robotically assisted approach is cost-effective remains to be determined. METHODS A decision-analytic model was constructed to evaluate the 1-year costs and quality-adjusted time between robotic, laparoscopic, and open colectomy. Model inputs were derived from available literature for costs, quality of life (QOL), and outcomes. Results are presented as incremental cost-effectiveness ratios (ICERs), defined as incremental costs per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to test the effect of clinically reasonable variations in the inputs on our results. RESULTS Open colectomy cost more and achieved lower QOL than robotic and laparoscopic approaches. From the societal perspective, robotic colectomy costs $745 more per case than laparoscopy, resulting in an ICER of $2,322,715/QALY because of minimal differences in QOL. From the healthcare sector perspective, robotics cost $1339 more per case with an ICER of $4,174,849/QALY. In both models, laparoscopic colectomy was more frequently cost-effective across a wide range of willingness-to-pay thresholds. Sensitivity analyses suggest robotic colectomy becomes cost-effective at $100,000/QALY if robotic disposable instrument costs decrease below $1341 per case, robotic operating room time falls below 172 minutes, or robotic hernia rate is less than 5%. CONCLUSIONS Laparoscopic and robotic colectomy are more cost-effective than open resection. Robotics can surpass laparoscopy in cost-effectiveness by achieving certain thresholds in QOL, instrument costs, and postoperative outcomes. With increased use of robotic technology in colorectal surgery, there is a burden to demonstrate these benefits.
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16
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A Population-Based Study of 90-Day Hospital Cost and Utilization Associated With Robotic Surgery in Colon and Rectal Cancer. J Surg Res 2019; 245:136-144. [PMID: 31419638 DOI: 10.1016/j.jss.2019.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of robotic surgery in colorectal cancer remains contentious with most data arising from small, single-institution studies. METHODS Stage I-III colorectal cancer resections from 2008 to 2014 were identified in New York State. Propensity score-adjusted negative binomial models were used to compare cost and utilization between robotic, laparoscopic, and open resections. RESULTS A total of 12,218 patients were identified. For colectomy, the robotic-to-open conversion rate was 3%, and the laparoscopic-to-open conversion rate was 13%. For rectal resection, the robotic-to-open conversion rate was 7% and the laparoscopic-to-open conversion rate was 32%. In intention-to-treat analysis, there was no significant difference in cost across the surgical approaches, both in overall and stratified analyses. Both laparoscopic and robotic approaches were associated with decreased 90-d hospital utilization compared with open surgery in intention-to-treat analyses. CONCLUSIONS Robotic and laparoscopic colorectal cancer resections were not associated with a hospital cost benefit after 90 d compared with open but were associated with decreased hospital utilization. Conversion to open resection was common, and efforts should be made to prevent them. Future research should continue to measure how robotic and laparoscopic approaches can add value to the health care system.
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17
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Al-Temimi MH, Chandrasekaran B, Agapian J, Peters WR, Wells KO. Robotic versus laparoscopic elective colectomy for left side diverticulitis: a propensity score-matched analysis of the NSQIP database. Int J Colorectal Dis 2019; 34:1385-1392. [PMID: 31230107 DOI: 10.1007/s00384-019-03334-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Robotic surgery might have an advantage over conventional laparoscopy for colonic diverticulitis. We intend to compare both approaches in the elective management of left side diverticulitis. METHODS The National Surgical Quality Improvement Program (NSQIP) database (2012-2014) was surveyed for patients undergoing elective left/sigmoid colectomy for diverticulitis. Patient demographics, co-morbidities, disease complexity, and intraoperative details were matched on propensity scores derived from logistic regression model. RESULTS We identified 441 robotic and 6584 laparoscopic cases. Mean age was 56.8 years. Mean BMI was 29.5, and 46.5% of patients were males. Low preoperative albumin (< 3.5 mg/dl, 11.1% vs. 6.8%, p = 0.003), splenectomy (0.45% vs. 0.05%, p = 0.002), and enterotomy repair (1.1% vs. 0.4%, p = 0.029) were higher in the robotic group than the laparoscopic group. Hand assistance (35.8% vs. 42.9%, p = 0.003), splenic flexure takedown (41.5% vs. 49.2%, p = 0.002), and ureteric stent placement (18.6% vs. 23.5%, p = 0.017) were less common in the robotic group than the laparoscopic group. Case-matched analysis showed that robotic surgery was associated with shorter hospital stay (3.89 ± 2.18 days vs. 4.75 ± 3.25 days, p < 0.001), lower conversion rate (7.5% vs. 14.3%, p = 0.001), and longer operative time (219.2 ± 95.6 min vs. 188.8 ± 82.3 min, p < 0.001) than laparoscopic surgery. Robotic approach was associated with lower overall morbidity in multivariate analysis (OR = 0.72, 95% CI = 0.55-0.96), but not in case-matched analysis (14.4% vs. 19.2%, p = 0.058). CONCLUSIONS Robotic surgery is associated with shorter hospital stay and lower conversion rate and may offer lower overall morbidity than laparoscopy after elective left side colectomy for diverticulitis. Controlled prospective studies are needed to confirm these findings.
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Affiliation(s)
- Mohammed H Al-Temimi
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA. .,Department of Surgery, Kaiser Permanente Fontana Medical Center, 9961 Sierra Ave., Fontana, CA, 92335, USA.
| | - Bindupriya Chandrasekaran
- Department of Surgery, Kaiser Permanente Fontana Medical Center, 9961 Sierra Ave., Fontana, CA, 92335, USA
| | - Johan Agapian
- Department of Surgery, Riverside University Health system, 26520 Cactus Ave,, Moreno Valley, CA, 92555, USA
| | - Walter R Peters
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA
| | - Katrina O Wells
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA
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Raskin ER, Keller DS, Gorrepati ML, Akiel-Fu S, Mehendale S, Cleary RK. Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease. JSLS 2019; 23:JSLS.2018.00073. [PMID: 30675092 PMCID: PMC6328361 DOI: 10.4293/jsls.2018.00073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives: The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States. Methods: This is a retrospective propensity score–matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons. Results: There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications—ileus, wound complications, and acute renal failure—and more patients discharged directly to home. Conclusions: The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.
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Affiliation(s)
- Elizabeth R Raskin
- Department of Surgery, Loma Linda University, Loma Linda, California, USA
| | | | - Madhu L Gorrepati
- Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Sylvie Akiel-Fu
- Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Shilpa Mehendale
- Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Robert K Cleary
- Department of Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan USA
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Batool F, Collins SD, Albright J, Ferraro J, Wu J, Krapohl GL, Campbell DA, Cleary RK. A Regional and National Database Comparison of Colorectal Outcomes. JSLS 2019; 22:JSLS.2018.00031. [PMID: 30410300 PMCID: PMC6203949 DOI: 10.4293/jsls.2018.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Objectives: The traditional open approach is still a common option for colectomy and the most common option chosen for rectal resections for cancer. Randomized trials and large database studies have reported the merits of the minimally invasive approach, while studies comparing laparoscopic and robotic options have reported inconsistent results. Methods: This study was designed to compare open, laparoscopic, and robotic colorectal surgery outcomes in protocol-driven regional and national databases. Logistic and multiple linear regression analyses were used to compare standard 30-day colorectal outcomes in the Michigan Surgical Quality Collaborative (MSQC) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases. The primary outcome was overall complications. Results: A total of 10,054 MSQC patients (open 37.5%, laparoscopic 48.8%, and robotic 13.6%) and 80,535 ACS-NSQIP patients (open 25.0%, laparoscopic 67.1%, and robotic 7.9%) met inclusion criteria. Overall complications and surgical site infections were significantly favorable for the laparoscopic and robotic approaches compared with the open approach. Anastomotic leaks were significantly fewer for the laparoscopic and robotic approaches compared with the open approach in ACS-NSQIP, while there was no significant difference between robotic and open approaches in MSQC. Laparoscopic complications were significantly less than robotic complications in MSQC but significantly more in ACS-NSQIP. Laparoscopic 30-day mortality was significantly less than for the robotic approach in MSQC, but there was no difference in ACS-NSQIP. Conclusion: Minimally invasive colorectal surgery is associated with fewer complications and has several other outcomes advantages compared with the traditional open approach. Individual complication comparisons vary between databases, and caution should be exercised when interpreting results in context.
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Affiliation(s)
- Farwa Batool
- Department of Surgery, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
| | - Stacey D Collins
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, Michign, USA
| | - Jeremy Albright
- Department of Academic Research, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - Jane Ferraro
- Department of Academic Research, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - Juan Wu
- Department of Academic Research, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - Greta L Krapohl
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, Michign, USA
| | - Darrell A Campbell
- Department of Surgery, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
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20
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Bastawrous A, Baer C, Rashidi L, Neighorn C. Higher robotic colorectal surgery volume improves outcomes. Am J Surg 2018; 215:874-878. [DOI: 10.1016/j.amjsurg.2018.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 12/28/2022]
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Reddy RM, Gorrepati ML, Oh DS, Mehendale S, Reed MF. Robotic-Assisted Versus Thoracoscopic Lobectomy Outcomes From High-Volume Thoracic Surgeons. Ann Thorac Surg 2018; 106:902-908. [PMID: 29704479 DOI: 10.1016/j.athoracsur.2018.03.048] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports of surgical outcomes comparing proficient surgeons who perform either robotic-assisted or video-assisted thoracoscopic lobectomy are lacking. We evaluate the comparative effectiveness of robotic-assisted and video-assisted thoracoscopic lobectomies by surgeons who performed 20 or more annual surgical procedures in a national database. METHODS Patients 18 years or older, who underwent elective lobectomy by surgeons who performed 20 or more annual lobectomies by robotic-assisted or thoracoscopic approach from January 2011 through September 2015, were identified in the Premier Healthcare database with the use of codes from the ninth revision of the International Statistical Classification of Diseases and Related Health Problems. Propensity-score matching based on patient and hospital characteristics and by year was performed 1:1 to identify comparable cohorts for analysis (n = 838 in each cohort). All tests were two-sided, with statistical significance set at p less than 0.05. RESULTS A total of 23,779 patients received an elective lobectomy during the study period: 9,360 were performed by video-assisted thoracoscopic approach and 2,994 were by robotic-assisted approach. Propensity-matched comparison of lobectomies performed by surgeons who performed 20 or more procedures annually (n = 838) showed that robotic-assisted procedures had a longer mean operative time by 25 minutes (mean 247.1 minutes vs 222.6 minutes, p < 0.0001) but had a lower conversion-to-open rate (4.8% vs 8.0%, p = 0.007) and a lower 30-day complication rate (33.4% vs 39.2%, p = 0.0128). Transfusion rates and 30-day mortality rates were similar between the two cohorts. CONCLUSIONS When surgical outcomes are limited to surgeons who perform 20 or more annual procedures, the robotic-assisted approach is associated with a lower conversion-to-open rate and lower 30-day complication rate when than video-assisted thoracoscopic surgeons, with a mean operative time difference of 25 minutes.
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Affiliation(s)
- Rishindra M Reddy
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
| | | | - Daniel S Oh
- Clinical Affairs, Intuitive Surgical, Inc, Sunnyvale, California; Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Shilpa Mehendale
- Clinical Affairs, Intuitive Surgical, Inc, Sunnyvale, California
| | - Michael F Reed
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Mirkin KA, Kulaylat AS, Hollenbeak CS, Messaris E. Robotic versus laparoscopic colectomy for stage I–III colon cancer: oncologic and long-term survival outcomes. Surg Endosc 2017; 32:2894-2901. [DOI: 10.1007/s00464-017-5999-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/02/2017] [Indexed: 01/26/2023]
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Stefanidis D, Bailey SB, Kuwada T, Simms C, Gersin K. Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc 2017; 32:610-616. [DOI: 10.1007/s00464-017-5710-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022]
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