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COSTA TN, TUSTUMI F, FERROS LSM, COLONNO BB, ABDALLA RZ, RIBEIRO-JUNIOR U, CECCONELLO I. ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: DIFFERENCES IN DIRECT COSTS FROM A BRAZILIAN PUBLIC INSTITUTE PERSPECTIVE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1714. [PMID: 36629691 PMCID: PMC9831626 DOI: 10.1590/0102-672020220002e1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.
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Affiliation(s)
| | - Francisco TUSTUMI
- Universidade de São Paulo, Department of Gastroenterology – São
Paulo (SP), Brazil
| | | | | | | | | | - Ivan CECCONELLO
- Universidade de São Paulo, Department of Gastroenterology – São
Paulo (SP), Brazil
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Luck ES, Gillespie BM. Technological Advancements in the OR: Do We Need to Redefine Intraoperative Nursing Roles? AORN J 2019; 106:280-282. [PMID: 28958313 DOI: 10.1016/j.aorn.2017.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
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Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor Racing Pit Stop Model. World J Surg 2018; 41:1943-1949. [PMID: 28357497 DOI: 10.1007/s00268-017-3936-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency. METHODS Direct observation of 45 pre-intervention robotic OR turnovers was performed. Following a previously successful model for handoffs, we employed concepts from motor racing pit stops, including briefings, leadership, role definition, task allocation and task sequencing. Turnover task cards for staff were developed, and card assignments were distributed for each turnover. Forty-one cases were observed post-intervention. RESULTS Average total OR turnover time was 99.2 min (95% CI 88.0-110.3) pre-intervention and 53.2 min (95% CI 48.0-58.5) at 3 months post-intervention. Average room ready time from when the patient exited the OR until the surgical technician was ready to receive the next patient was 42.2 min (95% CI 36.7-47.7) before the intervention, which reduced to 27.2 min at 3 months (95% CI 24.7-29.7) post-intervention (p < 0.0001). CONCLUSIONS Role definition, task allocation and sequencing, combined with a visual cue for ease-of-use, create efficient, and sustainable approaches to decreasing robotic OR turnover times. Broader system changes are needed to capitalize on that result. Pit stop and other high-risk industry models may inform approaches to the management of tasks and teams.
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The Impact of a Dedicated Robotic Team on Robotic-Assisted Sacrocolpopexy Outcomes. Female Pelvic Med Reconstr Surg 2018; 24:13-16. [DOI: 10.1097/spv.0000000000000413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abdel Raheem A, Song HJ, Chang KD, Choi YD, Rha KH. Robotic nurse duties in the urology operative room: 11 years of experience. Asian J Urol 2017; 4:116-123. [PMID: 29264216 PMCID: PMC5717981 DOI: 10.1016/j.ajur.2016.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/02/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022] Open
Abstract
The robotic nurse plays an essential role in a successful robotic surgery. As part of the robotic surgical team, the robotic nurse must demonstrate a high level of professional knowledge, and be an expert in robotic technology and dealing with robotic malfunctions. Each one of the robotic nursing team “nurse coordinator, scrub-nurse and circulating-nurse” has a certain job description to ensure maximum patient's safety and robotic surgical efficiency. Well-structured training programs should be offered to the robotic nurse to be well prepared, feel confident, and maintain high-quality of care.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.,Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Hyun Jung Song
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Don Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
The aim of this study was to explore the work experience of perioperative nurses involved in robotic surgery. A qualitative descriptive study was conducted. Participants were 15 nurses who had been on a robotic surgery team at one of five major university hospitals in Seoul, South Korea. Participants were one male and 14 female nurses (mean age, 31.33 [SD, 4.19] years; range, 25-41 years). Their experience as robotic surgery nurses ranged from 8 months to 6 years. Nurses' experiences with robotic surgery were categorized within four main themes: (1) constant checking on patients' safety and the robot's functions; (2) unexpected robotic machine errors or malfunctions; (3) feelings of burden in a robotic surgical team; and (4) need and desire for more information and education. This study showed that there are common concerns about patient safety and the possibility of emergencies related to robot system failure among nurses. Offering more support for nurses involved in robotic surgery should be a priority to empower them to play an extended role in robotic surgery.
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Abstract
Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.
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Affiliation(s)
- Allison Weaver
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott Steele
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
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Biffi R, Luca F, Bianchi PP, Cenciarelli S, Petz W, Monsellato I, Valvo M, Cossu ML, Ghezzi TL, Shmaissany K. Dealing with robot-assisted surgery for rectal cancer: Current status and perspectives. World J Gastroenterol 2016; 22:546-556. [PMID: 26811606 PMCID: PMC4716058 DOI: 10.3748/wjg.v22.i2.546] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/08/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition three-dimensional vision, it translates the surgeon’s hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors’ centre.
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Canale LS, Colafranceschi AS. Is robotic mitral valve surgery more expensive than its conventional counterpart?: Table 1:. Interact Cardiovasc Thorac Surg 2015; 20:844-7. [DOI: 10.1093/icvts/ivv038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
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Pai A, Melich G, Marecik SJ, Park JJ, Prasad LM. Current status of robotic surgery for rectal cancer: A bird's eye view. J Minim Access Surg 2015; 11:29-34. [PMID: 25598596 PMCID: PMC4290115 DOI: 10.4103/0972-9941.147682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 12/11/2022] Open
Abstract
Minimally invasive surgery for rectal cancer is now widely performed via the laparoscopic approach and has been validated in randomized controlled trials to be oncologically safe with better perioperative outcomes than open surgery including shorter length of stay, earlier return of bowel function, better cosmesis, and less analgesic requirement. Laparoscopic surgery, however, has inherent limitations due to two-dimensional vision, restricted instrument motion and a very long learning curve. Robotic surgery with its superb three-dimensional magnified optics, stable retraction platform and 7 degrees of freedom of instrument movement offers significant benefits during Total Mesorectal Excision (TME) including ease of operation, markedly lower conversion rates and better quality of the specimen in addition to shorter (steeper) learning curves. This review summarizes the current evidence for the adoption of robotic TME for rectal cancer with supporting data from the literature and from the authors' own experience. All relevant articles from PubMed using the search terms listed below and published between 2000 and 2014 including randomized trials, meta-analyses, prospective studies, and retrospective reviews with substantial numbers were included.
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Affiliation(s)
- Ajit Pai
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775, Dempster Street, Park Ridge, IL 60068, USA
| | - George Melich
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775, Dempster Street, Park Ridge, IL 60068, USA
| | - Slawomir J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775, Dempster Street, Park Ridge, IL 60068, USA
| | - John J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775, Dempster Street, Park Ridge, IL 60068, USA
| | - Leela M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775, Dempster Street, Park Ridge, IL 60068, USA
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Urrego H, Sanni A, Toro JP, Lytle N, McCready C, Davis SS, Sweeney JF, Lin E, Patel AD. Out by 3:30—A Study in Robotic Bariatric Surgery Efficiency. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hernan Urrego
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Aliu Sanni
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Juan P. Toro
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
- Department of Surgery, SOMA Clinic, Medellin, Antioquia, Colombia
| | - Nathaniel Lytle
- Department of General Surgery, Kaiser Permanente, Atlanta, Georgia
| | - Craig McCready
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - S. Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John F. Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward Lin
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ankit D. Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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