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Arishi AA, Hakami IA, Mashbari HN, Hobani AH, Al-Musawa HI, Abuhadi RI, Maslouf AH, Matari MH, Albrahim HT, Algarni MA, Iskander O, Alyahyawi K. Knowledge, attitude, and perception of robotic-assisted surgery among the general population in Saudi Arabia: a cross-sectional study. J Robot Surg 2024; 18:196. [PMID: 38703278 DOI: 10.1007/s11701-024-01892-z] [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: 01/12/2024] [Accepted: 02/28/2024] [Indexed: 05/06/2024]
Abstract
Minimally invasive surgery (MIS) has revolutionized surgical practices, with robotic-assisted surgery (RAS) significantly advancing. However, the understanding and acceptance of RAS vary, impacting its widespread adoption. This study aims to assess Saudi Arabians' attitudes and comprehension of RAS, which is crucial for promoting its integration into surgical procedures. A cross-sectional study was conducted in various Saudi Arabian cities. A total of 1449 participants were included, while participants with cognitive issues were excluded. Demographic information, knowledge, technology experience, attitudes, and perceptions about RAS were collected using an online self-administered questionnaire. Data were analyzed using descriptive and inferential statistics. Of the participants, 51.1% demonstrated awareness of RAS, mainly through social media (36.9%). Factors influencing awareness included gender, education, income, occupation, computer literacy, and technology comfort. Gender disparities were evident in attitudes and perceptions toward RAS. Concerns about RAS included robot malfunction (62.0%), surgical errors (45.4%), and surgeon competency (44.7%). 36.4% of the participants believe RAS is faster, 29.9% believe RAS is less painful, and 25.3% believe RAS has fewer complications. Positive perceptions encompassed the belief that robot-using surgeons are more skilled (44.5%) and hospitals offering RAS are better (54.3%). Notably, 47.7% expressed willingness to consider RAS as a treatment option. The study underscores the significance of promoting awareness and informed decisions to ensure the successful integration of RAS in surgical practices. Addressing concerns and misconceptions and enhancing public comprehension are pivotal for facilitating informed decision-making and fostering RAS acceptance within Saudi Arabia's surgical landscape.
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Affiliation(s)
- Abdulaziz A Arishi
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Ibrahim A Hakami
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Hassan N Mashbari
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Rana I Abuhadi
- Faculty of Medicine, Jazan University, 45142, Jazan, Saudi Arabia
| | - Atheer H Maslouf
- Faculty of Medicine, Jazan University, 45142, Jazan, Saudi Arabia
| | | | | | - Maram A Algarni
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Othamn Iskander
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Khalid Alyahyawi
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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Rivero-Moreno Y, Rodríguez-Rodríguez M, Machado-Paled D, Echevarria S, Pouwels S, Abou-Mrad A, Oviedo R. Robotic surgery across Latin America: a bibliometric analysis of research trends from 2009 to 2022. J Robot Surg 2024; 18:123. [PMID: 38492059 DOI: 10.1007/s11701-024-01865-2] [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: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
The rise of robotic surgery throughout the world, particularly in Latin America, justifies an objective evaluation of research in this field. This study aimed to use bibliometric techniques to identify the research trends and patterns of robotic surgery in Latin America. The research strategy used the terms "Robotic," "Surgery," and the name of all the Latin American countries, in all fields and collections of Web of Science database. Only original articles published between 2009 and 2022 were included. The software Rayyan, Bibliometric in the R Studio, and VOSViewer were used to develop the analyses. After screening, 96 articles were included from 60 different journals. There was a 22.51% annual increase in the scientific production of robotic surgery in the period studied. The more frequent topics by specialty were: Urology (35.4%), General Surgery (34.4%), and Obstetrics and Gynecology (12%). International cooperation was observed in 65.62% of the studies. The Latin American institution with the highest production of manuscripts was the Pontificia Universidad Católica de Chile. Mexico, Chile, and Brazil were, in descending order, the nations with the highest number of corresponding authors and total citations. When considering the total number of articles, Brazil ranked ahead of Chile. Scientific production regarding robotic surgery in Latin America has experienced accelerated growth since its beginning, supported by the high degree of collaboration with leading countries in the field.
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Affiliation(s)
| | | | - Debbye Machado-Paled
- Universidad Católica de Honduras Nuestra Señora Reina de La Paz, Tegucigalpa, Honduras
| | | | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Oberhausen, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Adel Abou-Mrad
- Centre Hospitalier Universitaire (CHU) d'Orléans, Orléans, France
| | - Rodolfo Oviedo
- Nacogdoches Medical Center, Nacogdoches, TX, USA
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
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Bravi CA, Mottaran A, Sarchi L, Piro A, Paciotti M, Nocera L, Piramide F, Balestrazzi E, Peraire M, Farinha R, Sorce G, Collà-Ruvolo C, Rebuffo S, De Backer P, D'Hondt F, De Groote R, De Naeyer G, Mottrie A. Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center. World J Urol 2023; 41:3737-3744. [PMID: 37917223 DOI: 10.1007/s00345-023-04665-9] [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: 02/03/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems. METHODS We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors. RESULTS A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: - 0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3). CONCLUSION We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations-in particular, cost analyses-these results have important implications for patients, surgeons, and healthcare policymakers.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.
- ORSI Academy, Ghent, Belgium.
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Piramide
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Peraire
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Gabriele Sorce
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Claudia Collà-Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Silvia Rebuffo
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | | | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
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Barkati N, Ntefeh N, Okasha A, Takshe AA, ElKhatib R, Chelli S. Robotic assisted surgery in the United Arab Emirates: healthcare experts' perceptions. J Robot Surg 2023; 17:2799-2806. [PMID: 37733210 PMCID: PMC10678779 DOI: 10.1007/s11701-023-01716-6] [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: 06/05/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
The adoption of Robotic Assisted Surgery (RAS) has grown around the world. This is also the case in the Middle East and Gulf region and specifically to the United Arab Emirates (UAE). The perception of RAS has been studied in the USA, Europe, and Canada. However, there is limited research on the perception of RAS in the UAE. The study aims to examine the perception of RAS among healthcare experts in the UAE and potential challenges. This qualitative study is based on interviewing healthcare experts in the UAE. Most of the study participants were clinicians and surgeons. In the UAE, RAS is adopted in general surgery, urology, brain surgery, and obstetrics and gynecology. Our findings show that healthcare experts have positive perceptions of RAS. The cost and lack of RAS training program are considered as challenges to adopting RAS in healthcare practices. More research is encouraged to examine perception variations with surgical practices in the UAE, Gulf and the Middle East.
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Affiliation(s)
- Nasim Barkati
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates
| | - Noura Ntefeh
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates
| | - Ahmad Okasha
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates
| | - Aseel A Takshe
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates.
| | - Rami ElKhatib
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates
| | - Sabrina Chelli
- Department of Public Health, Canadian University Dubai, Dubai, United Arab Emirates
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Rudiman R, Hanafi RV, Almawijaya A. Single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: A systematic review and meta-analysis. Ann Gastroenterol Surg 2023; 7:709-718. [PMID: 37663974 PMCID: PMC10472369 DOI: 10.1002/ags3.12688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 09/05/2023] Open
Abstract
Background The possibilities of minimally invasive cholecystectomy have emerged since the beginning of single-incision laparoscopic cholecystectomy (SILC) and single-site robotic cholecystectomy (SSRC). This study aimed to compare the feasibility, safety, and pain scores between SSRC and SILC. Methods The authors searched randomized or non-randomized controlled trials and observational studies in PubMed, EuroPMC, and ClinicalTrials.gov from April 2012 until April 2022. The authors analyzed the operation time, hospital stay, blood loss volume, conversion rate, intraoperative complication rates, postoperative complications, visual analog scale (VAS) immediately after surgery, and VAS at hospital discharge. This study aligned with PRISMA and AMSTAR guidelines. Results Thirteen studies were selected with 817 and 757 patients who underwent SSRC and SILC. Thus, this study demonstrated a lower incidence of intraoperative complication rates [relative risk (RR) 0.57 (95% CI 0.34-0.96), p = 0.03] and lesser VAS score at hospital discharge [Std. Mean Difference (SMD) -0.23 (95% CI -0.46, -0.01), p = 0.04] in the SSRC group. Regarding operation time and cost, SSRC revealed a longer time [SMD 1.02 (95% CI 0.45, 1.59), p = 0.0004] and higher cost [SMD 4.18 (95% CI 1.77, 6.58), p < 0.00001], respectively. Meanwhile, SSRC did not differ from SILC during a hospital stay, blood loss volume, conversion rate, postoperative complication rates, and VAS immediately after surgery. Conclusions Concerning intraoperative complication rates and VAS score at hospital discharge, SSRC was superior to SILC. Thus, SSRC is considered a feasible and safe procedure.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of MedicineUniversitas Padjadjaran, Hasan Sadikin General HospitalBandungIndonesia
| | - Ricarhdo Valentino Hanafi
- Department of General Surgery, School of MedicineUniversitas Padjadjaran, Hasan Sadikin General HospitalBandungIndonesia
| | - Almawijaya Almawijaya
- Division of Digestive Surgery, Department of General Surgery, School of MedicineUniversitas Padjadjaran, Hasan Sadikin General HospitalBandungIndonesia
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Bharadwaj HR, Wireko AA, Adebusoye FT, Ferreira T, Pacheco‐Barrios N, Abdul‐Rahman T, Mykolayivna NI. Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective. Health Sci Rep 2023; 6:e1519. [PMID: 37614285 PMCID: PMC10442525 DOI: 10.1002/hsr2.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
Background and Aims Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region. Methods This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers. Results RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues. Conclusion Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.
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Affiliation(s)
| | | | | | - Tomas Ferreira
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Niels Pacheco‐Barrios
- Faculty of Medicine, Alberto Hurtado Medical SchoolCayetano Heredia Peruvian UniversityLimaPeru
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7
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Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J, Acevedo-Rodríguez J, Dorado-Avila G, Osorio-Romero L, Chavez-Campos C, Acero-Alvarracín K. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus 2023; 15:e42370. [PMID: 37621804 PMCID: PMC10445506 DOI: 10.7759/cureus.42370] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.
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Affiliation(s)
| | | | | | - Luigi Pianetti
- General Surgery, Universidad Nacional del Litoral, Argentina, ARG
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8
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Azhar RA, Rabah D, Alenizi AM, Alammari A, Alasker A, Alqahtani AA, Alsaikhan BH, Alyami FA, Alzahrani HM, Alothman KI, Moazin MS, Alhgbani M, Baghdadi M, Alotaibi MF. Saudi Urological Association consensus guidelines on the use of robotic surgery in urology. Urol Ann 2022; 14:199-204. [PMID: 36117790 PMCID: PMC9472305 DOI: 10.4103/ua.ua_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.
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Affiliation(s)
- Raed A. Azhar
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Adel Alammari
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Alasker
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali A. Alqahtani
- Department of Urology, Aseer Central Hospital, Abha, Saudi Arabia
| | - Bader H. Alsaikhan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fahad A. Alyami
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hassan M. Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid I. Alothman
- Department of Urology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Maher S. Moazin
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mofarej Alhgbani
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Baghdadi
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed F. Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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9
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Al-Thani H, Al-Thani N, Al-Sulaiti M, Tabeb A, Asim M, El-Menyar A. A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches. Front Surg 2022; 9:848565. [PMID: 35310427 PMCID: PMC8927071 DOI: 10.3389/fsurg.2022.848565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
BackgroundCurrently, adrenalectomies are trending toward minimally invasive approach including robotic and laparoscopic surgery. We aimed to describe the clinical presentation and outcomes associated with the 3 different surgical approaches in patients who underwent adrenalectomy for adrenal mass at a single tertiary center.MethodsA retrospective descriptive observational study was conducted to include all patients who underwent surgical interventions for adrenal gland mass between 2004 and 2019. Patients were categorized into three groups according to the interventional approach (open, robotic vs. laparoscopic adrenalectomy) and data were analyzed and compared.ResultsA total of 124 patients underwent adrenalectomies (61.3% robotic, 22.6% open, and 16.1% laparoscopic approach). Incidentally discovered adrenal mass was reported in 67% of patients, and hypertension was the most prevalent comorbidity (53%). The tendency for malignancy increased with increasing tumor size while the functioning tumors were more in the smaller tumor size. Larger tumors were more common in younger patients. The robotic approach showed shorter surgical intensive care and hospital length of stay. Patients in the open adrenalectomy group frequently presented with abdominal pain (p = 0.001), had more nonfunctional adrenal mass (p = 0.04), larger mean tumor size (p = 0.001), and were frequently operated on the right side (p = 0.03). There was no post-operative mortality; however, during follow-up, 8 patients died (3 open, 3 laparoscopic and, 2 robotic approach). The median follow-up was 746 days (range 7–5,840).ConclusionsThe study explored the three surgical adrenalectomy approaches in a dedicated center for patients with adrenal pathology. It showed that robotic adrenalectomy could be safe and effective surgical approach for patients with benign functioning adrenal tumors of a diameter <6 cm. However, the choice of a surgical approach varies according to the adrenal mass presentation, patient fitness for surgery, type and sizes of the tumor, surgeon's experience, and hospital resources. Open surgery is considered the first choice for larger, ruptured adrenal tumor or malignancy. However, the recent restructuring of the surgical department resulted in selection bias in favor of the robotic surgery. Further studies are required to address the risk factors, selection criteria for appropriate management, cost, and quality of life.
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Affiliation(s)
| | - Noora Al-Thani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- *Correspondence: Ayman El-Menyar
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10
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Liatsikos E, Tsaturyan A, Kyriazis I, Kallidonis P, Manolopoulos D, Magoutas A. Market potentials of robotic systems in medical science: analysis of the Avatera robotic system. World J Urol 2021; 40:283-289. [PMID: 34424374 PMCID: PMC8381715 DOI: 10.1007/s00345-021-03809-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the potential opportunities and possible competitiveness of Avatera robotic system (ARS) (Avateramedical, Germany), and perform predictive cost-analysis for its implementation and dissemination. MATERIAL AND METHODS Our study employed a projective quantitative research design. SWOT (strengths, weaknesses, opportunities, threats) analysis was used to map ARS internal competencies towards external contexts, and potential opportunities and risks in the robotic market. The ARS purchase and procedural costs were evaluated in two different scenarios. RESULTS In the first scenario, setting the purchase cost of the Avatera at around $1.3-1.5 million, a total $400 procedural cost reduction compared to the RAS performed with the da Vinci Xi can be calculated. In the second scenario, with a purchase cos of the ARS of $700.000-800.000 and considering a 5-year period with an annual ARS volume of 500 procedures, only an additional $300 will be attributed to the robot itself. Our projections revealed that for an effective competition the purchase cost of ARS should range between $700.000 and $800.000 during the initial phase of market entry. The marketing strategy of the ARS should be oriented towards countries without any robotic system in operational use, followed by countries where the competition intensity in the marketplace is low. CONCLUSION The introduction of new robotic systems will greatly affect and reshape the market of robotic surgery. The ARS has all the technical capacity ensuring the performance of high-quality surgical procedures. A fast spread and implementation of the ARS could be expected should the purchase and maintenance costs be kept low.
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Affiliation(s)
- Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Iason Kyriazis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Dimitris Manolopoulos
- School of Social Sciences, Hellenic Open University, Athens, Greece.,Department of Business Administration, Athens University of Economics and Business, Athens, Greece
| | - Anastasios Magoutas
- School of Social Sciences, Hellenic Open University, Athens, Greece.,General Department, National and Kapodistrian University of Athens, Athens, Greece
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Azhar RA, Aldousari S, Alghamdi MM, Alotaibi MF, Alkhateeb SS, Nassir AM, Alshaalan A, Yaiesh S, Rabah D. Robot-Assisted Radical Prostatectomy in Low-Volume Regions: Should It Be Abandoned or Adopted? A Multi-Institutional Outcome Study. J Endourol 2021; 35:1013-1019. [PMID: 33470156 DOI: 10.1089/end.2020.0770] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To present multinational experience in robot-assisted radical prostatectomy (RARP) by fellowship-trained expertise in low-volume regions in Gulf Cooperation Council (GCC) countries and to compare the current results with global outcomes reported in recent meta-analyses. Methods: A retrospective review of prospectively collected data was performed for patients undergoing RARP for localized prostate cancer (PCa). Three fellowship-trained surgeons at four academic and referral centers in Saudi Arabia and Kuwait performed all procedures between February 2014 and December 2019. Data on demographics, perioperative characteristics, pathology, and adverse events were collected. Results: A total of 207 patients were included with a median (IQR) follow-up duration of 28 (15-38) months. The median prostate volume and prostate-specific antigen were 42 (32-53) g and 9.1 (5.8-14.1) ng/mL, respectively. While 65.2% of patients had a Gleason score ≥7, 20% had grade group 4 disease, and 7.8% had ≥cT3 disease. The mean ± SD operative time was 203 ± 52 minutes, and the mean estimated blood loss was 158 ± 107 mL. Only 4 (1.9%) patients received perioperative blood transfusions. Positive surgical margins were observed in 21.7% of patients, all of whom had ≥pT3 disease. There were 23 complications in 18 (8.7%) patients, including Clavien-Dindo grade III complications in 2.4%. At the 12-month follow-up, 35.8% of patients were potent, 94.6% were continent, and 9.2% had biochemical recurrence. Conclusions: The safety and efficacy of RARP by fellowship-trained expertise in GCC countries were well established. The outcomes seem promising and comparable to international centers and should improve with increasing case volume and fellowship-trained expertise.
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Affiliation(s)
- Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad Aldousari
- Department of Surgery, Division of Urology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Department of Urology, Division of Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Musab M Alghamdi
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed F Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Sultan S Alkhateeb
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Anmar M Nassir
- Department of Surgery, Umm-Alqura University, Makkah, Kingdom of Saudi Arabia
| | - Abdullah Alshaalan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cancer Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Said Yaiesh
- Department of Surgery, Urology Unit, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Danny Rabah
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.,Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cancer Research Chair, King Saud University, Riyadh, Saudi Arabia
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12
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Labban M, Bulbul M, Wazzan W, Khauli R, El Hajj A. Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon. Arab J Urol 2020; 19:152-158. [PMID: 34104490 PMCID: PMC8158259 DOI: 10.1080/2090598x.2020.1814184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy
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Affiliation(s)
- Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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13
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Aldousari SA, Buabbas AJ, Yaiesh SM, Alyousef RJ, Alenezi AN. Multiple perceptions of robotic-assisted surgery among surgeons and patients: a cross-sectional study. J Robot Surg 2020; 15:529-538. [PMID: 32776285 DOI: 10.1007/s11701-020-01136-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
Limited data exist regarding knowledge and perceptions of surgeons and patients about robotic-assisted surgery (RAS) in the Middle East. This study aimed to explore perceptions of surgeons and patients about RAS. A questionnaire-based survey was distributed among surgeons of different specialties and patients. Between March and September 2019, 278 and 256 surveys were completed by surgeons and patients, respectively (95.2% and 94.8% response rate, respectively). The surgeons' self-reported experience with technology was related to the level of comfort with computers and computer literacy. Most surgeons have heard of RAS availability, and the majority agreed to its introduction into the healthcare system. However, only 75 (27%) of the surgeons thought that the surgeon has complete control over the robot, and 69 (25%) surgeons were not sure of the level of control the surgeon has over the robot reflecting poor knowledge about this technology. Less than a third of patient respondents have heard of RAS. However, half of them would consider it should they need to undergo surgery. When compared to open surgery, 23 (9%), 26 (10%), and 94 (37%) patient respondents thought that RAS caused less pain, had fewer complications, and was faster than conventional surgery, respectively. Knowledge and perceptions about RAS are limited among surgeons and patients in Kuwait. Efforts should focus on increasing awareness.
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Affiliation(s)
- Saad A Aldousari
- Department of Surgery (Urology Division), Faculty of Medicine, Kuwait University, Safat, P.O. Box 24923, 13110, Kuwait City, Kuwait.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ali J Buabbas
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Rawan J Alyousef
- Kuwait Urology Program, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait
| | - Abdullah N Alenezi
- Kuwait Urology Program, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait
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Buabbas AJ, Aldousari S, Shehab AA. An exploratory study of public' awareness about robotics-assisted surgery in Kuwait. BMC Med Inform Decis Mak 2020; 20:140. [PMID: 32611407 PMCID: PMC7329483 DOI: 10.1186/s12911-020-01167-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/24/2020] [Indexed: 01/11/2023] Open
Abstract
Background The adoption of robotic-assisted surgery (RAS) requires a clear willingness, not only from healthcare organization to operate the robotic system but also from the public that is going to perceive it. This study aims to explore public’s awareness, understanding and their perceptions towards RAS in Kuwait. Methods This cross-sectional study used a survey questionnaire that was disseminated on a tablet device to people at their convenience in governmental institutions. Results A total of 1087 people agreed to participate in this study. The study results showed that only 36.8% of respondents had heard of RAS and 27.1% knew what RAS is. Moreover, 47.6% of the respondents were uncertain about its safety, while 29.7% thought RAS was safe. The results also showed that 40.9 and 34.4% of respondents thought that RAS is more precise and faster than conventional surgical procedures, respectively, whereas 30.6% feared malfunctioning issues during surgical procedures. Conclusion This public survey among a Middle Eastern population reveals lack of awareness and limited understanding of RAS. However, there was a tendency towards believing that RAS may have potential advantages in terms of better outcomes compared to conventional surgical procedures.
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Affiliation(s)
- Ali Jasem Buabbas
- Department of Community Medicine & Behavioral Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
| | - Saad Aldousari
- Department of Surgery (Urology Division), Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Abrar Abdulmohsen Shehab
- Department of Immunology, Mubarak Alkabeer Hospital, Hawally Health Region, Ministry of Health, Jabriya, Kuwait
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