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Jorgensen LN, Rosenberg J. Comment to: Cost analysis of open versus robot-assisted ventral hernia repair. Hernia 2024:10.1007/s10029-024-03131-8. [PMID: 39177905 DOI: 10.1007/s10029-024-03131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 07/28/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Lars Nannestad Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, DK-2400, Denmark.
| | - Jacob Rosenberg
- Department of Surgery and Cochrane Colorectal Group, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark
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Jaro VZ, Marc K, Bart W, Klaas VDH. Five years of robot-assisted ventral hernia repair: initial experience and surgical outcome. Acta Chir Belg 2024; 124:290-297. [PMID: 38197175 DOI: 10.1080/00015458.2024.2304386] [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: 05/30/2023] [Accepted: 01/06/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Robot-assisted ventral hernia repair (RVHR) has become a feasible alternative for open ventral hernia repair showing fewer postoperative complications and satisfying short-term results. However, long-term results are scarce in current literature. METHODS All consecutive patients who underwent robot-assisted surgery for ventral hernias from June 2018 until February 2023 were included. Patient records were retrospectively reviewed for indication, need for conversion, length of stay (LOS), postoperative complications, and postoperative pain.In addition, long-term (>24 months) results (recurrence, chronic pain, and esthetic satisfaction) were assessed by phone questionnaire. RESULTS In total, 177 patients underwent a robot-assisted ventral hernia repair. Indication for surgery was incisional hernia (N = 109) and primary hernia (N = 68), including 124 cases with abdominal rectus diastasis. A TransAbdominal Retromuscular Umbilical Prosthesis (TARUP) was performed in 138 patients. Robotic Transversus Abdominis Release (TAR) and Extended Totally Extraperitoneal Repair (eTEP) were performed in 20 (11%) and 9 (5%) cases, respectively.Median LOS was 2 days for TARUP and 3.5 days for TAR. Minor complications occurred in 22 patients (16 TARUP, 5 TAR, 1 eTEP). The average pain score on the first postoperative day was 1.8/10. No risk factors for morbidity could be identified by uni- and multivariable analysis.Hernia recurrence developed in four (2%) patients. Chronic pain was reported in two (1%) cases. Seven (4%) patients had esthetic complaints. CONCLUSION Robot-assisted ventral hernia repair is a safe procedure with low postoperative pain and short LOS. Long-term results including recurrence and chronic pain are satisfying.
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Affiliation(s)
- Van Zande Jaro
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Krick Marc
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Willaert Bart
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Van Den Heede Klaas
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
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Henriksen NA, Marckmann M, Christoffersen MW, Jensen KK. Cost analysis of open versus robot-assisted ventral hernia repair - a retrospective cohort study. Hernia 2024:10.1007/s10029-024-03089-7. [PMID: 38922513 DOI: 10.1007/s10029-024-03089-7] [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: 04/03/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Robot-assisted ventral hernia repair is associated with decreased length of stay and lower complication rates compared with open repair, but acquisition and maintenance of the robotic system is costly. The aim of this was study was to compare the procedure-specific cost of robot-assisted and open ventral and incisional hernia repair including cost of procedure-related readmissions and reoperations within 90 days postoperatively. METHODS Single-center retrospective cohort study of 100 patients undergoing robot-assisted ventral hernia. Patients were propensity-score matched 1:1 with 100 patients undergoing open repairs on age, type of hernia (primary/incisional), and horizontal defect size. The primary outcome of the study was the total cost per procedure in Euros including the cost of a robotic approach, extra ports, mesh, tackers, length of stay, length of readmission, and operative reintervention. The cost of the robot itself was not included in the cost calculation. RESULTS The mean length of stay was 0.3 days for patients undergoing robot-assisted ventral hernia repair, which was significantly shorter compared with 2.1 days for patients undergoing open repair, P < 0.005. The readmission rate was 4% for patients undergoing robot-assisted ventral hernia repairs and was significantly lower compared with open repairs (17%), P = 0.006. The mean total cost of all robot-assisted ventral and incisional hernia repairs was 1,094 euro compared with 1,483 euro for open repairs, P = 0.123. The total cost of a robot-assisted incisional hernia repair was significantly lower (1,134 euros) compared with open ventral hernia repair (2,169 euros), P = 0.005. CONCLUSIONS In a Danish cohort of patients with incisional hernia, robot-assisted incisional hernia repair was more cost-effective than an open repair due to shortened length of stay, and lower rates of readmission and reintervention within 90 days.
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Affiliation(s)
- Nadia A Henriksen
- Dept. of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, DK-2730, Denmark.
| | - Mads Marckmann
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Kristian K Jensen
- Dept. of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
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4
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Fry BT, Howard RA, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Surgical Approach and Long-Term Recurrence After Ventral Hernia Repair. JAMA Surg 2024:2820075. [PMID: 38865153 PMCID: PMC11170458 DOI: 10.1001/jamasurg.2024.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 06/13/2024]
Abstract
Importance The prevalence of robotic-assisted anterior abdominal wall (ventral) hernia repair has increased dramatically in recent years, despite conflicting evidence of patient benefit. Whether long-term hernia recurrence rates following robotic-assisted repairs are lower than rates following more established laparoscopic or open approaches remains unclear. Objective To evaluate the association between robotic-assisted, laparoscopic, and open approaches to ventral hernia repair and long-term operative hernia recurrence. Design, Setting, and Participants Secondary retrospective cohort analysis using Medicare claims data examining adults 18 years and older who underwent elective inpatient ventral, incisional, or umbilical hernia repair from January 1, 2010, to December 31, 2020. Data analysis was performed from January 2023 through March 2024. Exposure Operative approach to ventral hernia repair, which included robotic-assisted, laparoscopic, and open approaches. Main Outcomes and Measures The primary outcome was operative hernia recurrence for up to 10 years after initial hernia repair. To help account for potential bias from unmeasured patient factors (eg, hernia size), an instrumental variable analysis was performed using regional variation in the adoption of robotic-assisted hernia repair over time as the instrument. Cox proportional hazards modeling was used to estimate the risk-adjusted cumulative incidence of operative recurrence up to 10 years after the initial procedure, controlling for factors such as patient age, sex, race and ethnicity, comorbidities, and hernia subtype (ventral/incisional or umbilical). Results A total of 161 415 patients were included in the study; mean (SD) patient age was 69 (10.8) years and 67 592 patients (41.9%) were male. From 2010 to 2020, the proportion of robotic-assisted procedures increased from 2.1% (415 of 20 184) to 21.9% (1737 of 7945), while the proportion of laparoscopic procedures decreased from 23.8% (4799 of 20 184) to 11.9% (946 of 7945) and of open procedures decreased from 74.2% (14 970 of 20 184) to 66.2% (5262 of 7945). Patients undergoing robotic-assisted hernia repair had a higher 10-year risk-adjusted cumulative incidence of operative recurrence (13.43%; 95% CI, 13.36%-13.50%) compared with both laparoscopic (12.33%; 95% CI, 12.30%-12.37%; HR, 0.78; 95% CI, 0.62-0.94) and open (12.74%; 95% CI, 12.71%-12.78%; HR, 0.81; 95% CI, 0.64-0.97) approaches. These trends were directionally consistent regardless of surgeon procedure volume. Conclusions and Relevance This study found that the rate of long-term operative recurrence was higher for patients undergoing robotic-assisted ventral hernia repair compared with laparoscopic and open approaches. This suggests that narrowing clinical applications and evaluating the specific advantages and disadvantages of each approach may improve patient outcomes following ventral hernia repairs.
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Affiliation(s)
- Brian T. Fry
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
| | - Ryan A. Howard
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
| | - Jyothi R. Thumma
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
| | - Edward C. Norton
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan, Ann Arbor
- Department of Economics, University of Michigan, Ann Arbor
| | - Justin B. Dimick
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
- Surgical Innovation Editor, JAMA Surgery
| | - Kyle H. Sheetz
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
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Sabbatini F, La Regina D, Murgante Testa N, Senatore AM, Saporito A, Pini R, Mongelli F. Hospital costs of robotic-assisted and open treatment of large ventral hernias. Sci Rep 2024; 14:11523. [PMID: 38769410 PMCID: PMC11106311 DOI: 10.1038/s41598-024-62550-w] [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: 02/21/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024] Open
Abstract
Robotic-assisted treatment of ventral hernia offers many advantages, however, studies reported higher costs for robotic surgery compared to other surgical techniques. We aimed at comparing hospital costs in patients undergoing large ventral hernia repair with either robotic or open surgery. We searched from a prospectively maintained database patients who underwent robotic or open surgery for the treatment of the large ventral hernias from January 2016 to December 2022. The primary endpoint was to assess costs in both groups. For eligible patients, data was extracted and analyzed using a propensity score-matching. Sixty-seven patients were retrieved from our database. Thirty-four underwent robotic-assisted surgery and 33 open surgery. Mean age was 66.4 ± 4.1 years, 50% of patients were male. After a propensity score-matching, a similar total cost of EUR 18,297 ± 8,435 vs. 18,024 ± 7514 (p = 0.913) in robotic-assisted and open surgery groups was noted. Direct and indirect costs were similar in both groups. Robotic surgery showed higher operatory theatre-related costs (EUR 7532 ± 2,091 vs. 3351 ± 1872, p < 0.001), which were compensated by shorter hospital stay-related costs (EUR 4265 ± 4366 vs. 7373 ± 4698, p = 0.032). In the treatment of large ventral hernia, robotic surgery had higher operatory theatre-related costs, however, they were fully compensated by shorter hospital stays and resulting in similar total costs.
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Affiliation(s)
- Flaminia Sabbatini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland
| | - Nicole Murgante Testa
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Anna Maria Senatore
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland.
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Carter J, Ahamed F, Juprasert J, Anderson M, Lin M, Lebares C, Soriano I. Robotic repair of moderate-sized midline ventral hernias reduced complications, readmissions, and length of hospitalization compared to open techniques. J Robot Surg 2024; 18:142. [PMID: 38554231 DOI: 10.1007/s11701-024-01909-7] [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: 02/08/2024] [Accepted: 03/09/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias. METHODS From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3-10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien-Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications. RESULTS Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17, = 0.049). In regression models, only open technique predicted complications. CONCLUSIONS Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
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Affiliation(s)
- Jonathan Carter
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA.
| | - Fayyaz Ahamed
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Jackly Juprasert
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Mark Anderson
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Matthew Lin
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Carter Lebares
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Ian Soriano
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
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Mokhtari L, Hosseinzadeh F, Nourazarian A. Biochemical implications of robotic surgery: a new frontier in the operating room. J Robot Surg 2024; 18:91. [PMID: 38401027 DOI: 10.1007/s11701-024-01861-6] [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: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.
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Affiliation(s)
- Leila Mokhtari
- Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran.
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Mikhail AR, Daniels L, Cobb D, Kawji Y, Issa C, Danos DM, LeBlanc K. Robotic hernia repair: the trainee "Drag" factor-a single-surgeon 9-year experience. Hernia 2024; 28:241-247. [PMID: 38123830 DOI: 10.1007/s10029-023-02935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The use of robotic assisted surgery is increasing but training residents in its use may be associated with increased operative time and cost. The objective of this study is to compare the operative time of robotic incisional/ventral hernia repair (RIVHR) and robotic inguinal hernia repair (RIHR) when performed with and without a resident or fellow trainee. METHODS A review of prospectively collected data was performed on all patients who underwent RIVHR and RIHR by a single surgeon over a 9-year period (2014-2023). Study variables included presence of trainee (resident or fellow), procedure time, console time, and recurrent hernia. Primary outcomes include procedure time and console time. RESULTS A total of 402 surgeries were included for analysis. Residents assisted in 190 (47%) of the procedures, while fellows assisted in 97 (24%), and 115 (29%) were performed without a trainee. Median (IQR) console times in RIVHR assisted by fellows was 102 (72-145) minutes, compared to 90 (71-129) minutes among surgeries assisted by residents and 65 (52-82) minutes among surgeries performed without a trainee (p < 0.0001), a similar trend was observed for RIHR. The duration of hernia repair assisted by trainees was significantly longer than surgeries performed without a trainee. CONCLUSION Operative time for RIVHR and RIHR is significantly lower when performed without a trainee. However, RIHR assisted by residents showed a consistent decrease in operative time over the 9-year period.
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Affiliation(s)
- A R Mikhail
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA.
| | - L Daniels
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
| | - D Cobb
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
| | - Y Kawji
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
| | - C Issa
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
| | - D M Danos
- School of Public, Health Louisiana State University, 3rd Floor, 2020 Gravier St, New Orleans, LA, 70112, USA
| | - K LeBlanc
- Department of Surgery, Louisiana State University Health Science Center, Room 8105, 8th Floor, 2021 Perdido St, New Orleans, LA, 70112, USA
- Surgeons Group of Baton Rouge, Franciscan Health Physicians, 7777 Hennessy Blvd Ste 612, Baton Rouge, LA, 70808, USA
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Henriksen NA, Helgstrand F, Jensen KK. Short-term outcomes after open versus robot-assisted repair of ventral hernias: a nationwide database study. Hernia 2024; 28:233-240. [PMID: 38036692 PMCID: PMC10891222 DOI: 10.1007/s10029-023-02923-8] [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: 08/03/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE The robotic platform is widely implemented; however, evidence evaluating outcomes of robotic ventral hernia repair is still lacking. The aim of the study was to evaluate the short-term outcomes after open and robot-assisted repair of primary ventral and incisional hernias. METHODS Nationwide register-based cohort study with data from the Danish Ventral Hernia Database and the National Danish Patients Registry was from January 1, 2017 to August 22, 2022. Robot-assisted ventral hernia repairs were propensity score matched 1:3 with open repairs according to the confounding variables defect size, Charlson comorbidity index score, and age. Logistic regression analyses were performed for factors associated with length of stay > 2 days, readmission, and reoperation within 90 days. RESULTS A total of 528 and 1521 patients underwent robot-assisted and open repair, respectively. The mean length of hospital stay in days was 0.5 versus 2.1 for robot-assisted and open approach, respectively (P < 0.001) and open approach was correlated with risk of length of stay > 2 days (OR 23.25, CI 13.80-39.17, P < 0.001). The incidence of readmission within 90 days of discharge was significantly lower after robot-assisted repair compared to open approach (6.2% vs. 12.1%, P < 0.001). Open approach was independently associated with increased risk of readmission (OR 21.43, CI 13.28-39.17, P = 0.005, P < 0.001). CONCLUSION Robot-assisted ventral hernia repair is safe and feasible and associated with shorter length of stay and decreased risk of readmission compared with open ventral hernia repair.
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Affiliation(s)
- N A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - K K Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
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Aponte-Ortiz JA, Mayorga Pérez I, Alamo Irizarry L, Rosado Rivera JM, Romero Gines JE, Pelet-Mejías J. Bilateral Spigelian Hernias Robotic Repair: A Novel Approach to a Rare Surgical Entity. JSLS 2024; 28:e2023.00055. [PMID: 38562951 PMCID: PMC10984373 DOI: 10.4293/jsls.2023.00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Spigelian hernias are an uncommon protrusion defect noted between the rectus abdominis and the transversus abdominis muscles, at the semilunar line, with a low incidence of approximately 0.12% to 2% of all ventral hernias. Furthermore, the incidence of bilateral cases is noted to be even lower in the general population. They are associated with bowel incarceration and strangulation; hence surgical repair is indicated. Therapeutic alternatives for Spigelian hernias include open repair, however laparoscopic repair stands as the standard of care in these cases. Feasible and successful robotic repair has been reported, with associated advantages in terms of visualization and surgical instrument dexterity. We present the first ever reported cases of bilateral Spigelian hernias repaired using robotic approach. Two female Puerto Rican patients referred to our institution complaining of abdominal pain, where imaging studies found bilateral Spigelian hernias. In both cases, a transabdominal preperitoneal repair was performed using the Da Vinci Surgical System. Both patients were discharged home tolerating oral intake with adequate wound healing. On follow up visits, patients denied abdominal discomfort and had adequate wound healing. Robotic surgery for Spigelian hernias poses an advantage over laparoscopic repair as improved visualization, mobility, and precision in movements allow for more gentle tissue manipulation. Furthermore, this is the first evidence of safe and effective repair in the uncommon entity of bilateral cases, providing a newer alternative in the setting of such presentation.
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Affiliation(s)
- Jaime A Aponte-Ortiz
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
| | - Isabel Mayorga Pérez
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
| | - Luis Alamo Irizarry
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
| | - Josean M Rosado Rivera
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
| | - Jose E Romero Gines
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
| | - Jorge Pelet-Mejías
- University of Puerto Rico School of Medicine. (Drs. Aponte-Ortiz, Mayorga Pérez, Alamo Irizarry, and Pelet-Mejías)
- University of Health Sciences Antigua. (Dr. Rosado Rivera)
- University of Medicine and Health Sciences, St. Kitts & Nevis . (Dr. Romero Gines)
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de'Angelis N, Schena CA, Moszkowicz D, Kuperas C, Fara R, Gaujoux S, Gillion JF, Gronnier C, Loriau J, Mathonnet M, Oberlin O, Perez M, Renard Y, Romain B, Passot G, Pessaux P. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc 2024; 38:24-46. [PMID: 37985490 DOI: 10.1007/s00464-023-10545-5] [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: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. METHODS PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. RESULTS Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95 mL), shorter LOS (- 3.4 day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. CONCLUSION These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
- Faculty of Medicine, University of Paris Cité, Paris, France.
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| | - David Moszkowicz
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
| | | | - Régis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Muriel Mathonnet
- Department of General, Endocrine and Digestive Surgery, University Hospital of Limoges, Limoges, France
| | - Olivier Oberlin
- Service de Chirurgie, Groupe Hospitalier Privé Ambroise-Paré - Hartmann, Paris, France
| | - Manuela Perez
- Département de chirurgie viscérale, métabolique et cancérologie (CVMC), CHRU de Nancy-hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Yohann Renard
- Departement of General Surgery, Reims Champagne-Ardenne University, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Passot
- Department of Surgical Oncology, Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Patrick Pessaux
- Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
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Peng Y, Liu Y, Lai S, Li Y, Lin Z, Hao L, Dong J, Li X, Huang K. Global trends and prospects in health economics of robotic surgery: a bibliometric analysis. Int J Surg 2023; 109:3896-3904. [PMID: 37720937 PMCID: PMC10720792 DOI: 10.1097/js9.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Over 10 million robotic surgeries have been performed. However, the cost and benefit of robotic surgery need to be evaluated to help hospitals, surgeons, patients, and payers make proper choices, making a health economic analysis necessary. The authors revealed the bibliometric profile in the field of health economics of robotic surgery to prompt research development and guide future studies. MATERIALS AND METHODS The Web of Science Core Collection scientific database was searched for documents indexed from 2003 to 31 December 2022. Document types, years, authors, countries, institutions, journal sources, references, and keywords were analyzed and visualized using the Bibliometrix package, WPS Office software, Microsoft PowerPoint 2019, VOSviewer software (version 1.6.18), ggplot2, and Scimago Graphica. RESULTS The development of the health economics of robotic surgery can be divided into three phases: slow-growing (2003-2009), developing (2010-2018), and fast-developing (2019-2022). J.C.H. and S.L.C. were the most active and influential authors, respectively. The USA produced the most documents, followed by China, and Italy. Korea had the highest number of citations per document. Surgical Endoscopy and Other Interventional Techniques accepted most documents, whereas Annals of Surgery, European Urology, and Journal of Minimally Invasive Gynecology had the highest number of citations per document. The Journal of Robotic Surgery is promising. The most-cited document in this field is New Technology and Health Care Costs - The Case of Robot-Assisted Surgery in 2010. The proportion of documents on urology is decreasing, while documents in the field of arthrology are emerging and flourishing. CONCLUSION Research on the health economics of robotic surgery has been unbalanced. Areas awaiting exploration have been identified. Collaboration between scholars and coverage with provisions for evidence development by the government is needed to learn more comprehensively about the health economics of robotic surgery.
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Affiliation(s)
- Yihao Peng
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yuancheng Liu
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Sicen Lai
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yixin Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Zexu Lin
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Lingjia Hao
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Jingyi Dong
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Xu Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Kai Huang
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
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13
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Plitzko GA, Stüben BO, Giannou A, Reeh M, Izbicki JR, Melling N, Tachezy M. Robotic-assisted repair of incisional hernia-early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS). Langenbecks Arch Surg 2023; 408:396. [PMID: 37821644 PMCID: PMC10567888 DOI: 10.1007/s00423-023-03129-3] [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: 12/15/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE With robotic surgical devices, an innovative tool has stepped into the arena of minimally invasive hernia surgery. It combines the advantages of open (low recurrence rates and ability to perform complex procedure such as transverse abdominis release) and laparoscopic surgery (low rate of wound and mesh infections, less pain). However, a superiority to standard minimally invasive procedures has not yet been proven. We present our first experiences of robotic mesh repair of incisional hernias and a comparison of our results with open and minimally invasive sublay techniques. METHODS A retrospective analysis of all patients who underwent robotic-assisted mesh repair (RAHR) for incisional hernia between April and November 2022 (RAHR group) and patients who underwent open sublay (Sublay group) or eMILOS hernia repair (eMILOS group) between January 2018 and November 2022 was carried out. Patients in the RAHR group were matched 1:2 to patients in the Sublay group by propensity score matching. Patient demographics, preoperative hernia characteristics and cause of hernia, intraoperative variables, and postoperative outcomes were evaluated. Furthermore, a subgroup analysis of only midline hernia was performed. RESULTS A total of 21 patients received robotic-assisted incisional hernia repair. Procedures performed included robotic retro-muscular hernia repair (r-RMHR, 76%), with transverse abdominis release in 56% of the cases. In one patient, r-RHMR was combined with robotic inguinal hernia repair. Two patients (10%) were operated with total extraperitoneal technique (eTEP). Robotic-assisted transabdominal preperitoneal hernia repair (r-TAPP) was performed in three patients (14%). Median (range) operating time in the RAHR group was significantly longer than in the sublay and eMILOS group (291 (122-311) vs. 109.5 (48-270) min vs. 123 (100-192) min, respectively, p < 0.001). The meshes applied in the RAHR group were significantly compared to the sublay (mean (SD) 529 ± 311 cm2 vs. 356 ± 231, p = 0.037), but without a difference compared to the eMILOS group (mean (SD) 596 ± 266 cm2). Median (range) length of hospital stay in the RAHR group was significantly shorter compared to the Sublay group (3 (2-7) vs. 5 (1-9) days, p = 0.032), but not significantly different to the eMILOS group. In short term follow-up, no hernia recurrence was observed in the RAHR and eMILOS group, with 9% in the Sublay group. The subgroup analysis of midline hernia revealed very similar results. CONCLUSION Our data show a promising outcome after robotic-assisted incisional hernia repair, but no superiority compared to the eMILOS technique. However, RAHR is a promising technique especially for complex hernia in patients with relevant risk factors, especially immunosuppression. Longer follow-up times are needed to accurately assess recurrence rates, and large prospective trials are needed to show superiority of robotic compared to standard open and minimally invasive hernia repair.
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Affiliation(s)
- Gabriel A Plitzko
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Björn-Ole Stüben
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Anastasios Giannou
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany.
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14
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Maskal S, Beffa L. The Role of Robotics in Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:977-991. [PMID: 37709400 DOI: 10.1016/j.suc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Robotic abdominal wall reconstruction is becoming an accepted technique to approach complex hernias in a minimally invasive fashion. There remain a deficit of high-quality data to suggest significant clinical benefit but current randomized trials are ongoing. Robotic surgery can be applied to a range of abdominal wall defects safely and with positive outcomes which are at least equivocal to open abdominal wall techniques.
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Affiliation(s)
- Sara Maskal
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lucas Beffa
- Lerner College of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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15
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Patient-reported outcomes of laparoscopic versus robotic primary ventral and incisional hernia repair: a systematic review and meta-analysis. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2023; 27:245-257. [PMID: 36607459 DOI: 10.1007/s10029-022-02733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's. METHODS A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE. RESULTS Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission. CONCLUSION The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.
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16
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Cost analysis of training residents in robotic-assisted surgery. Surg Endosc 2022; 37:2765-2769. [PMID: 36471060 DOI: 10.1007/s00464-022-09794-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Use of robotic-assisted surgery is increasing, and resident involvement may lead to higher costs. We investigated whether senior resident involvement in noncomplex robotic cholecystectomy (RC) and inguinal hernia (RIH) would take more time and cost more when compared to non-robotic cholecystectomy (NRC) and inguinal hernia repair (NRIH). METHODS We extracted surgery duration and total cost of NRC, NRIH, RC, and RIH from 7/2016 to 6/2020 with senior resident (PGY4-5) involvement. We excluded complex cases as well as prisoner cases and those with new faculty and research residents. We assessed differences between robotic and non-robotic cases in surgery duration and total cost per minute, using one-way ANOVA. RESULTS We included 1608 cases (non-robotic 1145 vs. robotic 463). On average, RC cases with a senior resident took less time than NRC (179.4 < 185.8, p = 0.401); surgery duration of RIH cases was similar with NRIH cases. The total cost per minute of RC cases with a senior resident on average was $9.30 higher than NRC cases for each minute incurred in the operating room but did not lead to a significant change in overall cost. RIH cases, on the other hand, cost less per minute than NRIH cases (114.1 < 126.5, p = 0.399). CONCLUSION Training in robotic surgery is important. Noncomplex RC and RIH involving senior residents were not significantly longer nor did they incur significantly more cost than non-robotic procedures. Senior resident training in noncomplex robotic surgery can be efficient and can be included in the residency curriculum.
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Mederos MA, Jacob RL, Ward R, Shenoy R, Gibbons MM, Girgis MD, Kansagara D, Hynes D, Shekelle PG, Kondo K. Trends in Robot-Assisted Procedures for General Surgery in the Veterans Health Administration. J Surg Res 2022; 279:788-795. [PMID: 35970011 DOI: 10.1016/j.jss.2022.06.055] [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: 04/13/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Implementation of robot-assisted procedures is growing. Utilization within the country's largest healthcare network, the Veterans Health Administration, is unclear. METHODS A retrospective cohort study using data from the Department of Veterans Affairs Corporate Data Warehouse from January 2015 through December 2019. Trends in robot utilization for cholecystectomy, ventral hernia repair, and inguinal hernia repair were characterized nationally and regionally by Veterans Integrated Services Network. Patients, who underwent laparoscopic repairs for these procedures and open hernia repairs, were included to determine proportion performed robotically. RESULTS We identified 119,191 patients, of which 5689 (4.77%) received a robotic operation. The proportion of operations performed robotically increased from 1.49% to 10.55% (7.08-fold change; slope, 2.14% per year; 95% confidence interval [0.79%, 3.49%]). Ventral hernia repair had the largest growth in robotic procedures (1.51% to 13.94%; 9.23-fold change; slope, 2.86% per year; 95% confidence interval [1.04%, 4.68%]). Regions with the largest increase in robotic utilization were primarily along the Northeast, Midwest, and West Coast. CONCLUSIONS Robot utilization in general surgery is increasing at different rates across the United States in the Veterans Health Administration. Future studies should investigate the regional disparities and drivers of this approach.
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Affiliation(s)
- Michael A Mederos
- Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California.
| | - R Lorie Jacob
- Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Rachel Ward
- Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon
| | - Rivfka Shenoy
- Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California
| | - Melinda M Gibbons
- Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California
| | - Mark D Girgis
- Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California
| | - Devan Kansagara
- Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Department of Medical Informatics & Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Denise Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; College of Public Health and Human Services, Oregon State University, Corvallis, Oregon
| | - Paul G Shekelle
- Evidence Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, California
| | - Karli Kondo
- Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Research Integrity Office, Oregon Health and Science University, Portland, Oregon; Department of Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia
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