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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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2
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Steffens D, McBride KE, Hirst N, Solomon MJ, Anderson T, Thanigasalam R, Leslie S, Karunaratne S, Bannon PG. Surgical outcomes and cost analysis of a multi-specialty robotic-assisted surgery caseload in the Australian public health system. J Robot Surg 2023; 17:2237-2245. [PMID: 37289337 PMCID: PMC10492768 DOI: 10.1007/s11701-023-01643-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
This study aims to compare surgical outcomes and in-hospital cost between robotic-assisted surgery (RAS), laparoscopic and open approaches for benign gynaecology, colorectal and urological patients and to explore the association between cost and surgical complexity. This retrospective cohort study included consecutive patients undergoing RAS, laparoscopic or open surgery for benign gynaecology, colorectal or urological conditions between July 2018 and June 2021 at a major public hospital in Sydney. Patients' characteristics, surgical outcomes and in-hospital cost variables were extracted from the hospital medical records using routinely collected diagnosis-related groups (DRG) codes. Comparison of the outcomes within each surgical discipline and according to surgical complexity were performed using non-parametric statistics. Of the 1,271 patients included, 756 underwent benign gynaecology (54 robotic, 652 laparoscopic, 50 open), 233 colorectal (49 robotic, 123 laparoscopic, 61 open) and 282 urological surgeries (184 robotic, 12 laparoscopic, 86 open). Patients undergoing minimally invasive surgery (robotic or laparoscopic) presented with a significantly shorter length of hospital stay when compared to open surgical approach (P < 0.001). Rates of postoperative morbidity were significantly lower in robotic colorectal and urological procedures when compared to laparoscopic and open approaches. The total in-hospital cost of robotic benign gynaecology, colorectal and urological surgeries were significantly higher than other surgical approaches, independent of the surgical complexity. RAS resulted in better surgical outcomes, especially when compared to open surgery in patients presenting with benign gynaecology, colorectal and urological diseases. However, the total cost of RAS was higher than laparoscopic and open surgical approaches.
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Affiliation(s)
- Daniel Steffens
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia.
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Hirst
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Teresa Anderson
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sascha Karunaratne
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul G Bannon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- The Baird Institute, Sydney, NSW, Australia
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Vieira BB, da Cunha Reis A, de Paiva Loures A, Plácido ECR, de Sousa FF. An Integrated Cost Model Based on Real Patient Flow: Exploring Surgical Hospitalization. Healthcare (Basel) 2022; 10:healthcare10081458. [PMID: 36011115 PMCID: PMC9407941 DOI: 10.3390/healthcare10081458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Considering the gap observed in studies on health costs, this article aims to propose a cost calculation model for surgical hospitalization. A systematic literature review using PRISMA was conducted to map cost drivers adopted in similar studies and provide theoretical background. Based on the review, an integrated model considering real patient flow was developed using CHEERS guidelines. The micro-costing top-down method was adopted to develop the cost model allowing a balance between the accuracy of the information and the feasibility of the cost estimate. The proposed model fills two gaps in the literature: the standardization of a cost model and the ability to assess a vast number of different surgery costs in the same hospital. Flexibility stands out as an important advantage of the proposed model, as its application enables evaluation of elective and urgent surgeries of medium and high complexity performed in public and private hospitals. As a limitation, the hospital should have hospital information and cost systems implemented. The proposed cost model can provide important information that can result in better decision making. This becomes more relevant in public health, especially in low- and middle-income countries, which faces a lack of resources and whose positive effects can improve healthcare.
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Affiliation(s)
- Bruno Barbosa Vieira
- Production Engineering Department, Federal Center for Technological Education Celso Suckow da Fonseca-CEFET-RJ, Rio de Janeiro 20271-110, Brazil;
- Juiz de Fora Federal University Hospital—HU-UFJF, Juiz de Fora Federal University—UFJF, Juiz de Fora 36036-110, Brazil; (A.d.P.L.); (E.C.R.P.); (F.F.d.S.)
- Correspondence:
| | - Augusto da Cunha Reis
- Production Engineering Department, Federal Center for Technological Education Celso Suckow da Fonseca-CEFET-RJ, Rio de Janeiro 20271-110, Brazil;
| | - Alan de Paiva Loures
- Juiz de Fora Federal University Hospital—HU-UFJF, Juiz de Fora Federal University—UFJF, Juiz de Fora 36036-110, Brazil; (A.d.P.L.); (E.C.R.P.); (F.F.d.S.)
| | - Eliel Carlos Rosa Plácido
- Juiz de Fora Federal University Hospital—HU-UFJF, Juiz de Fora Federal University—UFJF, Juiz de Fora 36036-110, Brazil; (A.d.P.L.); (E.C.R.P.); (F.F.d.S.)
| | - Fernanda Ferreira de Sousa
- Juiz de Fora Federal University Hospital—HU-UFJF, Juiz de Fora Federal University—UFJF, Juiz de Fora 36036-110, Brazil; (A.d.P.L.); (E.C.R.P.); (F.F.d.S.)
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Tanhaeivash R, Grimm MO. Factors Affecting Transperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2021; 32:781-786. [PMID: 34962160 DOI: 10.1089/lap.2021.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of robot-assisted radical prostatectomy (RARP) and lymph node (LN) involvement. Methods: A total number of 225 consecutive patients were included in the study who underwent transperitoneal RARP by 1 surgeon. We defined the following parameters as dependent variables: duration of prostatectomy, duration of pelvic lymphadenectomy, incision to suture time, console time, number of dissected LNs and number of positive LNs for metastasis. We assessed the impact of the following covariates using univariate nonparametric and multivariate analysis: BMI, preoperative D'Amico risk classification, history of inguinal herniotomy, and previous abdominal operations. Results: We observed a statistically significant difference among our three BMI groups (<25, ≥25 and <30, and ≥30 kg/m2) regarding pelvic lymphadenectomy and LN metastasis. Moreover, among the three risk groups (low, intermediate, and high) duration of prostatectomy, pelvic lymphadenectomy, and LN metastasis were statistically different. Previous abdominal operations have been also demonstrated to significantly influence the pelvic lymphadenectomy. In addition, our multivariate model proved the impact of our covariates on pelvic lymphadenectomy. Conclusions: Our findings highlight the impact of BMI and preoperative risk on various steps of RARP. We revealed longer duration of pelvic lymphadenectomy and more nodal yield in patients with higher BMI and high-risk disease. Therefore, we suggest that BMI and risk classification according to D'Amico should be taken into account while a RARP is being planned.
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Affiliation(s)
- Roozbeh Tanhaeivash
- Department of Urology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
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Okhawere KE, Shih IF, Lee SH, Li Y, Wong JA, Badani KK. Comparison of 1-Year Health Care Costs and Use Associated With Open vs Robotic-Assisted Radical Prostatectomy. JAMA Netw Open 2021; 4:e212265. [PMID: 33749767 PMCID: PMC7985723 DOI: 10.1001/jamanetworkopen.2021.2265] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE With the current patterns of adoption and use of robotic surgery and improvement in the overall survival of patients with prostate cancer, it is important to evaluate the immediate and long-term cost implications of treatments for patients with prostate cancer. OBJECTIVE To compare health care costs and use 1 year after open radical prostatectomy (ORP) vs robotic-assisted radical prostatectomy (RARP). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a US commercial claims database from January 1, 2013, to December 31, 2018. A total of 11 457 men aged 18 to 64 years who underwent inpatient radical prostatectomy for prostate cancer and were continuously enrolled with medical and prescription drug coverage from 180 days before to 365 days after inpatient prostatectomy were identified. An inverse probability of treatment weighting analysis was performed to examine the differences in costs and use of health care services by surgical modality. Data analysis was conducted from September 2019 to July 2020. EXPOSURES Type of surgical procedure: ORP vs RARP. MAIN OUTCOMES AND MEASURES Three outcomes within 1 year after the inpatient prostatectomy were investigated: (1) total health care costs, including reimbursement paid by insurers and out of pocket by patients; (2) health care use, including inpatient readmission, emergency department, hospital outpatient, and office visits; and (3) estimated days missed from work due to health care use. RESULTS Of the 11 457 patients who underwent inpatient prostatectomy, 1604 (14.0%) had ORP and 9853 (86.0%) had RARP and most patients (8467 [73.9%]) were aged 55 to 64 years. Compared with patients who underwent ORP, those who received RARP had a higher cost at the index hospitalization (mean difference, $2367; 95% CI, $1821-$2914; P < .001), but similar total cumulative costs were observed within 180 days (mean difference, $397; 95% CI, -$582 to $1375; P = .43) and 1 year after discharge (-$383; 95% CI, -$1802 to $1037; P = .60). One-year postdischarge health care use was significantly lower in the RARP compared with ORP group for mean numbers of emergency department visits (-0.09 visits; 95% CI, -0.11 to -0.07 visits; P < .001) and hospital outpatient visits (-1.5 visits; -1.63 to -1.36 visits; P < .001). The reduction in use of health care services among patients who underwent RARP translated into additional savings of $2929 (95% CI, $1600-$4257; P < .001) and approximately 1.69 fewer days (95% CI, 1.49-1.89 days; P < .001) missed from work for health care visits. CONCLUSIONS AND RELEVANCE Total cumulative cost in this study was similar between ORP and RARP 1 year post discharge; this finding suggests that lower postdischarge health care use after RARP may offset the higher costs during the index hospitalization.
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Affiliation(s)
- Kennedy E. Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - I-Fan Shih
- Intuitive Surgical Inc, Sunnyvale, California
| | | | - Yanli Li
- Intuitive Surgical Inc, Sunnyvale, California
| | - Jaime A. Wong
- Intuitive Surgical Inc, Sunnyvale, California
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Ketan K. Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
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de Oliveira RAR, Guimarães GC, Mourão TC, de Lima Favaretto R, Santana TBM, Lopes A, de Cassio Zequi S. Cost-effectiveness analysis of robotic-assisted versus retropubic radical prostatectomy: a single cancer center experience. J Robot Surg 2021; 15:859-868. [PMID: 33417155 DOI: 10.1007/s11701-020-01179-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Prostate cancer (PCa) treatment has been greatly impacted by the robotic surgery. The economics literature about PCa is scarce. We aim to carry-out cost-effectiveness and cost-utility analyses of the robotic-assisted radical prostatectomy (RALP) using the "time-driven activity-based cost" methodology. Patients who underwent radical prostatectomy in 2013 were retrospectively analyzed in a cancer center over a 5-year period. Fifty-six patients underwent RALP and 149 patients underwent retropubic radical prostatectomy (RRP). The amounts were subject to a 5% discount as correction of monetary value considering time elapsed. Calculation of the Incremental Cost-Effectiveness Ratios (ICER) related to events avoided and the Incremental Cost-Utility Ratio (ICUR) related to "QALY saved" were performed. QALY was performed using values of utility and "disutility" weights from the "Cost-Effectiveness Analysis Registry". Hypothetical cohorts were simulated with 1000 patients in each group, based on the treatment outcomes. Total and average costs were R$1,903,671.93, and R$12,776.32 for the RRP group, and R$1,373,987.26, and R$24,535.49 for the RALP group, respectively. The costs to treat the hypothetical cohorts were R$10,010,582.35 for RRP, and R$19,224,195.90 for RALP. ICER calculation evidenced R$9,213,613.55 of difference between groups. ICUR was R$ 22,690.83 per QALY saved. Limitations were the lack of cost-effectiveness analyses related to re-hospitalization rates and complications, single center perspective, and currency-translation differences. Medical fees were not included. RALP showed advantages in cost-effectiveness and cost-utility over RRP in the long term. Despite the increased costs to the introduction of robotic technology, its adoption should be encouraged due to the gains.
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Affiliation(s)
- Renato Almeida Rosa de Oliveira
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.,ACCamargo Cancer Center, Urology Division, São Paulo, Brazil
| | | | - Thiago Camelo Mourão
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.
| | - Ricardo de Lima Favaretto
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil
| | - Thiago Borges Marques Santana
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, Rua Martiniano de Carvalho, 965, São Paulo, SP, 01323-030, Brazil.,ACCamargo Cancer Center, Urology Division, São Paulo, Brazil
| | - Ademar Lopes
- Head of Pelvic Surgery Department, ACCamargo Cancer Center, São Paulo, Brazil
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Randell R, Honey S, Alvarado N, Greenhalgh J, Hindmarsh J, Pearman A, Jayne D, Gardner P, Gill A, Kotze A, Dowding D. Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study. BMJ Open 2019; 9:e028635. [PMID: 31203248 PMCID: PMC6589012 DOI: 10.1136/bmjopen-2018-028635] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 05/23/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To capture stakeholders' theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice. DESIGN A literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered. SETTING Nine hospitals in England where robot-assisted surgery is used for colorectal operations. PARTICIPANTS Forty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists. RESULTS Interviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other's knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential. CONCLUSIONS We captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.
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Affiliation(s)
| | - Stephanie Honey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Jon Hindmarsh
- School of Management and Business, Kings College London, London, UK
| | - Alan Pearman
- Centre for Decision Research, University of Leeds, Leeds, UK
| | - David Jayne
- School of Medicine, University of Leeds, Leeds, UK
| | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, UK
| | - Arron Gill
- Geoffrey Giles Theatres, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alwyn Kotze
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, UK
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Connelly TM, Malik Z, Sehgal R, Byrnes G, Coffey JC, Peirce C. The 100 most influential manuscripts in robotic surgery: a bibliometric analysis. J Robot Surg 2019; 14:155-165. [PMID: 30949890 DOI: 10.1007/s11701-019-00956-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
Abstract
Since the first robotic assisted surgery in 1985, the number of procedures performed annually has steadily increased. Bibliometric analysis highlights the key studies that have influenced current practice in a field of interest. We use bibliometric analysis to evaluate the 100 most cited manuscripts on robotic surgery and discuss their content and influence on the evolution of the platform. The terms 'robotic surgery,' 'robot assisted surgery' and 'robot-assisted surgery' were used to search Thomson Reuters Web of Science database for full length, English language manuscripts. The top 100 cited manuscripts were analyzed by manuscript type, surgical specialty, first and last author, institution, year and journal of publication. 14,980 manuscripts were returned. Within the top 100 cited manuscripts, the majority featured urological surgery (n = 28), followed by combined results from multiple surgical subspecialties (n = 15) and colorectal surgery (n = 13). The majority of manuscripts featured case series/reports (n = 42), followed by comparative studies (n = 24). The most cited paper authored by Nelson et al. (432 citations) reviewed technological advances in the field. The year and country with the greatest number of publications were 2009 (n = 15) and the USA (n = 68). The Johns Hopkins University published the most top 100 manuscripts (n = 18). The 100 most cited manuscripts reflect the progression of robotic surgery from a basic instrument-holding platform to today's articulated instruments with 3D technology. From feasibility studies to multicenter trials, this analysis demonstrates how robotic assisted surgery has gained acceptance in urological, colorectal, general, cardiothoracic, orthopedic, maxillofacial and neuro surgery.
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Affiliation(s)
- Tara M Connelly
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
| | - Zoya Malik
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rishabh Sehgal
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Gerrard Byrnes
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - J Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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The Role of Provider Characteristics in the Selection of Surgery or Radiation for Localized Prostate Cancer and Association With Quality of Care Indicators. Am J Clin Oncol 2018; 41:1076-1082. [PMID: 29668486 DOI: 10.1097/coc.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to identify the role of provider and facility characteristics in receipt of radical prostatectomy (RP) or external beam radiation therapy (EBRT) and adherence to quality of care measures in men with localized prostate cancer (PCa). MATERIALS AND METHODS Subjects included 2861 and 1630 men treated with RP or EBRT, respectively, for localized PCa whose records were reabstracted as part of the Centers for Disease Control and Prevention Breast and Prostate Patterns of Care Study. We utilized multivariable generalized estimating equation regression analysis to assess patient, clinical, and provider (year of graduation, urologist density) and facility (group vs. solo, academic/teaching status, for-profit status, distance to treatment facility) characteristics that predicted use of RP versus EBRT as well as quality of care outcomes. RESULTS Multivariable analysis revealed that group (vs. solo) practice was associated with a decreased risk of RP (odds ratio, 0.47; 95% confidence interval, 0.25-0.91). Among RP patients with low-risk disease, receipt of a bone scan that was not recommended was significantly predicted by race and insurance status. Surgical quality of care measures were associated with physician's year of graduation and receiving care at a teaching facility. CONCLUSIONS In addition to demographic factors, we found that provider and facility characteristics were associated with treatment choice and specific quality of care measures. Long-term follow-up is required to determine whether quality of care indicators are related to PCa outcomes.
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Schroeck FR, Jacobs BL, Bhayani SB, Nguyen PL, Penson D, Hu J. Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy. Eur Urol 2017; 72:712-735. [PMID: 28366513 PMCID: PMC5623181 DOI: 10.1016/j.eururo.2017.03.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
CONTEXT Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. OBJECTIVE To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. EVIDENCE ACQUISITION We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. EVIDENCE SYNTHESIS RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer's perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the limited comparative data on outcomes. Using the Grades of Recommendation, Assessment, Development and Evaluation approach, the quality of evidence was low for RARP and IMRT, and very low for proton beam therapy. CONCLUSIONS Treatment with new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective. PATIENT SUMMARY We review the cost and cost effectiveness of robot-assisted radical prostatectomy, intensity-modulated radiotherapy, and proton beam therapy in prostate cancer treatment. These technologies are costlier than their traditional counterparts. It remains unclear whether their use is associated with improved cure and reduced morbidity, and whether the increased cost is worth the expense.
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Affiliation(s)
- Florian Rudolf Schroeck
- White River Junction VA Medical Center, White River Junction, VT, USA; Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sam B Bhayani
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - David Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - Jim Hu
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
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Altok M, Achim MF, Matin SF, Pettaway CA, Chapin BF, Davis JW. A decade of robot-assisted radical prostatectomy training: Time-based metrics and qualitative grading for fellows and residents. Urol Oncol 2017; 36:13.e19-13.e25. [PMID: 28964658 DOI: 10.1016/j.urolonc.2017.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES As modern urology residency and fellowship training in robot-assisted surgery evolves toward standardized curricula (didactics, dry/wet-laboratory exercises, and surgical assistance), additional tools are needed to evaluate on-console performance. At the start of our robotics program in 2006, we set-up a time- and quality-based evaluation program and aim to consolidate this data into a simple set of metrics for self-evaluation. MATERIALS AND METHODS Using our index procedure of robot-assisted radical prostatectomy (RARP), we prospectively collected data on 2,215 cases over 10 years from 6 faculty surgeons and 94 trainees (43 urologic oncology fellows and 51 urology residents). The steps of the operation were divided into 11 consistent steps, and the metrics included time to completion and quality using a 6-level grading system. Time metrics were consolidated into quartiles for benchmarking. RESULTS The median times for trainees to complete each step were 15% to 120% higher than those of the staff (P<0.001). Each step can be presented with quartile-based time metrics by pooled trainee and staff results. Steps performed by trainees were carefully chosen for a high success rate, and on our Likert-like scale were graded 4 to 5 in more than 95% of cases. There were no grade 0 (very poor) cases, and grades 1 (multiple technical errors) and 2 (could not be completed but without safety issues) were rare (<1%). CONCLUSIONS RARP training can be evaluated with a time-based metric that allows a quartile-based comparison to a large experience of trainees and staff. As a trainee progress through a rotation, these benchmarks can assist in prioritizing the need for more attention to a basic step vs. progression to more advanced steps.
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Affiliation(s)
- Muammer Altok
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Mary F Achim
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | | | - Brian F Chapin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - John W Davis
- Department of Urology, MD Anderson Cancer Center, Houston, TX.
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Löppenberg B, Friedlander DF, Krasnova A, Tam A, Leow JJ, Nguyen PL, Barry H, Lipsitz SR, Menon M, Abdollah F, Sammon JD, Sun M, Choueiri TK, Kibel AS, Trinh QD. Variation in the use of active surveillance for low-risk prostate cancer. Cancer 2017; 124:55-64. [DOI: 10.1002/cncr.30983] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/28/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Björn Löppenberg
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - David F. Friedlander
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Anna Krasnova
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Andrew Tam
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | | | - Paul L. Nguyen
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Hawa Barry
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Stuart R. Lipsitz
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Jesse D. Sammon
- Division of Urology and Center for Outcomes Research and Evaluation, Maine Medical Center; Portland Maine
| | - Maxine Sun
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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Randell R, Honey S, Hindmarsh J, Alvarado N, Greenhalgh J, Pearman A, Long A, Cope A, Gill A, Gardner P, Kotze A, Wilkinson D, Jayne D, Croft J, Dowding D. A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BackgroundThe implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice.ObjectivesTo (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS.DesignRealist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings.FindingsThe introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner.ConclusionsOur research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests.LimitationsThis study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed.Future workFuture research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Rebecca Randell
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Stephanie Honey
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jon Hindmarsh
- School of Management & Business, Faculty of Social Science & Public Policy, King’s College London, London, UK
| | - Natasha Alvarado
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Alan Pearman
- Centre for Decision Research, University of Leeds, Leeds, UK
| | - Andrew Long
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alexandra Cope
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Arron Gill
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Gardner
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alwyn Kotze
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - David Jayne
- Leeds Institute of Biomedical & Clinical Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Julie Croft
- Leeds Institute of Clinical Trials Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Dawn Dowding
- School of Nursing, Columbia University Medical Center, Columbia University, New York, NY, USA
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Pentafecta Rates of Three-Dimensional Laparoscopic Radical Prostatectomy: Our Experience after 150 Cases. Urologia 2017; 84:93-97. [DOI: 10.5301/uj.5000239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/27/2023]
Abstract
Introduction Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision. The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature. Methods We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta. Results One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months. Conclusions Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.
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Nowacki M, Nazarewski Ł, Kloskowski T, Tyloch D, Pokrywczyńska M, Pietkun K, Jundziłł A, Tyloch J, Habib SL, Drewa T. Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation. Arch Med Sci 2016; 12:1158-1173. [PMID: 27695507 PMCID: PMC5016594 DOI: 10.5114/aoms.2016.61919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/08/2015] [Indexed: 01/09/2023] Open
Abstract
On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.
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Affiliation(s)
- Maciej Nowacki
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Chair of Surgical Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Łukasz Nazarewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kloskowski
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Dominik Tyloch
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Marta Pokrywczyńska
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Katarzyna Pietkun
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Arkadiusz Jundziłł
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Janusz Tyloch
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Samy L. Habib
- Department of Geriatrics, Geriatric Research, Education, and Clinical Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of General and Oncological Urology, Nicolaus Copernicus Hospital, Torun, Poland
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Bijlani A, Hebert AE, Davitian M, May H, Speers M, Leung R, Mohamed NE, Sacks HS, Tewari A. A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:391-403. [PMID: 27325331 DOI: 10.1016/j.jval.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/23/2015] [Accepted: 12/27/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. OBJECTIVES The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. METHODS We performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. RESULTS Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. CONCLUSIONS Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.
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Affiliation(s)
| | | | - Mike Davitian
- Intuitive Surgical, Sunnyvale, CA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Holly May
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Mark Speers
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Robert Leung
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Nihal E Mohamed
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Henry S Sacks
- Thomas C. Chalmers Clinical Trials Unit, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Mount Sinai Hospital, New York, NY, USA.
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17
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Potretzke AM, Kim EH, Knight BA, Anderson BG, Park AM, Sherburne Figenshau R, Bhayani SB. Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy. J Robot Surg 2016; 10:151-6. [DOI: 10.1007/s11701-016-0588-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
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18
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Abel EJ, Wong K, Sado M, Leverson GE, Patel SR, Downs TM, Jarrard DF. Surgical operative time increases the risk of deep venous thrombosis and pulmonary embolism in robotic prostatectomy. JSLS 2016. [PMID: 24960494 PMCID: PMC4035641 DOI: 10.4293/jsls.2014.00101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: To evaluate the effect of operative time on the risk of symptomatic venous thromboembolic events (VTEs) in patients undergoing robot-assisted radical prostatectomy (RARP). Methods: We reviewed the records of all patients at our institution who underwent RARP by a single surgeon from January 2007 until April 2011. Clinical and pathologic information and VTE incidence were recorded for each patient and analyzed by use of logistic regression to evaluate for association with VTE risk. All patients had mechanical prophylaxis, and beginning in February 2008, a single dose of unfractionated heparin, 5000 U, was administered before surgery. Results: A total of 549 consecutive patients were identified, with a median follow-up period of 8 months. During the initial 30 days postoperatively, 10 patients (1.8%) had a VTE (deep venous thrombosis in 7 and pulmonary embolism in 3). The median operative time was 177 minutes (range, 121–360 minutes). An increase in operative time of 30 or 60 minutes was associated with 1.6 and 2.8 times increased VTE risks. A 5-point increase in body mass index and need for blood transfusion were also associated with increased risk of VTEs (odds ratios of 2.0 and 11.8, respectively). Heparin prophylaxis was not associated with a significant VTE risk reduction but also was not associated with a significant increase in estimated blood loss (P = .23) or transfusion rate (P = .37). Conclusion: A prolonged operative time increases the risk of symptomatic VTEs after RARP. Future studies are needed to evaluate the best VTE prophylactic approach in patients at risk.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705-2281, USA.
| | - Kelvin Wong
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Martins Sado
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glen E Leverson
- Department of Surgery, Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sutchin R Patel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tracy M Downs
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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19
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Reimbursement for Prostate Cancer Treatment. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Perlbarg J, Rabetrano H, Soulié M, Salomon L, Durand-Zaleski I. [Economic evaluation of the treatments of non-metastatic prostate cancer]. Prog Urol 2015; 25:1108-15. [PMID: 26519969 DOI: 10.1016/j.purol.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prostate cancer is the most frequent cancer and the third leading cause of cancer death in men in France. The development of treatment for prostate cancer is fast and sometimes relies on costly innovations. Medico-economic studies are however rare in this area. This literature review aims to summarize available medico-economic data on the initial management of localized prostate cancer and discuss the quality and usability of existing economic studies on the subject. MATERIALS AND METHOD Literature review was done using PubMed and Cochrane databases. Studies and articles were selected based on several criteria: population with initial treatment for localized prostate cancer (without metastasis), comparative studies with surgery as control treatment, studies in countries members of the OECD, articles in English or French published between 2004 and 2014. RESULTS The surgical robot, one of the newest innovations, is more expensive than conventional open surgery or no robotic laparoscopy, even if it is associated with a reduction of the original period of stay. Radiation therapy seems more expensive than surgery as initial therapy of localized prostate cancer. CONCLUSION Conclusions remain limited because of the rarity of reliable health economic studies on the subject.
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Affiliation(s)
- J Perlbarg
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
| | - H Rabetrano
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - I Durand-Zaleski
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
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Gandaglia G, Montorsi F, Karakiewicz PI, Sun M. Robot-assisted radical prostatectomy in prostate cancer. Future Oncol 2015; 11:2767-73. [DOI: 10.2217/fon.15.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
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Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Francesco Montorsi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Maxine Sun
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
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Tandogdu Z, Vale L, Fraser C, Ramsay C. A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:457-67. [PMID: 26239361 DOI: 10.1007/s40258-015-0185-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Robot assisted laparoscopic (RAL) surgery developed to overcome the limitations of laparoscopy to assist in surgical procedures, has high capital and operating costs. Systematically assembled evidence demonstrating its clinical and cost effectiveness would be helpful for its adoption by decision makers. OBJECTIVE To summarise the evidence on the cost-effectiveness of robot-assisted laparoscopic (RAL) surgery compared with relevant alternatives. Methods and results of identified studies were assessed to identify the deficiencies in evidence and areas for further research. METHODS Studies reporting both costs and outcomes for comparisons of RAL with laparoscopy and/or open surgery were systematically identified. Searches were conducted in February 2015 on MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed against a standard checklist for economic analyses. Length of hospital stay and operating time (determinants of cost), cost of intervention, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were extracted. To aid comparison, costs were converted into a common currency and price year (2014 US dollars). RESULTS Forty-seven eligible studies were identified (full economic evaluation n = 6 and cost analysis n = 41). Economic models were used in 11 (23%) studies. Only three studies used a model considered representative of the disease and clinical pathway with a time-horizon allowing capture of relevant differences in outcomes across strategies. The cost of RAL varied substantially between uses, ranging from US$7011 for hysterectomy to over US$30,000 for radical cystectomy. The majority of estimates were between US$15,000 and US$25,000 per person. In part this difference is explained by the difference between studies in which costs were included. It was also identified to have higher costs than the alternatives it was compared against. Incremental cost per QALY for RAL radical prostatectomy was US$28,801-$31,763 over a 10-year period assuming 200 cases per annum. CONCLUSION The clinical evidence available for RAL overall and used within included studies is limited. RAL surgery costs were consistently higher than open and laparoscopic surgery. Therefore, in adopting the robotic technology decision makers need to take into account the cost effectiveness within their own systems. Economic models generated and published for radical prostatectomy and hysterectomy may be adapted to other health systems if the care pathway is similar to provide locally relevant data.
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Affiliation(s)
- Zafer Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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23
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Independent predictors of prolonged operative time during robotic-assisted radical prostatectomy. J Robot Surg 2015; 9:117-23. [DOI: 10.1007/s11701-015-0497-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/16/2015] [Indexed: 12/20/2022]
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24
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Esteban F, Menoyo A, Abrante A. Critical Analysis of Robotic Surgery for Laryngeal Tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Análisis crítico de la cirugía robótica laríngea. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:365-72. [DOI: 10.1016/j.otorri.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
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26
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Alvimopan, a Peripherally Acting μ-Opioid Receptor Antagonist, is Associated with Reduced Costs after Radical Cystectomy: Economic Analysis of a Phase 4 Randomized, Controlled Trial. J Urol 2014; 191:1721-7. [DOI: 10.1016/j.juro.2013.12.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/21/2022]
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27
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Thomas AA, Kim B, Derboghossians A, Chang A, Finley DS, Chien GW, Slezak J, Jacobsen SJ. Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy. Urol Ann 2014; 6:142-6. [PMID: 24833827 PMCID: PMC4021655 DOI: 10.4103/0974-7796.130645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/29/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy (RARP). However, it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization. MATERIALS AND METHODS We conducted a retrospective review of RARP cases performed at our institution from September 2008 to December 2010 using a single robotic platform. Case order was determined from surgical schedules each day and surgeries were grouped into 1(st), 2(nd) and 3(rd) round cases. Fourth round cases (n = 1) were excluded from analysis. We compared clinicopathological variables including operative time, estimated blood loss (EBL), surgical margin rates and complication rates between groups. RESULTS Of the 1018 RARP cases in this cohort, 476 (47%) were performed as 1(st) round cases, 398 (39%) 2(nd) round cases and 144 (14%) 3(rd) round cases by a total of 18 surgeons. Mean operative time was shorter as cases were performed later in the day (213 min vs. 209 min vs. 180 min, P < 0.0001) and similarly, EBL also decreased with surgical order (136 mL vs. 134 mL vs. 103 mL, P = 0.01). Transfusion rates, surgical margin rates and complication rates did not significantly differ between groups. Patients undergoing RARP later in the day were much more likely to have a hospital stay of 2 or more days than earlier cases (10% vs. 11% vs. 32%, P = 0.01). CONCLUSIONS Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3(rd) round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.
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Affiliation(s)
- Anil A Thomas
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - Brian Kim
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - Armen Derboghossians
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - Allen Chang
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - David S Finley
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angele, CA, USA
| | - Jeffrey Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
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Aykan S, Singhal P, Nguyen DP, Yigit A, Tuken M, Yakut E, Colakerol A, Sulejman S, Semercioz A. Perioperative, Pathologic, and Early Continence Outcomes Comparing Three-Dimensional and Two-Dimensional Display Systems for Laparoscopic Radical Prostatectomy—A Retrospective, Single-Surgeon Study. J Endourol 2014; 28:539-43. [DOI: 10.1089/end.2013.0630] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Paras Singhal
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Daniel P. Nguyen
- Department of Urology, Berne University Hospital, Berne, Switzerland
| | - Akin Yigit
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Emrah Yakut
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Suhejb Sulejman
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Davis JW, Kreaden US, Gabbert J, Thomas R. Learning curve assessment of robot-assisted radical prostatectomy compared with open-surgery controls from the premier perspective database. J Endourol 2014; 28:560-6. [PMID: 24350787 DOI: 10.1089/end.2013.0534] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The primary aims of this study were to assess the learning curve effect of robot-assisted radical prostatectomy (RARP) in a large administrative database consisting of multiple U.S. hospitals and surgeons, and to compare the results of RARP with open radical prostatectomy (ORP) from the same settings. MATERIALS AND METHODS The patient population of study was from the Premier Perspective Database (Premier, Inc., Charlotte, NC) and consisted of 71,312 radical prostatectomies performed at more than 300 U.S. hospitals by up to 3739 surgeons by open or robotic techniques from 2004 to 2010. The key endpoints were surgery time, inpatient length of stay, and overall complications. We compared open versus robotic, results by year of procedures, results by case volume of specific surgeons, and results of open surgery in hospitals with and without a robotic system. RESULTS The mean surgery time was longer for RARP (4.4 hours, standard deviation [SD] 1.7) compared with ORP (3.4 hours, SD 1.5) in the same hospitals (p<0.0001). Inpatient stay was shorter for RARP (2.2 days, SD 1.9) compared with ORP (3.2 days, SD 2.7) in the same hospitals (p<0.0001). The overall complications were less for RARP (10.6%) compared with ORP (15.8%) in the same hospitals, as were transfusion rates. ORP results in hospitals without a robot were not better than ORP with a robot, and pretreatment co-morbidity profiles were similar in all cohorts. Trending of results by year of procedure showed no differences in the three cohorts, but trending of RARP results by surgeon experience showed improvements in surgery time, hospital stay, conversion rates, and complication rates. CONCLUSIONS During the initial 7 years of RARP development, outcomes showed decreased hospital stay, complications, and transfusion rates. Learning curve trends for RARP were evident for these endpoints when grouped by surgeon experience, but not by year of surgery.
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Affiliation(s)
- John W Davis
- 1 Department of Urology, MD Anderson Cancer Center , Houston, Texas
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30
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Carugno J, Gyang A, Hoover F, Taylor K, Lamvu G. Physician Risk Estimation of Operative Time: A Comparison of Risk Factors for Prolonged Operative Time in Robotic and Conventional Laparoscopic Hysterectomy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jose Carugno
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Anthony Gyang
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Frederick Hoover
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Kelly Taylor
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Georgine Lamvu
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
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31
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Huang KH, Carter SC, Hu JC. Does robotic prostatectomy meet its promise in the management of prostate cancer? Curr Urol Rep 2014; 14:184-91. [PMID: 23564268 DOI: 10.1007/s11934-013-0327-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Following Walsh's advances in pelvic anatomy and surgical technique to minimize intraoperative peri-prostatic trauma more than 30 years ago, open retropubic radical prostatectomy (RRP) evolved to become the gold standard treatment of localized prostate cancer, with excellent long-term survival outcomes [1•]. However, RRP is performed with great heterogeneity, even among high volume surgeons, and subtle differences in surgical technique result in clinically significant differences in recovery of urinary and sexual function. Since the initial description of robotic-assisted radical prostatectomy (RARP) in 2000 [2], and U.S. Food and Drug Administration approval shortly thereafter, RARP has been rapidly adopted and has overtaken RRP as the most popular surgical approach in the management of prostate cancer in the United States [3]. However, the surgical management of prostate cancer remains controversial. This is confounded by the idolatry of new technologies and aggressive marketing versus conservatism in embracing tradition. Herein, we review the literature to compare RRP to RARP in terms of perioperative, oncologic, and quality-of-life outcomes as well as healthcare costs. This is a particularly relevant, given the absence of randomized trials and long-term (more than 10-year) follow-up for RARP biochemical recurrence-free survival.
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Affiliation(s)
- Kuo-How Huang
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Suite 1000, Los Angeles, CA 90024, USA
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Abstract
BACKGROUND The use of local therapy for prostate cancer may increase because of the perceived advantages of new technologies such as intensity-modulated radiotherapy (IMRT) and robotic prostatectomy. OBJECTIVE To examine the association of market-level technological capacity with receipt of local therapy. DESIGN Retrospective cohort. SUBJECTS Patients with localized prostate cancer who were diagnosed between 2003 and 2007 (n=59,043) from the Surveillance Epidemiology and End Results-Medicare database. MEASURES We measured the capacity for delivering treatment with new technology as the number of providers offering robotic prostatectomy or IMRT per population in a market (hospital referral region). The association of this measure with receipt of prostatectomy, radiotherapy, or observation was examined with multinomial logistic regression. RESULTS For each 1000 patients diagnosed with prostate cancer, 174 underwent prostatectomy, 490 radiotherapy, and 336 were observed. Markets with high robotic prostatectomy capacity had higher use of prostatectomy (146 vs. 118 per 1000 men, P=0.008) but a trend toward decreased use of radiotherapy (574 vs. 601 per 1000 men, P=0.068), resulting in a stable rate of local therapy. High versus low IMRT capacity did not significantly impact the use of prostatectomy (129 vs. 129 per 1000 men, P=0.947) and radiotherapy (594 vs. 585 per 1000 men, P=0.579). CONCLUSIONS Although there was a small shift from radiotherapy to prostatectomy in markets with high robotic prostatectomy capacity, increased capacity for both robotic prostatectomy and IMRT did not change the overall rate of local therapy. Our findings temper concerns that the new technology spurs additional therapy of prostate cancer.
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Carter SC, Lipsitz S, Shih YCT, Nguyen PL, Trinh QD, Hu JC. Population-based determinants of radical prostatectomy operative time. BJU Int 2014; 113:E112-8. [DOI: 10.1111/bju.12451] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Stacey C. Carter
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health; Brigham and Women's Hospital; Boston MA USA
| | - Ya-Chen T. Shih
- Department of Medicine; University of Chicago; Chicago IL USA
| | - Paul L. Nguyen
- Department of Radiation Oncology; Brigham and Women's Hospital; Boston MA USA
| | - Quoc-Dien Trinh
- Department of Surgery; Division of Urology; Brigham and Women's Hospital; Boston MA USA
- Dana Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
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Nosnik IP, Gan TJ, Moul JW. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer? Expert Rev Anticancer Ther 2014; 7:1309-17. [PMID: 17892432 DOI: 10.1586/14737140.7.9.1309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.
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Affiliation(s)
- Israel P Nosnik
- Duke University School of Medicine, Division of Urology, Box 3707, Durham, NC 27710, USA.
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35
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Abstract
Radical retropubic prostatectomy is the current gold standard for surgical removal of the prostate gland. Recently, laparoscopic radical prostatectomy has been developed in an attempt to decrease surgical morbidity, and the technical difficulty of laparoscopy has been countered with the development of the da Vinci robotic interface. Studies that have compared the minimally invasive approaches with the traditional open approach have reported comparable perioperative outcomes. While long-term oncological data are available for open prostatectomy, there are only short-term studies available for laparoscopic prostatectomy. Functional outcomes, including urinary continence and sexual function, appear to be similar between the surgical approaches in the short term. However, currently, costs appear to favor open surgery, with the da Vinci-assisted prostatectomy having the highest expenses. Longer-term data are required to confidently determine the optimal balance between morbidity, oncological efficacy, functional outcomes and cost among the differing surgical approaches.
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Affiliation(s)
- Carter Q Le
- Department of Urology, Mayo Clinic, Gonda 7S, 200 First Street, SW, Rochester, MN 55905, USA.
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36
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Greenfield S, Sohn W. The complexities of comparative effectiveness research on devices: the case of robotic-assisted surgery for prostate cancer. J Comp Eff Res 2013; 2:367-70. [PMID: 24236676 DOI: 10.2217/cer.13.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sheldon Greenfield
- Health Policy Research Institute & the Department of Urology, University of California, Irvine, CA, USA
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Trinh QD, Bjartell A, Freedland SJ, Hollenbeck BK, Hu JC, Shariat SF, Sun M, Vickers AJ. A systematic review of the volume-outcome relationship for radical prostatectomy. Eur Urol 2013; 64:786-98. [PMID: 23664423 PMCID: PMC4109273 DOI: 10.1016/j.eururo.2013.04.012] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 04/09/2013] [Indexed: 01/09/2023]
Abstract
CONTEXT Due to the complexity and challenging nature of radical prostatectomy (RP), it is likely that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as by the hospital. OBJECTIVE To review systematically the association between hospital and surgeon volume and perioperative, oncologic, and functional outcomes after RP. EVIDENCE ACQUISITION A systematic review of the literature was performed, searching PubMed, Embase, and Scopus databases for original and review articles between January 1, 1995, and December 31, 2011. Inclusion and exclusion criteria comprised RP, hospital and/or surgeon volume reported as a predictor variable, a measurable end point, and a description of multiple hospitals or surgeons. EVIDENCE SYNTHESIS Overall 45 publications fulfilled the inclusion criteria, where most data originated from retrospective institutional or population-based cohorts. Studies generally focused on hospital or surgeon volume separately. Although most of these analyses corroborated the impact of increasing volume with better outcomes, some failed to find any significant effect. Studies also differed with respect to the proposed volume cut-off for improved outcomes, as well as the statistical means of evaluating the volume-outcome relationship. Five studies simultaneously compared hospital and surgeon volume, where results suggest that the importance of either hospital or surgeon volume largely depends on the end point of interest. CONCLUSIONS Undeniable evidence suggests that increasing volume improves outcomes. Although it would seem reasonable to refer RP patients to high-volume centers, such regionalization may not be entirely practical. As such, the implications of such a shift in practice have yet to be fully determined and warrant further exploration.
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Affiliation(s)
- Quoc-Dien Trinh
- CRCHUM, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
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Lumen N, Van Praet C, De Troyer B, Fonteyne V, Oosterlinck W, Decaestecker K, Mottrie A. Safe introduction of robot-assisted radical prostatectomy after a training program in a high-volume robotic centre. Urol Int 2013; 91:145-52. [PMID: 23860435 DOI: 10.1159/000350652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/04/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Localized prostate cancer is increasingly treated by robot-assisted radical prostatectomy (RARP). We evaluated the introduction of RARP following a training program at a high-volume robotic center. MATERIALS AND METHODS Before starting RARP, a young urologist followed a 6-month training program. The outcome of his first 50 RARPs was compared with the last 50 open radical prostatectomies (ORPs) performed by an experienced urologist at the same institution. Tumor characteristics were similar in both groups. Median follow-up was 12 (RARP) and 31 (ORP) months (p < 0.001). RESULTS RARP was associated with more nerve sparing (82 vs. ORP 46%, p < 0.001), longer operation time [median 205 (range 120-310) vs. ORP 180 (85-280) min, p = 0.001], lower decline of postoperative hemoglobin [RARP -2.1 (0.1-4.5) vs. ORP -4.0 (1.0-7.0) g/dl, p < 0.001] and shorter catheter stay [6 (5-47) vs. ORP 14 (9-43) days, p < 0.001]. Complication rates were similar. Overall and pT2-positive surgical margin rate was 8 vs. 24% (p = 0.054) and 0 vs. 11.8% (p = 0.114) for RARP vs. ORP, respectively. One-year urinary continence rate was 76.7 (RARP) and 75.8% (ORP, p = 0.833). CONCLUSIONS RARP was safely introduced after a training program in a high-volume robotic center, both surgically, oncologically and functionally.
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Affiliation(s)
- Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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39
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Hospitalization Costs for Radical Prostatectomy Attributable to Robotic Surgery. Eur Urol 2013; 64:11-6. [DOI: 10.1016/j.eururo.2012.08.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/12/2012] [Indexed: 11/22/2022]
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Healy DA, Murphy SP, Burke JP, Coffey JC. Artificial interfaces (“AI”) in surgery: Historic development, current status and program implementation in the public health sector. Surg Oncol 2013; 22:77-85. [DOI: 10.1016/j.suronc.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/04/2012] [Accepted: 12/22/2012] [Indexed: 02/07/2023]
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Huang KH, Carter SC, Shih YCT, Hu JC. Robotic and standard open radical prostatectomy: oncological and quality-of-life outcomes. J Comp Eff Res 2013; 2:293-9. [DOI: 10.2217/cer.13.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prostate cancer is the second leading cause of cancer death among men in the USA. Use of robot-assisted radical prostatectomy (RARP) for the management of localized prostate cancer has increased dramatically in recent years. This review focuses on comparing quality of life following RARP versus retropubic radical prostatectomy. RARP is associated with improved perioperative outcomes, such as reduced blood loss and fewer transfusions. In addition, cancer control after RARP versus retropubic radical prostatectomy is equivalent, with similar incidences of positive surgical margins and comparable early oncological outcomes. RARP appears to provide advantages in recovery of continence, potency and quality of life compared with retropubic radical prostatectomy; however, methodological limitations exist in current literature.
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Affiliation(s)
- Kuo-How Huang
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California, LA, USA
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Stacey C Carter
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California, LA, USA
| | - Ya-Chen Tina Shih
- Section of Hospital Medicine, Department of Medicine, The University of Chicago, IL, USA
| | - Jim C Hu
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California, LA, USA.
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Warren J, da Silva V, Caumartin Y, Luke PPW. Robotic renal surgery: The future or a passing curiosity? Can Urol Assoc J 2013; 3:231-240. [PMID: 19543471 DOI: 10.5489/cuaj.1080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada.
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Affiliation(s)
- Jeff Warren
- Department of Surgery, Division of Urology, University of Western Ontario
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Anderson CB, Penson DF, Ni S, Makarov DV, Barocas DA. Centralization of Radical Prostatectomy in the United States. J Urol 2013; 189:500-6. [DOI: 10.1016/j.juro.2012.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Affiliation(s)
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee
- United States Department of Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
| | - Shenghua Ni
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danil V. Makarov
- Department of Urology, New York University School of Medicine and the United States Department of Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Alemozaffar M, Chang SL, Kacker R, Sun M, DeWolf WC, Wagner AA. Comparing costs of robotic, laparoscopic, and open partial nephrectomy. J Endourol 2013; 27:560-5. [PMID: 23130756 DOI: 10.1089/end.2012.0462] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Abstract Background and Purpose: Laparoscopic and robot-assisted partial nephrectomy (LPN and RPN) are common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. Cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. PATIENTS AND METHODS Costs were captured for 25 patients in each group who underwent RPN, LPN, or OPN at our institution between November 2008 and September 2010. Variable costs included operating room (OR) time, supplies, anesthesia, and inpatient care costs. Fixed costs included equipment purchase and maintenance. Impact of variable and fixed costs were estimated using sensitivity analysis. RESULTS Overall variable costs were similar for RPN, LPN, and OPN ($6375 vs $6075 vs $5774, P=0.117, respectively). OR supplies contributed a greater cost for RPN and LPN than OPN ($2179 vs $1987 vs $181, P<0.0001, respectively), while inpatient stay costs were higher for OPN compared with LPN and RPN ($2418 vs $1305 vs $1274, P<0.0001, respectively). Sensitivity analysis of variable costs demonstrates that RPN and LPN can represent less costly alternatives to OPN if hospital stay for RPN and LPN is ≤2 days and OR time <195 and 224 minutes, respectively. Inclusion of fixed costs made OPN less expensive than LPN and RPN unless use of the robot increases and operative times are reduced. CONCLUSION By minimizing OR time and hospital stay, RPN and LPN can be cost equivalent to OPN regarding variable costs. When including fixed costs, RPN and LPN were more costly than OPN, but equivalence may be possible with improvements in efficiency.
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Affiliation(s)
- Mehrdad Alemozaffar
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Mirheydar HS, Parsons JK. Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health. World J Urol 2012; 31:455-61. [PMID: 23274528 DOI: 10.1007/s00345-012-1015-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/11/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Robotic technology disseminated into urological practice without robust comparative effectiveness data. OBJECTIVE To review the diffusion of robotic surgery into urological practice. METHODS We performed a comprehensive literature review focusing on diffusion patterns, patient safety, learning curves, and comparative costs for robotic radical prostatectomy, partial nephrectomy, and radical cystectomy. RESULTS Robotic urologic surgery diffused in patterns typical of novel technology spreading among practicing surgeons. Robust evidence-based data comparing outcomes of robotic to open surgery were sparse. Although initial Level 3 evidence for robotic prostatectomy observed complication outcomes similar to open prostatectomy, subsequent population-based Level 2 evidence noted an increased prevalence of adverse patient safety events and genitourinary complications among robotic patients during the early years of diffusion. Level 2 evidence indicated comparable to improved patient safety outcomes for robotic compared to open partial nephrectomy and cystectomy. Learning curve recommendations for robotic urologic surgery have drawn exclusively on Level 4 evidence and subjective, non-validated metrics. The minimum number of cases required to achieve competency for robotic prostatectomy has increased to unrealistically high levels. Most comparative cost-analyses have demonstrated that robotic surgery is significantly more expensive than open or laparoscopic surgery. CONCLUSIONS Evidence-based data are limited but suggest an increased prevalence of adverse patient safety events for robotic prostatectomy early in the national diffusion period. Learning curves for robotic urologic surgery are subjective and based on non-validated metrics. The urological community should develop rigorous, evidence-based processes by which future technological innovations may diffuse in an organized and safe manner.
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Affiliation(s)
- Hossein S Mirheydar
- Division of Urologic Oncology Moores UCSD Comprehensive Cancer Center, University of California, San Diego, CA, USA
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Kim SP, Boorjian SA, Shah ND, Weight CJ, Tilburt JC, Han LC, Thompson RH, Trinh QD, Sun M, Moriarty JP, Karnes RJ. Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy. J Urol 2012; 189:514-20. [PMID: 23253307 DOI: 10.1016/j.juro.2012.09.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/29/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE We described population level trends in radical prostatectomy for patients with prostate cancer by hospitals with robotic surgery, and assessed whether socioeconomic disparities exist in access to such hospitals. MATERIALS AND METHODS After merging the NIS (Nationwide Inpatient Sample) and the AHA (American Hospital Association) survey from 2006 to 2008, we identified 29,837 patients with prostate cancer who underwent radical prostatectomy. The primary outcome was treatment with radical prostatectomy at hospitals that have adopted robotic surgery. Multivariate logistic regression was used to identify patient and hospital characteristics associated with radical prostatectomy performed at hospitals with robotic surgery. RESULTS Overall 20,424 (68.5%) patients were surgically treated with radical prostatectomy at hospitals with robotic surgery, while 9,413 (31.5%) underwent radical prostatectomy at hospitals without robotic surgery. There was a marked increase in radical prostatectomy at hospital adopters from 55.8% in 2006 and 70.7% in 2007 to 76.1% in 2008 (p <0.001 for trend). After adjusting for patient and hospital features, lower odds of undergoing radical prostatectomy at hospitals with robotic surgery were seen in black patients (OR 0.81, p <0.001) and Hispanic patients (OR 0.77, p <0.001) vs white patients. Compared to having private health insurance, being primarily insured with Medicaid (OR 0.70, p <0.001) was also associated with lower odds of being treated at hospitals with robotic surgery. CONCLUSIONS Although there was a rapid shift of patients who underwent radical prostatectomy to hospitals with robotic surgery from 2006 to 2008, black and Hispanic patients or those primarily insured by Medicaid were less likely to undergo radical prostatectomy at such hospitals.
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Affiliation(s)
- Simon P Kim
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Hyams ES, Mullins JK, Pierorazio PM, Partin AW, Allaf ME, Matlaga BR. Impact of robotic technique and surgical volume on the cost of radical prostatectomy. J Endourol 2012; 27:298-303. [PMID: 22967039 DOI: 10.1089/end.2012.0147] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. METHODS The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. RESULTS There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; P<0.001) based primarily on operating room charges and supply charges. Multivariate regression demonstrated that RALRP was associated with a significantly higher cost (β coeff 4.1; P<0.001), even within high-volume hospitals (β coeff 3.3; P<0.001). High-volume surgeons and high-volume hospitals, however, were associated with a significantly lower cost for RP overall. High surgeon volume was associated with lower cost for RALRP and RRP, while high institutional volume was associated with lower cost for RALRP only. CONCLUSIONS High surgical volume was associated with lower cost of RP. Even at high surgical volume, however, the cost of RALRP still exceeded that of RRP. As robotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to improve the cost-effectiveness of prostate cancer surgical therapy.
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Affiliation(s)
- Elias S Hyams
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Mmeje CO, Martin AD, Nunez-Nateras R, Parker AS, Thiel DD, Castle EP. Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy. Curr Urol Rep 2012. [DOI: 10.1007/s11934-012-0292-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Robot-assisted hysterectomy vs total laparoscopic hysterectomy: a comparison of short-term surgical outcomes. Int J Med Robot 2012; 8:453-7. [DOI: 10.1002/rcs.1463] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 11/07/2022]
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Bolenz C, Freedland SJ, Hollenbeck BK, Lotan Y, Lowrance WT, Nelson JB, Hu JC. Costs of radical prostatectomy for prostate cancer: a systematic review. Eur Urol 2012; 65:316-24. [PMID: 22981673 DOI: 10.1016/j.eururo.2012.08.059] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 08/28/2012] [Indexed: 12/29/2022]
Abstract
CONTEXT Robot-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted as a new approach for radical prostatectomy (RP) in patients with prostate cancer (PCa). The use of new technology may increase costs for RP. OBJECTIVE To summarize data on direct costs of various approaches to RP and to discuss the consequences of cost differences. EVIDENCE ACQUISITION A systematic literature search was performed in March 2012 using the PubMed, Web of Science, and Cochrane Library databases. A complex search strategy was applied. Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Articles reporting on direct costs of RP (open retropubic [RRP], radical perineal [RPP], laparoscopic [LRP], RALP) in men with clinically localized PCa were eligible for study inclusion. EVIDENCE SYNTHESIS Of 1218 articles initially screened by title, the multistep, systematic search identified 11 studies presenting direct costs of different approaches to RP. Of the 11 studies, 7 compared the costs of different RP approaches. Minimally invasive RP (MIRP) (ie, LRP or RALP) was more expensive than RRP in most studies, mainly due to increased surgical instrumentation costs. In the comparative studies, costs ranged from (in US dollars) $5058 to $11,806 for MIRP and from $4075 to $6296 for RRP, with RALP having the highest direct costs. In one study applying standardized, health economic-evaluation criteria, RALP was not found to be cost effective. Limitations of this review include significant differences in observational study designs and an absence of prospective comparative studies. Moreover, there are limited post-RP data on the costs of adjuvant treatments and other health care-related expenses after PCa surgery. CONCLUSIONS Few studies compared direct costs of different approaches to RP. The use of new technology, particularly RALP, results in added costs for the procedure. Cost effectiveness of new technologies should be assessed before widespread adoption. To date, in the lone study to evaluate this, RALP was not found to be cost effective from a health care, economic standpoint. However, longer follow-up of patients is required to better evaluate its impact on overall costs and quality of PCa care.
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Affiliation(s)
- Christian Bolenz
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
| | - Stephen J Freedland
- Department of Surgery - Durham VA Medical Center, and Departments of Surgery (Urology) and Pathology, Duke University School of Medicine, Durham, NC, USA
| | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William T Lowrance
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Joel B Nelson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jim C Hu
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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