Robot-assisted surgery in India: A SWOT analysis

S. S. Exploring the acceptance of robotic assisted surgery among the Indian population: An empirical investigation

Background

Technology has completely transformed healthcare, starting with X-ray machines and MRIs to telehealth and robotic surgeries to e-health records. The launch of minimally invasive surgery (MIS) serves as a milestone in medical history, offering benefits such as smaller incisions, shorter hospital stays, and faster recovery, making it a preferred surgical option. This study mainly explores patients' willingness to adopt robot-assisted surgery (RAS) technology in a surgical intervention and is assessed in the backdrop of the Technology Acceptance Model (TAM).

Methods

This research project employs a post-positivist research philosophy and a cross-sectional research design. A structured, pre-tested questionnaire was used to collect data from 280 respondents.

Results

The results revealed that trust had a significant impact on Perceived Usefulness (β = 0.099) and Perceived Ease of Use (β = .157), and eHealth literacy had a significant impact on Perceived Ease of Use (β = 0.438) and Perceived Usefulness (β = 0.454). Additionally, Perceived Usefulness partially influenced behavioral intention (β = 0.123), and attitude had a significant influence on behavioral intention (β = 0.612). The analysis revealed an insignificant impact of eHealth literacy on Perceived Usefulness (β = 0.067). The Standard Root Mean Square Residual (SRMR) value was <0.8. Mediation analysis also revealed partial mediation between the constructs. The SRMR rating of this model is 0.067, indicating that it fits the data well.

Conclusion

This study revealed that a patient's intention will be high if he or she believes that RAS is beneficial in treating his or her ailment. In comparison, information related to RAS is clearly known, and it does not directly affect selection intention. eHealth literacy is a significant antecedent to patients' behavioral intention. Hence, the healthcare industry must devise strategies to promote the acceptance of RAS at all levels.

Stakeholder perspectives on scaling robotic surgery in India: qualitative research

Robotic surgery (RS) is a milestone in minimally invasive surgery. More than 500 surgeons are trained in RS in India, and more than 100 robotic systems have been installed across various centers. RS offers various benefits to patients and surgeons. Although it is rapidly advancing and has several advantages, a robotic system is a complex system that is equipped with complex instruments. Qualitative research aims to take a broad view of the perceptions of stakeholders of RS and to synthesize their views to gain insight into scaling RS. This qualitative study aimed to explore the perspectives of relevant stakeholders on RS to learn how to develop the field and make it more affordable. This study is based on grounded theory methodology and uses the standards for reporting qualitative research (SRQR) guidelines for reporting. Three premier hospitals that are pioneers in RS in India served as the study locations. Purposive sampling was used to collect data from surgeons, nurses, and insurance staff. The surgeons interviewed have national and international exposure and are consulting and performing robotic surgeries across India and internationally. We conducted one-on-one interviews and wrote memos to gather further information before approaching each stakeholder. Samples were determined based on theoretical saturation. Fellowship training, which includes simulation, bedside assistance, and individual cases under supervision, was found to be the standard training method. The stakeholders mentioned a few prerequisites for performing RS, such as prior laparoscopic experience, passion for surgical knowledge and skill, and proper case selection. The surgeons discussed some technical considerations of RS, such as medico-legal issues and mechanical faults associated with it. Although there is increased scope for establishing robotic surgery, surgeons feel that the cost of RS is high. From the interactions with the stakeholders, it is understood that robotic surgeons are the most significant players in RS. Robotic surgery demands more skills and more trained professionals to scale up. Key findings highlight the importance of fellowship training, prior laparoscopic experience, and proper case selection. While RS has potential for growth, high costs, and technical issues remain concerns. Insurance companies include robotic surgery in their policies under the category of "modernized medicine." Depending on the insurance plan that the patient selects, the necessity of the robotic surgery, and the surgeon's justification, the insurance company will pay for the patient's robotic surgery. To make it affordable for patients, complete insurance coverage is mandatory along with creating more awareness among patients. The growth of RS is inevitable in the future with other robotic companies emerging which will ultimately reduce the capital cost and robotic surgeons are pivotal in advancing RS.

Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges

The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.

Perception of robotic-assisted surgery (RAS) among medical students: a systematic review and meta-analysis

INTRODUCTION

Robotic surgery, also known as robotic-assisted surgery (RAS), involves a camera and a small surgical instrument attached to a robotic arm. A trained surgeon operates the robot from a viewing screen while being in the same room.

METHODOLOGY

This review was prepared following Cochrane collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Two authors independently searched and appraised the studies published in PubMed, cumulative index to nursing and allied health literature (CINAHL), Embase, Clinical Key, and Google Scholar. Pooled data analyzed and reported in RevMan software version-5.4.

RESULTS

This systematic review and meta-analysis comprised 1400 medical students, from 8 studies. The participants' age ranged from 23 to 49 years. Similarly, the sample size ranged from 25 and 300. The pooled prevalence of the existing studies revealed that 29.8% of medical students, were favorable towards RAS. Effect size (ES), 95% confidence intervals (CI) and heterogeneity (I2) [ES = 29.8, 95% CI 16.4-43.2, I2 = 95.1%, P < 0.00]. About 40% of Australian medical students' positive opinion on RAS [ES = 40.4, 95% CI 25.7-55.2]. Similarly, 34.2% of students from Saudi Arabia [ES = 29.8, 95% CI 22.4-90.8, I2 = 99.3%, P < 0.00], 27.8% students from Canada [ES = 27.8, 95% CI 15.9-39.6], 24.8% from USA [ES = 24.8, 95% CI 6.9-42.7, I2 = 77.3%, P < 0.00] and 24% [ES = 24, 95% CI 18-30] from India favorable towards RAS.

DISCUSSION

Medical students from developed nations display favorable attitudes towards RAS. However, implementing of revised curriculum at the beginning of the graduation level sparks medical students' attitude towards robotic surgery.

Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective

Background and Aims

Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region.

Methods

This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers.

Results

RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues.

Conclusion

Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.

Artificial Intelligence With Robotics in Healthcare: A Narrative Review of Its Viability in India

This short review focuses on the emerging role of artificial intelligence (AI) with robotics in the healthcare sector. It may have particular utility for India, which has limited access to healthcare providers for a large growing population and limited health resources in rural India. AI works with an amalgamation of enormous amounts of data using fast and complex algorithms. This permits the software to quickly adapt the pattern of the data characteristics. It has the possibility to collide with most of the facets of the health system which may range from discovery to prediction and deterrence. The use of AI with robotics in the healthcare sector has shown a remarkable rising trend in the past few years. Functions like assistance with surgery, streamlining hospital logistics, and conducting routine checkups are some of the tasks that may be managed with great efficiency using artificial intelligence in urban and rural hospitals across the country. AI in the healthcare sector is advantageous in terms of ensuring exclusive patient care, safe working conditions where healthcare providers are at a lower risk of getting infected, and perfectly organized operational tasks. As the healthcare segment is globally recognized as one of the most dynamic and biggest industries, it tends to expedite development through modernization and original approaches. The future of this lucrative industry is looking forward to a great revolution aiming to create intelligent machines that work and respond like human beings. The future perspective of AI and robotics in the healthcare sector encompasses the care of elderly people, drug discovery, diagnosis of deadly diseases, a boost in clinical trials, remote patient monitoring, prediction of epidemic outbreaks, etc. However, the viability of using robotics in healthcare may be questionable in terms of expenditure, skilled workforce, and the conventional mindset of people. The biggest challenge is the replication of these technologies to the smaller towns and rural areas so that these facilities may reach the larger segment of the entire population of the country. This review aims to examine the adaptability and viability of these new technologies in the Indian scenario and identify the major challenges.

Long-term comparative outcome analysis of a robot-assisted laparoscopic prostatectomy with retropubic radical prostatectomy by a single surgeon

We aimed to report a comprehensive outcome analysis of robot-assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic radical prostatectomies (RRP) done by the same surgeon in a high-volume center. Preoperative, perioperative, and postoperative data were collected prospectively and compared with retrospective retropubic radical prostatectomy data. Perioperative, oncological data, and functional results in the first year were compared between the two groups. There were 547 RARPs between 4th August 2011 and 31st December 2018, and 428 RRPs between 1st January 1996 and 31st December 2009 which were included in this review. While the operation time was in favour of the open group (196 vs 160 min, p < 0.01), the estimated blood loss (188 vs 316 ml, p < 0.01), blood transfusion rate (3% vs 7%, p = 0.021), hospital stay (4 days vs 7 days), and mean catheter duration (12 vs 15 days) were in favour of the robotic group. Majority of the complications belonged to Clavien-Dindo group II in both groups and the rates were not significantly different (p = 0.33). The 12-month continence rate was in favour of the RALP group (98.3% vs 99.2%, p < 0.01). Overall survival of the RALP cohort at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%), and 108 months was 79.5%. Overall survival at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%, and 108 months 79.5%. RALP is a safe, minimally invasive, technically feasible procedure with comparable functional and oncological outcomes. Our study showed superior perioperative and continence outcomes in RALP. However, despite its growing popularity, RRP still remains the gold standard in India due to its affordability and accessibility.

Effect of SWOT Analysis Combined with the Medical and Nursing Integration Emergency Nursing Process on Emergency Treatment Efficiency and Prognosis of Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) is a common clinical emergency. Effective emergency treatment at the early stage of onset can effectively reduce the mortality rate. Time is the key of emergency treatment, which is directly related to the treatment effect and the prognosis of patients, and clinical intensive nursing intervention for emergency treatment is of great significance in improving the efficiency of emergency treatment and prognosis. In this study, the effects of routine emergency care flow and SWOT analysis combined with medical and nursing integration on emergency treatment efficiency and prognosis of patients with acute myocardial infarction were compared. The results showed that the combined scheme could improve the rescue effect and success rate of patients with acute myocardial infarction, shorten the rescue time, and reduce the mortality and complication rate of myocardial infarction, which provided a new direction for clinical emergency treatment of acute myocardial infarction.

Feasibility and usefulness of online virtual training of urology residents in times of COVID-19: A single-center experience and an evidence-based strength, weakness, opportunity, and threat analysis

BACKGROUND

The COVID-19 disease has resulted in an almost complete shutdown of all services worldwide. Hospitals continued to provide emergency services and treatment for COVID-19 disease. Teaching hospitals like ours had another responsibility at hand; training of our surgical residents. Not allowing this pandemic to take away months of training, we resorted to online virtual training programs, for continuing academic activities. After having conducted thirty such sessions, we took feedback from the participating students and faculty members to evaluate the usefulness of this new initiative and identify the lacunae that needed to be addressed.

MATERIALS AND METHODS

The initial twenty classes were held on the GoTo Meeting ® online platform, whereas the last ten were conducted using the Google Meet application. A 20-item questionnaire covering four broad domains of general perception, feasibility, knowledge gained, and drawbacks was circulated, and 19 responses were registered anonymously. Strength, weakness, opportunity, and threat analysis was done based on the responses received.

RESULTS

About 89.5% of the participants believed that online classes were the ideal platform for continuing education and 84.2% of the participants were overall satisfied with the whole exercise. The Achilles' heel was the availability of a good Internet connection, and the major lacunae were the poor quality of video and audio transmission. Seventy-four percent of the participants wanted to continue online training in the future too, whereas 26% wanted to revert to the traditional face-to-face teaching.

CONCLUSION

Online virtual training classes are an effective and feasible alternative to traditional teaching in times such as these, which demanded strict social distancing. It naturally lacked the warmth and personal touch of the traditional teaching classes, but it allowed us to continue teaching our residents and also prepare them to face the biggest menace of all times.

Role of laparoscopy in the era of robotic surgery in urology in developing countries

With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.