Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery

Abstract Introduction Since inception of robotic-assisted surgery (RAS) in 1999, there has been an exponential rise in RAS in both number and complexity of surgical cases performed. The majority of these cases are gynecologic surgery in nature, with only a quarter of them labeled as general surgery. The purpose of this study is to determine if RAS in the Department of Defense (DoD) mirrors these trends. Methods A total of 6,204 RAS cases from across the DoD were reviewed between 01 January 2015 and 30 September 2017 from every Military Treatment Facility (MTF) that employs a robotic surgical device (various models of the da Vinci robotic surgical system by Intuitive Surgical). Specialty, number, and surgeon were recorded for each case. These end points were also examined for trends overtime and compared to similar civilian data. Results The number of MTFs performing robotic surgery and the number of cases performed increased significantly. An average of 373 cases per quarter-year were performed in 2015, 647 in 2016, and 708 in 2017. The number of RAS cases increased by about 10% every quarter-year during this time period. RAS was most commonly performed by general surgery in 10 of the 14 MTFs examined. Conclusions MTFs implemented RAS much later than the civilian world. However, since its implementation, the frequency of RAS use has increased at a faster rate in the DoD than in the civilian world. Possible reasons for this are a younger pool of surgeons in the military and less demands on cost-effective productivity, allowing these younger surgeons to focus on emerging technology rather than maximizing surgical cost efficiency. General surgery constitutes the majority of RAS cases in the DoD. It is unclear why this difference from the civilian world exists.

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Video Symposium 2 “Robotic-assisted Surgery in Bronchoesophagology”

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.67.116 ◽

2016 ◽

Vol 67 (2) ◽

pp. 116-117

Author(s):

N. Ikeda

Keyword(s):

Robotic Assisted ◽

Robotic Assisted Surgery

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01 / The Effect of Insufflation Pressure in Major Robotic-Assisted Gynecologic Surgery on Perioperative Pain and Respiratory Parameters

10.26226/morressier.5aeb0acc07b0d6001a79ac2f ◽

2018 ◽

Author(s):

Jian Qun Huang

Keyword(s):

Gynecologic Surgery ◽

Robotic Assisted ◽

Perioperative Pain ◽

Insufflation Pressure ◽

Respiratory Parameters

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04 / Temperature changes during robotic assisted surgery

10.26226/morressier.5aeb0acd07b0d6001a79ad94 ◽

2018 ◽

Author(s):

Fouad Atallah

Keyword(s):

Temperature Changes ◽

Robotic Assisted ◽

Robotic Assisted Surgery

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Faculty Opinions recommendation of Robotic-Assisted Surgery Improves the Quality of Total Mesorectal Excision for Rectal Cancer Compared to Laparoscopy: Results of a Case-Controlled Analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725952842.793523151 ◽

2016 ◽

Author(s):

Scott Steele

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Mesorectal Excision ◽

Robotic Assisted ◽

Robotic Assisted Surgery

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Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload

BMC Health Services Research ◽

10.1186/s12913-021-06105-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kate McBride ◽

Daniel Steffens ◽

Christina Stanislaus ◽

Michael Solomon ◽

Teresa Anderson ◽

...

Keyword(s):

Public Sector ◽

Health Sector ◽

Public Hospitals ◽

Fixed Costs ◽

Tertiary Referral Hospital ◽

Robotic Assisted ◽

The Public ◽

Robotic Assisted Surgery ◽

Specific Implementation ◽

Theatre Utilisation

Abstract Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.

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Robotic natural orifice specimen extraction surgery versus traditional robotic-assisted surgery (NOTR) for patients with colorectal cancer: a study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05077-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rui Luo ◽

Fangfang Zheng ◽

Haobo Zhang ◽

Weiquan Zhu ◽

Penghui He ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Robotic Assisted ◽

Randomized Controlled ◽

Robotic Assisted Surgery ◽

Secondary Outcomes

Abstract Background Natural orifice specimen extraction surgery for colorectal cancer has been introduced in order to reduce the abdominal incision, demonstrating major development potential in minimally invasive surgery. We are conducting this randomized controlled trial to assess whether robotic NOSES is non-inferior to traditional robotic-assisted surgery for patients with colorectal cancer in terms of primary and secondary outcomes. Method/design Accordingly, a prospective, open-label, randomized controlled, parallel-group, multicenter, and non-inferiority trial will be conducted to discuss the safety and efficacy of robotic natural orifice extraction surgery compared to traditional robotic-assisted surgery. Here, 550 estimated participants will be enrolled to have 80% power to detect differences with a one-sided significance level of 0.025 in consideration of the non-inferiority margin of 10%. The primary outcome is the incidence of surgical complications, which will be classified using the Clavien-Dindo system. Discussion This trial is expected to reveal whether robotic NOSES is non-inferior to traditional robotic-assisted surgery, which is of great significance in regard to the development of robotic NOSES for patients with colorectal cancer in the minimally invasive era. Furthermore, robotic NOSES is expected to exhibit superiority to traditional robotic-assisted surgery in terms of both primary and secondary outcomes. Trial registration ClinicalTrials.govNCT04230772. Registered on January 15, 2020.

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Room Size Influences Flow in Robotic-Assisted Surgery

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157984 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7984

Author(s):

Falisha Kanji ◽

Tara Cohen ◽

Myrtede Alfred ◽

Ashley Caron ◽

Samuel Lawton ◽

...

Keyword(s):

New Technology ◽

Surgical Robots ◽

Physical Size ◽

Robotic Assisted ◽

Surgical Technology ◽

Room Size ◽

Robotic Assisted Surgery ◽

Academic Hospitals ◽

Environmental Causes ◽

The Impact

The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = −2.488, df = 54, β = −0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.

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