scholarly journals Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 265
Author(s):  
Julia Spiegelberg ◽  
Tanja Iken ◽  
Markus K. Diener ◽  
Stefan Fichtner-Feigl
Keyword(s):  
Degrees Of Freedom ◽  
Liver Tumors ◽  
3D Visualization ◽  
Financial Burden ◽  
High Volume ◽  
Economic Benefits ◽  
Retrospective Case ◽  
Robotic Assisted ◽  
Primary Liver Tumors ◽  
Robotic Assisted Surgery

Hepatocellular and cholangiocellular carcinoma are fatal primary hepatic tumors demanding extensive liver resection. Liver surgery is technically challenging due to the complex liver anatomy, with an intensive and variant vascular and biliary system. Therefore, major hepatectomies in particular are often performed by open resection and minor hepatectomies are often performed minimally invasively. More centers have adopted robotic-assisted surgery, intending to improve the laparoscopic surgical limits, as it offers some technical benefits such as seven degrees of freedom and 3D visualization. The da Vinci® Surgical System has dominated the surgical robot market since 2000 and has shown surgical feasibility, but there is still much controversy about its economic benefits and real benefits for the patient over the gold standard. The currently available retrospective case studies are difficult to compare, and larger, prospective studies and randomized trials are still urgently missing. Therefore, here we summarize the technical, surgical, and economic outcomes of robotic versus open and laparoscopic hepatectomies for primary liver tumors found in the latest literature reviews and meta-analyses. We conclude that complex robotic liver resections (RLR) are safe and feasible after the steep learning curve of the surgical team has plateaued. The financial burden is lower in high volume centers and is expected to decrease soon as new surgical systems will enter the market.

scholarly journals 1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ng ◽  
A Nathan ◽  
N Campain ◽  
Y Yuminaga ◽  
F Mumtaz ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Anatomical Variation ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Robot Assisted ◽  
Renal Masses ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Estimated Blood Loss

Abstract Introduction Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Method Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate). Results The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients. Conclusions We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.

scholarly journals Early Economic Evaluation Demonstrates That Noncomputerized Tomography Robotic-Assisted Surgery Is Cost-Effective in Patients Undergoing Unicompartmental Knee Arthroplasty at High-Volume Orthopaedic Centres

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Leo M. Nherera ◽  
Sanjay Verma ◽  
Paul Trueman ◽  
Simon Jennings
Keyword(s):  
Cost Effectiveness ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cost Effective ◽  
High Volume ◽  
Osteoarthritis Of The Knee ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Unicompartmental Knee

Background. For over fifty years, unicompartmental knee arthroplasty (UKA) has been used to treat single-compartment osteoarthritis of the knee and is considered a safe alternative to total knee arthroplasty (TKA). The development and use of robotic-assisted surgery (r-UKA) have made the execution of the procedure more precise, and various studies have reported improved radiographic outcomes and implant survival rates; however, its cost-effectiveness is unknown. This study aimed at assessing the cost-effectiveness of noncomputerized tomography (non-CT) r-UKA compared to the traditional unicompartmental knee arthroplasty (t-UKA) method in patients with unicompartmental knee osteoarthritis from the UK payer’s perspective. Methods. We developed a 5-year four-state Markov model to evaluate the expected costs and outcomes of the two strategies in patients aged 65 years. Failure rates for t-UKA were taken from the British National Joint Registry while data for non-CT r-UKA were obtained from a 2-year observational study. Cost was obtained from the NHS reference cost valued at 2018/19 GBP£, and a discount rate of 3.5% was applied to both costs and benefits. Results. For a high-volume orthopaedic centre that performs 100 UKA operations per year, non-CT r-UKA was more costly than t-UKA but offered better clinical outcomes, and the estimated cost per QALY was £2,831. The results were more favourable in younger patients aged less than 55 and sensitive to case volumes and follow-up period. Conclusion. Non-CT r-UKA is cost-effective compared with t-UKA over a 5-year period. Results are dependent on case volumes and follow-up period and favour younger age groups.

Eight years after introducing liver resection at the Oncology Institute of Vojvodina

2013 ◽  
Vol 21 (3-4) ◽  
pp. 101-104
Author(s):  
Ivan Majdevac ◽  
Nikola Budisin ◽  
Milan Ranisavljevic ◽  
Dejan Lukic ◽  
Imre Lovas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Tumors ◽  
Liver Parenchyma ◽  
Malignant Neoplasms ◽  
Chemotherapy Treatment ◽  
Primary Liver Tumors ◽  
Cancer Metastases ◽  
Colorectal Cancer Metastases ◽  
Medical Histories

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

Rearrangement of a common cellular DNA domain on chromosome 4 in human primary liver tumors.

1988 ◽  
Vol 62 (2) ◽  
pp. 629-632 ◽  
Author(s):  
C Pasquinelli ◽  
F Garreau ◽  
L Bougueleret ◽  
E Cariani ◽  
K H Grzeschik ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Chromosome 4 ◽  
Primary Liver Tumors ◽  
Cellular Dna

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

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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