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Ou JT, Tawiah W, Wainwright J, Gay SS, Nguyen A, Barimani B, Wenke JC. Robotic-assistance did not reduce complications in total hip arthroplasty. J Orthop 2025; 64:147-152. [PMID: 40352779 PMCID: PMC12059589 DOI: 10.1016/j.jor.2025.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Accepted: 04/21/2025] [Indexed: 05/14/2025] Open
Abstract
Aims & objectives Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA. Materials & methods Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture. Results The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772-1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)]. Conclusion Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.
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Affiliation(s)
- Joshua T. Ou
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, United States
| | - Winston Tawiah
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, United States
| | - Jared Wainwright
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Samuel S. Gay
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Adam Nguyen
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Bardia Barimani
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Division of Orthopedic Surgery, McGill University, Montreal, Canada
| | - Joseph C. Wenke
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
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Wang S, Wu J, He W, Chen J, Yang J, Tang K, Xu D, He S. Transperitoneal robotic-assisted versus laparoscopic partial nephrectomy for renal duplication: a comparative clinical analysis. Sci Rep 2025; 15:10286. [PMID: 40133345 PMCID: PMC11937523 DOI: 10.1038/s41598-025-94019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 03/11/2025] [Indexed: 03/27/2025] Open
Abstract
This retrospective study aimed to compare the efficacy and safety of robotic-assisted laparoscopic partial nephrectomy (RALPN) versus laparoscopic partial nephrectomy (LPN) in pediatric patients with renal duplication. Data from 105 pediatric patients who underwent surgery for renal duplication at the Department of Pediatric Surgery, Fujian Provincial Hospital, between January 2019 and March 2024 were reviewed. Patients were categorized into two groups based on surgical approach: RALPN and LPN. The RALPN group had a significantly higher mean age (5.10 ± 2.63 years) compared to the LPN group (2.67 ± 2.16 years, p < 0.001). RALPN patients experienced shorter hospital stay (7.3 ± 1.7 days vs. 9.5 ± 3.3 days, p < 0.001)) and higher hospitalization expenses ($5,723 ± 1,322 vs. $1,787 ± 564, p < 0.001). No significant differences were observed in gender distribution, follow-up duration, BMI, side of surgery, presenting symptoms, coexisting urinary system diseases, or readmission rates between the groups. Intraoperative data showed that RALPN resulted in a trend towards lower blood loss (8.41 ± 3.58 ml vs. 10.73 ± 4.60 ml, p = 0.023) but required a longer total operation time (234.68 ± 58.02 min vs. 185.36 ± 54.07 min, p < 0.001). However, the partial nephrectomy duration was shorter in RALPN (125.45 ± 19.27 min vs. 153.49 ± 48.81 min, p < 0.001). RALPN had faster recovery with shorter durations of postoperative hematuria and catheterization. At 12 months post-surgery, RALPN showed significantly lower anteroposterior diameter of renal pelvis and maximum cross-sectional area of the cyst, indicating better preservation of renal function. Both RALPN and LPN are safe and effective for treating renal duplication in pediatric patients. Despite RALPN is associated with higher hospitalization costs, its overall cost-effectiveness may be comparable to LPN due to fewer complications and faster recovery. Further multicenter, randomized controlled trials are warranted to validate these findings and assess long-term outcomes.
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Affiliation(s)
- Sisi Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Jiayue Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Wenyun He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Jingyi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Jingwen Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Kunbin Tang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Di Xu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China
| | - Shaohua He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, Fujian, China.
- Department of Pediatric Surgery, Children Medical Center, Fujian Provincial Hospital, Fuzhou, 350000, Fujian, China.
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Bauerle W, Franey D, Allsbrook A, Evans J, Reese V, Stoltzfus J, Harrison M, Burfeind W, Brown AM. Retrospective cost analysis of robotic and laparoscopic anti-reflux surgery and paraesophageal hernia repair. Surg Endosc 2024:10.1007/s00464-024-11294-9. [PMID: 39367133 DOI: 10.1007/s00464-024-11294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/13/2024] [Indexed: 10/06/2024]
Abstract
INTRODUCTION Increased adoption of robotics in foregut surgery evokes questions regarding efficacy, safety, and cost. To many, cost remains a barrier to adoption of a robotic approach. The authors' aim to determine the difference in cost of a robotic (R-) vs laparoscopic (L-) approach for paraesophageal hernia repair (PEHR). METHODS Patients 18 years and older who underwent PEHR between July 2016 and June 2021 at a university health network were included. Variables of interest included 30 day outcomes, 1 year recurrence rates, and several cost variables including hospital length of stay, operating room (OR) time, chargeable supplies and implants, non-chargeable supplies, and indirect cost. Cost data were stratified by type and the presence of fundoplication, as well as the elective versus urgent nature of the procedures. Statistical analysis consisted of parametric and non-parametric analyses, with p < 0.05 denoting statistical significance. RESULTS 405 patients were included in the study (n = 188 for R-, n = 217 for L-). Significant differences were observed in the type of anti-reflux procedure performed (p < 0.001), use of mesh (R- 70.2% vs. L- 59.0%, p = 0.019), and whether a Collis gastroplasty was performed (R- 4.3% vs. L- 10.2%, p = 0.023). No differences in 30-day readmission or reoperation rates, Clavien-Dindo complication rates, or 1-year hernia recurrence rates were observed. For elective cases, regardless of the type of anti-reflux procedure performed, a robotic approach was associated with a significantly greater cost (p < 0.002). Comparing all procedures, a statistically significant increase in cost was seen with a robotic approach (R- $29,706.88 vs. L- $23,457.07, p < 0.001). CONCLUSIONS Complication rates and surgical outcomes between the two approaches were similar; however, cost is significantly increased when a robotic approach is utilized. Future studies are needed to delineate which drivers of cost are modifiable with the robot.
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Affiliation(s)
- Wayne Bauerle
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Daniel Franey
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Anthony Allsbrook
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Joseph Evans
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Vanessa Reese
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Meredith Harrison
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - William Burfeind
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Andrew M Brown
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA.
- , 701 Ostrum St. Suite 202, Bethlehem, PA, 18015, USA.
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Deeb AL, De Leon L, Mazzola E, Kucukak S, Singh A, McAllister M, Garrity M, Jaklitsch MT, Wee JO, Rochefort MM. Early adoption of robotic lung resection in an established video assisted thoracic surgery practice. Surg Open Sci 2024; 20:189-193. [PMID: 39148816 PMCID: PMC11325388 DOI: 10.1016/j.sopen.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 08/17/2024] Open
Abstract
Background Reported advantages to robotic thoracic surgery include shorter length of stay (LOS), improved lymphadenectomy, and decreased complications. It is uncertain if these benefits occur when introducing robotics into a well-established video-assisted thoracoscopy (VATS) practice. We compared the two approaches to investigate these advantages. Materials and methods IRB approval was obtained for this project. Patients who underwent segmentectomy or lobectomy from May 2016-December 2018 were propensity-matched 2: 1 (VATS: robotic) and compared using weighted logistic regression with age, gender, Charlson Comorbidity Index, surgery type, stage, Exparel, and epidural as covariates. Complication rates, operation times, number of sampled lymph nodes, pain level, disposition, and LOS were compared using Wilcoxon rank-sum and with Rao-Scott Chi-squared tests. Results 213 patients (142 VATS and 71 robot) were matched. Duration of robotic cases was longer than VATS (median 186 min (IQR 78) vs. 164 min (IQR 78.75); p < 0.001). Significantly more lymph nodes (median 11 (IQR 7.50) vs. 8 (IQR 7.00); p = 0.004) and stations were sampled (median 4 (IQR 2.00) vs. 3 (IQR 1.00); p < 0.001) with the robot. Interestingly, robotic resections had higher 72-hour pain scores (median 3 (IQR 3.25) vs. 2 (IQR 3.50); p = 0.04) and 48-hour opioid usage (median 37.50 morphine milligram equivalents (MME) (IQR 45.50) vs. 22.50 MME (IQR 37.50); p = 0.01). Morbidity, LOS, and disposition were similar (all p > 0.05). Conclusions The robotic approach facilitates better lymph node sampling, even in an established VATS practice.
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Affiliation(s)
- Ashley L Deeb
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Luis De Leon
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Suden Kucukak
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Anupama Singh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Miles McAllister
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Matthew Garrity
- University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Matthew M Rochefort
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
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Xue M, Liu J, Lu M, Zhang H, Liu W, Tian H. Robotic assisted minimally invasive esophagectomy versus minimally invasive esophagectomy. Front Oncol 2024; 13:1293645. [PMID: 38288099 PMCID: PMC10824560 DOI: 10.3389/fonc.2023.1293645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background Esophagectomy is the gold standard treatment for resectable esophageal cancer; however, there is insufficient evidence to indicate potential advantages over standard minimally invasive esophagectomy (MIE) in treating thoracic esophageal cancer. Robot-assisted minimally invasive esophagectomy (RAMIE) bridges the gap between open and minimally invasive surgery. In this single-center retrospective review, we compare the clinical outcomes of EC patients treated with MIE and RAMIE. Method We retrospectively reviewed the clinical data of patients with esophageal cancer who underwent surgery at Qilu Hospital between August 2020 and August 2022, including 159 patients who underwent MIE and 35 patients who received RAMIE. The intraoperative, postoperative, and preoperative patient characteristics in both groups were evaluated. Results Except for height, the MIE and RAMIE groups showed no significant differences in preoperative features (P>0.05). Further, there were no significant differences in intraoperative indices, including TNM stage of the resected tumor, tumor tissue type, or ASA score, between the two groups. However, statistically significant differences were found in some factors; the RAMIE group had a shorter operative time, less intraoperative bleeding, and more lymph nodes removed compared to the MIE group. Patients in the RAMIE group reported less discomfort and greater chest drainage on the first postoperative day than patients in the MIE group; however, there were no differences in other features between the two datasets. Conclusion By comparing the clinical characteristics and outcomes of RAMIE with MIE, this study verified the feasibility and safety of RAMIE for esophageal cancer. Overall, RAMIE resulted in more complete lymph node clearance, shorter operating time, reduced surgical hemorrhage, reduced postoperative discomfort, and chest drainage alleviation in patients. To investigate the function of RAMIE in esophageal cancer, we propose undertaking a future clinical trial with long-term follow-up to analyze tumor clearance, recurrence, and survival after RAMIE.
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Affiliation(s)
| | | | | | | | | | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
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Liu Y, Mao M, Bai J, Cai M, Wang Q, Fu H, Zhao M, Wang C, Si L, Guo R. Is robotic-assisted vaginectomy a better choice in vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery? BMC Womens Health 2024; 24:36. [PMID: 38218831 PMCID: PMC10788024 DOI: 10.1186/s12905-024-02882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Vaginectomy has been shown to be effective for select patients with vaginal high-grade squamous intraepithelial lesions (HSIL) and is favored by gynecologists, while there are few reports on the robotic-assisted laparoscopic vaginectomy (RALV). The aim of this study was to evaluate the safety and treatment outcomes between RALV and the conventional laparoscopic vaginectomy (CLV) for patients with vaginal HSIL. METHODS This retrospective cohort study was conducted in 109 patients with vaginal HSIL who underwent either RALV (RALV group) or CLV (CLV group) from December 2013 to May 2022. The operative data, homogeneous HPV infection regression rate and vaginal HSIL regression rate were compared between the two groups. Student's t-test, the Mann-Whitney U test, Pearson χ2 test or the Fisher exact test, Kaplan-Meier survival analysis and Cox proportional-hazards models were used for data analysis. RESULTS There were 32 patients in the RALV group and 77 patients in the CLV group. Compared with the CLV group, patients in the RALV group demonstrated less estimated blood loss (41.6 ± 40.3 mL vs. 68.1 ± 56.4 mL, P = 0.017), lower intraoperative complications rate (6.3% vs. 24.7%, P = 0.026), and shorter flatus passing time (2.0 (1.0-2.0) vs. 2.0 (2.0-2.0), P < 0.001), postoperative catheterization time (2.0 (2.0-3.0) vs. 4.0 (2.0-6.0), P = 0.001) and postoperative hospitalization time (4.0 (4.0-5.0) vs. 5.0 (4.0-6.0), P = 0.020). In addition, the treatment outcomes showed that both RALV group and CLV group had high homogeneous HPV infection regression rate (90.0% vs. 92.0%, P > 0.999) and vaginal HSIL regression rate (96.7% vs. 94.7%, P = 0.805) after vaginectomy. However, the RALV group had significantly higher hospital costs than that in the CLV group (53035.1 ± 9539.0 yuan vs. 32706.8 ± 6659.2 yuan, P < 0.001). CONCLUSIONS Both RALV and CLV can achieve satisfactory treatment outcomes, while RALV has the advantages of less intraoperative blood loss, fewer intraoperative complications rate and faster postoperative recovery. Robotic-assisted surgery has the potential to become a better choice for vaginectomy in patients with vaginal HSIL without regard to the burden of hospital costs.
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Affiliation(s)
- Yana Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Meng Mao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Jing Bai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Mingbo Cai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Qian Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Hanlin Fu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Mengling Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Chunfang Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Lulu Si
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China.
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Ahuja V, Paredes LG, Leeds IL, Perkal MF, Tsutsumi A, Bhandarkar S, King JT. Racial disparities in complications following elective colon cancer resection: Impact of laparoscopic versus robotic approaches. Am J Surg 2024; 227:85-89. [PMID: 37806892 PMCID: PMC10842593 DOI: 10.1016/j.amjsurg.2023.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND We sought to examine differences in outcomes for Black and White patients undergoing robotic or laparoscopic colectomy to assess the potential impact of technological advancement. METHODS We queried the ACS-NSQIP database for elective robotic (RC) and laparoscopic (LC) colectomy for cancer from 2012 to 2020. Outcomes included 30-day mortality and complications. We analyzed the association between outcomes, operative approach, and race using multivariable logistic regression. RESULTS We identified 64,460 patients, 80.9% laparoscopic and 19.1% robotic. RC patients were most frequently younger, male, and White, with fewer comorbidities (P < 0.001). After adjustment, there was no difference in mortality by approach or race. Black patients who underwent LC had higher complications (OR 1.10, 95% CI 1.03-1.08, P = 0.005) than their White LC counterparts and RC patients. CONCLUSIONS Robotic colectomy was associated with lower rates of complications in minority patients. Further investigation is required to identify the causal pathway that leads to our finding.
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Affiliation(s)
- Vanita Ahuja
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA; Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Lucero G Paredes
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA; National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Ira L Leeds
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA; Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Melissa F Perkal
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA; Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ayaka Tsutsumi
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - Joseph T King
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA; Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
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Sanchez-Encinas M, Rey-Biel J, Alias D, Noguero-Meseguer R, Granell J, Muguruza I, Herrero A, Ayala JL, Barba R. Performance of a multidisciplinary robotic surgery program at a university hospital (2012-2022). J Robot Surg 2023; 17:2869-2874. [PMID: 37804394 DOI: 10.1007/s11701-023-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Abstract
Robotic-assisted surgery has become widely adopted for its ability to expand the indications for minimally invasive procedures. This technology aims to improve precision, accuracy, and outcomes while reducing complications, blood loss, and recovery time. Successful implementation of a robotic surgery program requires careful initial design and a focus on maintenance and expansion to maximize its benefits. This article presents a comprehensive study conducted at a University Hospital on the robotic surgery program from December 2012 to December 2022. Data from hospital databases, including patient demographics, surgical department, surgical time, operating room occupancy, and primary diagnosis, were analyzed. The analysis covered various time periods (surgical sessions, weeks, months, and years) to assess the program's evolution over time. Over the 10-year period, a total of 1847 robotic-assisted interventions were performed across five surgical services. Urology accounted for 57% of the cases, general surgery 17%, gynecology 16%, otorhinolaryngology 6%, and thoracic surgery 4%. The most frequently performed procedures included robotic prostatectomies (643 cases), hysterectomies (261 cases), and colposacropexies (210 cases). The weekly volume of interventions showed a notable increase, rising from 2 cases per week in 2013-2014 cases in 2022. Moreover, the average surgical duration per intervention exhibited a progressive decrease from 275 min in 2013 to 184 min in 2022. This study highlights the potential of a well-managed robotic surgery program as a viable alternative to conventional surgical approaches. Effective coordination and resource utilization contribute to the program's efficiency. The findings underscore the successful integration of robotic-assisted surgery in diverse surgical specialties.
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Affiliation(s)
- Miguel Sanchez-Encinas
- Department of Urology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, 28933, Madrid, Spain
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain
| | - Juan Rey-Biel
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain
- Department of Maxilofacial Surgery, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - David Alias
- Department of General Surgery, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Rosario Noguero-Meseguer
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain
- Department of Gynecology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - José Granell
- Department of Otorhinolaryngology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Ignacio Muguruza
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain
- Department of Thoracic Surgery, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - Jose Luis Ayala
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Raquel Barba
- International Doctorate School, Rey Juan Carlos University, 28933, Madrid, Spain.
- Research Institute-Fundacion Jimenez Diaz, Madrid, Spain.
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
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Urrutia R, Espejo D, Evens N, Guerra M, Sühn T, Boese A, Hansen C, Fuentealba P, Illanes A, Poblete V. Clustering Methods for Vibro-Acoustic Sensing Features as a Potential Approach to Tissue Characterisation in Robot-Assisted Interventions. SENSORS (BASEL, SWITZERLAND) 2023; 23:9297. [PMID: 38067671 PMCID: PMC10708300 DOI: 10.3390/s23239297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
This article provides a comprehensive analysis of the feature extraction methods applied to vibro-acoustic signals (VA signals) in the context of robot-assisted interventions. The primary objective is to extract valuable information from these signals to understand tissue behaviour better and build upon prior research. This study is divided into three key stages: feature extraction using the Cepstrum Transform (CT), Mel-Frequency Cepstral Coefficients (MFCCs), and Fast Chirplet Transform (FCT); dimensionality reduction employing techniques such as Principal Component Analysis (PCA), t-Distributed Stochastic Neighbour Embedding (t-SNE), and Uniform Manifold Approximation and Projection (UMAP); and, finally, classification using a nearest neighbours classifier. The results demonstrate that using feature extraction techniques, especially the combination of CT and MFCC with dimensionality reduction algorithms, yields highly efficient outcomes. The classification metrics (Accuracy, Recall, and F1-score) approach 99%, and the clustering metric is 0.61. The performance of the CT-UMAP combination stands out in the evaluation metrics.
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Affiliation(s)
- Robin Urrutia
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile; (R.U.); (V.P.)
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | - Diego Espejo
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | - Natalia Evens
- Instituto de Anatomia, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5111187, Chile; (N.E.); (M.G.)
| | - Montserrat Guerra
- Instituto de Anatomia, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5111187, Chile; (N.E.); (M.G.)
| | - Thomas Sühn
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
- SURAG Medical GmbH, 39118 Magdeburg, Germany;
| | - Axel Boese
- INKA Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Christian Hansen
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany;
| | - Patricio Fuentealba
- Instituto de Electricidad y Electrónica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | | | - Victor Poblete
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile; (R.U.); (V.P.)
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
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10
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Panse NS, Prasath V, Quinn PL, Chokshi RJ. Economic evaluation of robotic and laparoscopic paraesophageal hernia repair. Surg Endosc 2023; 37:6806-6817. [PMID: 37264228 DOI: 10.1007/s00464-023-10119-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Robotic approach in paraesophageal hernia (PEH) repair may improve outcomes over laparoscopic approach, though at additional cost. This study aimed to compare cost-effectiveness of robotic and laparoscopic PEH repair. METHODS A decision tree was created analyzing cost-effectiveness of robotic and laparoscopic PEH repair. Costs were obtained from 2021 Medicare data and were accumulated within 60 months after surgery. Effectiveness was measured in quality-adjusted life-years (QALYs). Branch-point probabilities and costs of robotic surgery consumables were obtained from published literature. The primary outcome of interest was incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed. A secondary analysis including attributable capital and maintenance costs of robotic surgery was conducted as well. RESULTS Laparoscopic repair yielded 3.660 QALYs at $35,843.82. Robotic repair yielded 3.661 QALYs at $36,342.57, with an ICER of $779,488.62/QALY. Robotic repair was favored when rates of open conversion and symptom recurrence were low, or with reduced cost of robotic instruments. A probabilistic sensitivity analysis favored laparoscopic repair in 100% of simulations. When accounting for costs of robotic technology, robotic approach was preferred only in unrealistic clinical scenarios. CONCLUSIONS Laparoscopic repair is likely more cost-effective for most institutions, though results were relatively similar. With experienced surgeons who surpass the initial learning curve, robotic surgery may improve outcomes enough to be cost-effective, but only when excluding capital and maintenance fees.
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Affiliation(s)
- Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
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11
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Mills J, Liebert C, Wren SM, Pratt JSA, Earley M, Eisenberg D. Robotic General Surgery Trends in the Veterans Health Administration, Community Practice, and Academic Centers From 2013 to 2021. JAMA Surg 2023; 158:552-554. [PMID: 36790771 PMCID: PMC9932937 DOI: 10.1001/jamasurg.2022.7728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/04/2022] [Indexed: 02/16/2023]
Abstract
This cross-sectional study compares trends in use of robotic surgery for general surgical procedures among the Veterans Health Administration (VHA), community practice, and academic health centers from 2013 to 2021.
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Affiliation(s)
- John Mills
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Cara Liebert
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Janey S. A. Pratt
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Michelle Earley
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Dan Eisenberg
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
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12
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Day EK, Galbraith NJ, Ward HJT, Roxburgh CS. Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review. J Robot Surg 2022; 17:811-826. [PMID: 36315379 DOI: 10.1007/s11701-022-01461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.
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Affiliation(s)
- Elizabeth K Day
- Urology Department, University College London Hospital, Westmoreland Street, London, UK.
| | - Norman J Galbraith
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hester J T Ward
- Public Health Scotland, Gyle Square, Gyle Crescent, Edinburgh, UK
| | - Campbell S Roxburgh
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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13
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Protecting procedural care-cybersecurity considerations for robotic surgery. NPJ Digit Med 2022; 5:148. [PMID: 36127420 PMCID: PMC9489690 DOI: 10.1038/s41746-022-00693-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
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