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Betser L, Le Bras A, Etienne H, Roussel A, Bobbio A, Al-Zreibi C, Martinod E, Alifano M, Castier Y, Assouad J, Durand-Zaleski I, Mordant P. Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals. J Robot Surg 2024; 18:124. [PMID: 38492119 DOI: 10.1007/s11701-024-01879-w] [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: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Robotic-assisted thoracic surgery (RATS) is an effective treatment of non-small cell lung cancer (NSCLC) but the effects of its implementation in university hospital networks has not been described. We analyzed the early clinical outcomes, estimated costs, and revenues associated with three robotic systems implemented in the Paris Public Hospital network. A retrospective study included patients who underwent RATS for NSCLC in 2019 and 2020. Ninety-day morbidity, mortality, hospital costs, and hospital revenues were described. Economic analyses were conducted either from the hospital center or from the French health insurance system perspectives. Cost drivers were tested using univariate and multivariable analyses. Sensitivity analyses were performed to assess uncertainty over in-hospital length of stay (LOS), number of robotic surgeries per year, investment cost, operating room occupancy time, maintenance cost, and commercial discount. The study included 188 patients (65.8 ± 9.3 years; Charlson 4.1 ± 1.4; stage I 76.6%). Median in-hospital LOS was 6 days [5-9.5], 90-day mortality was 1.6%. Mean hospital expenses and revenues were €12,732 ± 4914 and €11,983 ± 5708 per patient, respectively. In multivariable analysis, factors associated with hospital costs were body mass index, DLCO, major complications, and transfer to intensive care unit. Sensitivity analyses showed that in-hospital LOS (€11,802-€15,010) and commercial discounts on the list price (€11,458-€12,732) had an important impact on costs. During the first 2 years following the installation of three robotic systems in Paris Public Hospitals, the clinical outcomes of RATS for NSCLC have been satisfactory. Without commercial discount, hospital expenses would have exceeded hospital revenues.Clinical registration number CNIL, N°2221601, CERC-SFCTCV-2021-07-20-Num17_MOPI_robolution.
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Affiliation(s)
- Léa Betser
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Alicia Le Bras
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Arnaud Roussel
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Charles Al-Zreibi
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Bobigny, France
- Hôpitaux de Paris, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Department of Public Health, Université Paris Est, Hôpital Henri Mondor, Créteil, France
- Hôpitaux de Paris, Paris, France
| | - Pierre Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
- Hôpitaux de Paris, Paris, France.
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Alvarado CE, Worrell SG, Sarode AL, Jiang B, Halloran SJ, Argote-Greene LM, Linden PA, Towe CW. Comparing Thoracoscopic and Robotic Lobectomy Using a Nationally Representative Database. Am Surg 2023; 89:5340-5348. [PMID: 36573595 DOI: 10.1177/00031348221148347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Studies of robotic lobectomy (Robot-L) have been performed using data from high-volume, specialty centers which may not be generalizable. The purpose of this study was to compare mortality, length of stay (LOS), and cost between Robot-L and thoracoscopic lobectomy (VATS-L) using a nationally representative database hypothesizing they would be similar. METHODS The Premier Healthcare Database was used to identify patients receiving elective lobectomy for lung cancer from 2009 to 2019. Patients were categorized as receiving Robot-L or VATS-L using ICD-9/10 codes. Survey methodology and patient level weighting were used to correct for sampling error and estimation of a nationally representative sample. A propensity match analysis was performed to reduce bias between the groups. Primary outcome of interest was in-hospital mortality. Secondary outcomes were LOS and patient charges. RESULTS Among 62 698 patients, 19 506 (31.1%) underwent Robot-L and 43 192 (68.9%) underwent VATS-L. Differences between the groups included age, race, comorbidities, and insurance type. A propensity matched cohort demonstrated similar in-hospital mortality for Robot-L and VATS-L (.9% vs .9%, respectively, P = .91). Patients who underwent Robot-L had a shorter LOS (4 vs 5d, respectively, P < .001) but higher patient charges (90 593.0 vs 72 733.3 USD, respectively, P < .001). CONCLUSIONS In a nationally representative database, Robot-L and VATS-L had similar mortality. Although Robot-L was associated with shorter hospitalization, it was also associated with excess charges of almost $20,000. As Robot-L is now the most common approach for lobectomy in the U.S., further study into the cost and benefit of robotic surgery is warranted.
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Affiliation(s)
- Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephanie G Worrell
- Section of Thoracic Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Anuja L Sarode
- UH-RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Boxiang Jiang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sean J Halloran
- Department of Surgery, University of Toledo School College of Medicine and Life Sciences, Toledo, OH, USA
| | - Luis M Argote-Greene
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Forcada C, Gómez-Hernández MT, Fuentes MG, Rivas CE, Novoa NM, Aranda JL, Varela G, Jiménez MF. Robotic-Assisted Thoracoscopic Anatomical Lung Resection Improves Cardiopulmonary Outcomes in Patients With Body Mass Index≥25kg/m 2: A Propensity Score Matching Analysis. Arch Bronconeumol 2023; 59:779-781. [PMID: 37709586 DOI: 10.1016/j.arbres.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - María Teresa Gómez-Hernández
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain.
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Cristina E Rivas
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - José Luis Aranda
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
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Tasoudis PT, Diehl JN, Merlo A, Long JM. Long-term outcomes of robotic versus video-assisted pulmonary lobectomy for non-small cell lung cancer: systematic review and meta-analysis of reconstructed patient data. J Thorac Dis 2023; 15:5700-5713. [PMID: 37969301 PMCID: PMC10636447 DOI: 10.21037/jtd-23-582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/25/2023] [Indexed: 11/17/2023]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are two viable options in patients undergoing lobectomy for non-small cell lung cancer (NSCLC); however, the debate on which one is superior is unceasing. Methods PubMed and Scopus databases were queried for studies including patients who underwent either VATS or RATS lobectomy. This meta-analysis is in accordance with the recommendations of the PRISMA statement. Individual patient data on overall survival (OS) and disease-free survival (DFS) were extracted from Kaplan-Meier curves. One- and two-stage survival analyses, and random-effects meta-analyses were conducted. Results Ten studies met our eligibility criteria, incorporating 1,231 and 814 patients in the VATS and RATS groups, respectively. Patients who underwent VATS had similar OS compared with those who underwent RATS [hazard ratio (HR): 1.05, 95% confidence interval (CI): 0.88-1.27, P=0.538] during a weighted median follow-up of 51.7 months, and this was validated by the two-stage meta-analysis (HR: 1.27, 95% CI: 0.85-1.90, P=0.24, I2=68.50%). Regarding DFS, the two groups also displayed equivalent outcomes (HR: 1.07, 95% CI: 0.92-1.25, P=0.371) and this was once again validated by the two-stage meta-analysis (HR: 1.05, 95% CI: 0.85-1.30, P=0.67, I2=28.27%). Both RATS and VATS had similar postoperative complication rates, prolonged air leak, conversion to thoracotomy and operative times. RATS was found to be superior to VATS in terms of length of hospital stay and number of lymph nodes dissected. Conclusions In patients undergoing lobectomy for NSCLC, VATS and RATS have equivalent overall and DFS at a median follow-up of 51.7 months.
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Affiliation(s)
| | - J. Nathaniel Diehl
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aurelie Merlo
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason M. Long
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Shanahan B, Galloway R, Stamenkovic S, Lau K, Waller D, Wilson H, Perikleous P. Thoracoscopic surgery in lung cancer: the rise of the robot. J Thorac Dis 2023; 15:5263-5267. [PMID: 37969288 PMCID: PMC10636456 DOI: 10.21037/jtd-23-1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023]
Affiliation(s)
| | - Richard Galloway
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | | | - Kelvin Lau
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | - David Waller
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | - Henrietta Wilson
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
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Jacob A, Coker A, Stamenkovic SA. Robotic-Assisted Thoracic Surgery Approach to Thoracic Endometriosis Syndrome with Unilateral Diaphragmatic Palsy. Case Rep Surg 2023; 2023:5493232. [PMID: 37649828 PMCID: PMC10465253 DOI: 10.1155/2023/5493232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
Endometriosis is characterized by endometrial-like glands and stroma outside the uterine cavity, affecting women of reproductive age. Thoracic endometriosis syndrome (TES) is an entity producing a range of clinical and radiological manifestations, including catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules within the thoracic cavity or on the diaphragm. TES symptoms are nonspecific, warranting a high degree of clinical suspicion. Management includes hormone replacement therapy, surgical management, or a combination of both. We present a case of a 37-year-old woman who presented with TES and unilateral diaphragmatic palsy, managed with robotic-assisted thoracoscopic surgery and hormone replacement.
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Affiliation(s)
- Abiah Jacob
- Barts Thorax Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Adeyemi Coker
- Queens University Hospital Endometriosis Centre, Barking Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AD, UK
- Advanced Laparoscopic Gynaecology, Barts Health NHS Trust, West Smithfield, London, UK
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Mattioni G, Palleschi A, Mendogni P, Tosi D. Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review. J Robot Surg 2022; 17:797-809. [DOI: 10.1007/s11701-022-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
AbstractRobotic-Assisted Thoracic Surgery (RATS) is considered one of the main issues of present thoracic surgery. RATS is a minimally invasive surgical technique allowing enhanced view, accurate and complex movements, and high ergonomics for the surgeon. Despite these advantages, its application in lung procedures has been limited, mainly by its costs. Since now many different approaches have been proposed and the experience in RATS for lungs ranges from wedge resection to pneumonectomy and is mainly related to lung cancer. The present narrative review explores main approaches and outcomes of RATS lobectomy for lung cancer. A non-systematic review of literature was conducted using the PubMed search engine. An overview of lung robotic surgery is given, and main approaches of robotic lobectomy for lung cancer are exposed. Initial experiences of biportal and uniportal RATS are also described. So far, retrospective analysis reported satisfactory robotic operative outcomes, and comparison with VATS might suggest a more accurate lymphadenectomy. Some Authors might even suggest better perioperative outcomes too. From an oncological standpoint, no definitive prospective study has yet been published but several retrospective analyses report oncological outcomes comparable to those of VATS and open surgery. Literature suggests that RATS for lung procedures is safe and effective and should be considered as a valid additional surgical option.
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Rocha Júnior E, Terra RM. Robotic lung resection: a narrative review of the current role on primary lung cancer treatment. J Thorac Dis 2022; 14:5039-5055. [PMID: 36647483 PMCID: PMC9840053 DOI: 10.21037/jtd-22-635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
Background and Objective Robotic-assisted thoracic surgery (RATS) has increasingly been applied to primary lung cancer treatment. Given the many facilities provided by the robotic platform in the manipulation of tissues and precision of movements, there is continuous enquiring about its contribution to the improvement of surgical outcomes. Also, the possibility to perform complex resections in a minimally invasive way using a robotic approach starts to become possible as the centers' learning curve expands. We propose to perform a review of the current status of robotic surgery for lung cancer focusing on key frontier points: sublobar resections, quality of lymphadenectomy, complex resections, postoperative outcomes, and innovative technologies to arrive. Methods We performed a narrative review of the literature aggregating the most current references available in English. Key Content and Findings According to the current data, the flourishing of the robotic platform seems to be in line with the spread of sublobar resections. The technological benefits inherent to the platform, also seem to promote an increase in the quality of lymphadenectomy and a shorter learning curve when compared to video-assisted thoracic surgery (VATS) with equivalent oncological results. Its application in complex resections such as bronchial sleeve already presents consistent results and new technology acquisitions such as three-dimensional reconstructions, augmented reality and artificial intelligence tend to be implemented collaborating with the digitization of surgery. Conclusions Robotic surgery for lung cancer resection is at least equivalent to the VATS approach considering the currently available literature. However, more practice time and prospective clinical trials are needed to identify more exact benefits.
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Affiliation(s)
- Eserval Rocha Júnior
- Division of Thoracic Surgery at University of São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil;,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo Mingarini Terra
- Division of Thoracic Surgery at University of São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil;,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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