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Lazar DJ, Ferzli GS. Is the robotic revolution stunting surgical skills? Surg Open Sci 2024; 19:63-65. [PMID: 38595831 PMCID: PMC11002294 DOI: 10.1016/j.sopen.2024.03.009] [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: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow. Key message The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.
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Affiliation(s)
- Damien J. Lazar
- New York University Langone Health, Department of General Surgery, New York, NY, United States of America
| | - George S. Ferzli
- New York University Langone Health, Department of General Surgery, New York, NY, United States of America
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2
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Wu KA, Boccaccio K, Buckles D, Hartwig MG, Klapper JA. Efforts to improve the billing accuracy of robotic-assisted thoracic surgery through education, updated procedure cards, and electronic medical record system changes. BMJ Open Qual 2024; 13:e002710. [PMID: 38649198 PMCID: PMC11043709 DOI: 10.1136/bmjoq-2023-002710] [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: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
Precise medical billing is essential for decreasing hospital liability, upholding environmental stewardship and ensuring fair costs for patients. We instituted a multifaceted approach to improve the billing accuracy of our robotic-assisted thoracic surgery programme by including an educational component, updating procedure cards and removing the auto-populating function of our electronic medical record. Overall, we saw significant improvements in both the number of inaccurate billing cases and, specifically, the number of cases that overcharged patients.
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Affiliation(s)
- Kevin A Wu
- Duke University School of Medicine, Durham, North Carolina, USA
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kenneth Boccaccio
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Danielle Buckles
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Matthew G Hartwig
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jacob A Klapper
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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de'Angelis N, Conso C, Bianchi G, Rodríguez AGB, Marchegiani F, Carra MC, Lafont C, Canouï-Poitrine F, Slim K, Pessaux P. Systematic review of carbon footprint of surgical procedures. J Visc Surg 2024; 161:7-14. [PMID: 38087700 DOI: 10.1016/j.jviscsurg.2023.03.002] [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] [Indexed: 05/01/2024]
Abstract
The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4-814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.
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Affiliation(s)
- Nicola de'Angelis
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Christel Conso
- Service de chirurgie orthopedique, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Giorgio Bianchi
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Ana Gabriela Barría Rodríguez
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Francesco Marchegiani
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Maria Clotilde Carra
- Service of odontology, department of periodontology, Rothschild hospital, U.F.R. of odontology-Garancière, université de Paris, AP-HP, 75006 Paris, France
| | - Charlotte Lafont
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Florence Canouï-Poitrine
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Karem Slim
- Department of digestive surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), university hospital, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Patrick Pessaux
- Digestive surgery department, HPB unit, Nouvel Hôpital Civil, university of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Slim K, Tilmans G, Occéan BV, Dziri C, Pereira B, Canis M. Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers. J Visc Surg 2024; 161:76-89. [PMID: 38355331 DOI: 10.1016/j.jviscsurg.2024.01.004] [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] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location. METHOD The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis "meta" version 6.5-0. RESULTS Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n=1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR=0.48 [0.24-0.95], p=0.04, I2=0%), and a longer operative time for RS (mean difference=39.11min [9.39-68.83], p<0.01, I2=96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5hours earlier after RS), and lymph node dissection (one more lymph node for LS). CONCLUSION This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.
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Affiliation(s)
- Karem Slim
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Gilles Tilmans
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Chadly Dziri
- Honoris Center for Medical Simulation, Tunis, Tunisia
| | - Bruno Pereira
- Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Canis
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [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: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Limperg TB, Novoa VY, Curlin HL, Veersema S. Laparoscopic Trocars: Marketed Versus True Dimensions-A Descriptive Study. J Minim Invasive Gynecol 2024; 31:304-308. [PMID: 38242350 DOI: 10.1016/j.jmig.2024.01.008] [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: 07/05/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
STUDY OBJECTIVE To establish true dimensions of single-use laparoscopic trocars compared with marketed dimensions, calculate corresponding incision sizes, examine what trocar size categories are based on, and outline accessibility of information regarding true dimensions. DESIGN Descriptive study. SETTING Laparoscopic disposable trocars available in North America and Europe are marketed in several distinct categories. In practice, trocars in the same-size category exhibit different functionality (ability to introduce instruments/needles and retrieve specimens) and warrant different incision lengths. PATIENTS Not applicable. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS True dimensions for 125 trocars (bladeless, optical, and balloon) were obtained from 9 vendors covering 8 marketed size categories (3-, 3.5-, 5-, 8-, 10-, 11-, 12-, and 15-mm trocars). On average, true inner cannula diameter was 0.92 mm wider (SD, 0.41 mm; range, 0-2.4 mm) than the marketed size category, with the widest range in the 5 mm category. For 5-mm trocars, mean true inner diameter was 6.1 mm (SD, 0.45; range, 5.5-7.4) and true outer diameter 8.3 mm (SD, 0.71; range, 8.0-10.7). For 12-mm trocars, mean true inner diameter was 13.0 mm (SD, 0.21; range, 12-13.3) and outer diameter 15.3 mm (SD, 0.48; range, 14.4-16.8). Five-mm trocars necessitate a mean incision size of 13.0 mm (SD, 1.1; range, 12.1-16.8) and 12-mm trocars a mean incision of 24.0 mm (SD, 0.75; range, 22.6-26.4). No vendors stated actual diameters on company website or catalog. In one instance the Instructions For Use document contained the true inner diameter. CONCLUSION Trocar size categories give a false sense of standardization when in actuality there are considerable within-category differences in both inner and outer diameters, corresponding to differences in functionality and required incision sizes. There is no universally applied definition for trocar size categories. Accessibility of information on true dimensions is limited.
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Affiliation(s)
- Tobias B Limperg
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands (Dr. Limperg); Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee (Drs. Limperg, Novoa, and Curlin); Endometriose in Balans, Haaglanden Medisch Centrum, The Hague, The Netherlands (Dr. Limperg).
| | - Victoria Y Novoa
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee (Drs. Limperg, Novoa, and Curlin)
| | - Howard L Curlin
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee (Drs. Limperg, Novoa, and Curlin)
| | - Sebastiaan Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands (Dr. Veersema)
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Slim K, Martin F. Surgery, innovation, research and sustainable development. J Visc Surg 2024; 161:63-68. [PMID: 38071141 DOI: 10.1016/j.jviscsurg.2023.10.005] [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] [Indexed: 05/01/2024]
Abstract
In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.
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Affiliation(s)
- Karem Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé (CERES), Beaumont, France.
| | - Frédéric Martin
- Private Hospitals of Versailles - Ramsay Santé, Versailles, France
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Grössmann-Waniek N, Riegelnegg M, Gassner L, Wild C. Robot-assisted surgery in thoracic and visceral indications: an updated systematic review. Surg Endosc 2024; 38:1139-1150. [PMID: 38307958 PMCID: PMC10881599 DOI: 10.1007/s00464-023-10670-1] [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: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery. METHODS We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration's Tool Version 1. RESULTS For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications-recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting. CONCLUSION In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment.
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Affiliation(s)
- Nicole Grössmann-Waniek
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Michaela Riegelnegg
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Lucia Gassner
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
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Boal M, Di Girasole CG, Tesfai F, Morrison TEM, Higgs S, Ahmad J, Arezzo A, Francis N. Evaluation status of current and emerging minimally invasive robotic surgical platforms. Surg Endosc 2024; 38:554-585. [PMID: 38123746 PMCID: PMC10830826 DOI: 10.1007/s00464-023-10554-4] [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: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework. METHODS A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature. RESULTS 21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0. CONCLUSIONS The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
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Affiliation(s)
- M Boal
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | | | - F Tesfai
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - T E M Morrison
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - S Higgs
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - J Ahmad
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - N Francis
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK.
- Yeovil District Hospital, Somerset NHS Foundation Trust, Yeovil, UK.
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Dargent J. Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project. Sci Rep 2024; 14:1252. [PMID: 38218989 PMCID: PMC10787753 DOI: 10.1038/s41598-024-51441-9] [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: 05/10/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021-March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.
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Affiliation(s)
- Jerome Dargent
- Polyclinique de Rillieux, 65 Rue des Contamines, 69140, Rillieux-la-Pape, France.
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Marcus HJ, Ramirez PT, Khan DZ, Layard Horsfall H, Hanrahan JG, Williams SC, Beard DJ, Bhat R, Catchpole K, Cook A, Hutchison K, Martin J, Melvin T, Stoyanov D, Rovers M, Raison N, Dasgupta P, Noonan D, Stocken D, Sturt G, Vanhoestenberghe A, Vasey B, McCulloch P. The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring. Nat Med 2024; 30:61-75. [PMID: 38242979 DOI: 10.1038/s41591-023-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/20/2023] [Indexed: 01/21/2024]
Abstract
The next generation of surgical robotics is poised to disrupt healthcare systems worldwide, requiring new frameworks for evaluation. However, evaluation during a surgical robot's development is challenging due to their complex evolving nature, potential for wider system disruption and integration with complementary technologies like artificial intelligence. Comparative clinical studies require attention to intervention context, learning curves and standardized outcomes. Long-term monitoring needs to transition toward collaborative, transparent and inclusive consortiums for real-world data collection. Here, the Idea, Development, Exploration, Assessment and Long-term monitoring (IDEAL) Robotics Colloquium proposes recommendations for evaluation during development, comparative study and clinical monitoring of surgical robots-providing practical recommendations for developers, clinicians, patients and healthcare systems. Multiple perspectives are considered, including economics, surgical training, human factors, ethics, patient perspectives and sustainability. Further work is needed on standardized metrics, health economic assessment models and global applicability of recommendations.
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Affiliation(s)
- Hani J Marcus
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK.
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK.
| | - Pedro T Ramirez
- Department of Obstetrics and Gynaecology, Houston Methodist Hospital Neal Cancer Center, Houston, TX, USA
| | - Danyal Z Khan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Simon C Williams
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - David J Beard
- RCS Surgical Interventional Trials Unit (SITU) & Robotic and Digital Surgery Initiative (RADAR), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
| | - Rani Bhat
- Department of Gynaecological Oncology, Apollo Hospital, Bengaluru, India
| | - Ken Catchpole
- Department of Anaesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Cook
- NIHR Coordinating Centre and Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, Ontario, Canada
| | - Tom Melvin
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Maroeska Rovers
- Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands
| | - Nicholas Raison
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Prokar Dasgupta
- King's Health Partners Academic Surgery, King's College London, London, UK
| | | | - Deborah Stocken
- RCSEng Surgical Trials Centre, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Anne Vanhoestenberghe
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Baptiste Vasey
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Roscioli R, Wyllie T, Neophytou K, Dent L, Lowen D, Tan D, Dunne B, Hodgson R. How we can reduce the environmental impact of our operating theatres: a narrative review. ANZ J Surg 2023. [PMID: 37985608 DOI: 10.1111/ans.18770] [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: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re-use and re-processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service.
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Affiliation(s)
- Robert Roscioli
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Tracey Wyllie
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | | | - Lana Dent
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | - Darren Lowen
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - David Tan
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
| | - Ben Dunne
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Peter Macallum Cancer Centre, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Russell Hodgson
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
- Division of Surgery, Northern Health, Epping, Victoria, Australia
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da Silva Filho AL, Cândido EB, Praça MSL, Saraiva PHT, Lamaita RM, Canis M. Embracing a Sustainable Approach in Gynecology and Obstetrics: The Surgeon's Duty to Safeguard both Patient and Environment. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e435-e438. [PMID: 37683654 PMCID: PMC10491468 DOI: 10.1055/s-0043-1772472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Affiliation(s)
| | - Eduardo Batista Cândido
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mariana Seabra Leite Praça
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Rívia Mara Lamaita
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Michel Canis
- Department of Obstetrics and Gynecology, University Hospital Clermont-Ferrand, 63000 Clermont Ferrand, France
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14
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Chan KS, Lo HY, Shelat VG. Carbon footprints in minimally invasive surgery: Good patient outcomes, but costly for the environment. World J Gastrointest Surg 2023; 15:1277-1285. [PMID: 37555111 PMCID: PMC10405111 DOI: 10.4240/wjgs.v15.i7.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 07/21/2023] Open
Abstract
Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery (MIS). Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and mortality. MIS has become the first-line surgical intervention for some types of gastrointestinal surgery, such as laparoscopic cholecystectomy and appendicectomy. Carbon dioxide (CO2) is the main gas used for insufflation in MIS. CO2 contributes 9%-26% of the greenhouse effect, resulting in global warming. The rise in global CO2 concentration since 2000 is about 20 ppm per decade, up to 10 times faster than any sustained rise in CO2 during the past 800000 years. Since 1970, there has been a steady yet worrying increase in average global temperature by 1.7 °C per century. A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO2 emission per surgery, with higher CO2 emission following robotic compared to laparoscopic surgery. However, with superior benefits of MIS over open surgery, this poses an ethical dilemma to surgeons. A recent survey in the United Kingdom of 130 surgeons showed that the majority (94%) were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental sustainability. Given the deleterious environmental effects of MIS, this study aims to summarize the trends of MIS and its carbon footprint, awareness and attitudes towards this issue, and efforts and challenges to ensuring environmental sustainability.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Hong Yee Lo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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15
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Slim K. Robotic colonic surgery-the debate is not over. Colorectal Dis 2023; 25:497. [PMID: 36424362 DOI: 10.1111/codi.16431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery and Ambulatory Surgery Unit, University Hospital Clermont, France
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Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:131-138. [PMID: 36601490 PMCID: PMC9763485 DOI: 10.7602/jmis.2022.25.4.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 12/23/2022]
Abstract
Purpose Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database. Methods Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI). Results The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%-37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%-13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively. Conclusion MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.
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Affiliation(s)
- Paul B. S. Lai
- Department of Surgery The Chinese University of Hong Kong Hong Kong
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Affiliation(s)
- L Brunaud
- University of Lorraine, CHRU Nancy, Hospital Brabois Adultes, Department of Gastrointestinal, Visceral, and Metabolic Surgery (CVMC), INSERM U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - K Slim
- University Hospital, CHU Clermont-Ferrand, Department of Digestive Surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
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Assessment of the Versius Robotic Surgical System in Minimal Access Surgery: A Systematic Review. J Clin Med 2022; 11:jcm11133754. [PMID: 35807035 PMCID: PMC9267445 DOI: 10.3390/jcm11133754] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Despite the superiority of minimal access surgery (MAS) over open surgery, MAS is difficult to perform and has a demanding learning curve. Robot-assisted surgery is an advanced form of MAS. The Versius® surgical robot system was developed with the aim of overcoming some of the challenges associated with existing surgical robots. The present study was designed to investigate the feasibility, clinical safety, and effectiveness of the Versius system in MAS. Materials and Methods: A comprehensive search was carried out in the Medline, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan), and Scopus databases for articles published until February 2022. The keywords used were Versius robot, visceral, colorectal, gynecology, and urologic surgeries. Articles on the use of the Versius robot in minimal access surgery (MAS) were included in the review. Results: Seventeen articles were reviewed for the study. The investigation comprised a total of 328 patients who had been operated on with this robot system, of which 48.3%, 14.2%, and 37.5% underwent colorectal, visceral, and gynecological procedures, respectively. Postoperative and major complications within 30 days varied from 7.4% to 39%. No major complications and no readmissions or reoperations were reported in visceral and gynecological surgeries. Readmission and reoperation rates in colorectal surgeries were 0–9%. Some procedures required conversion to conventional laparoscopic surgery (CLS) or open surgery, and all procedures were completed successfully. Based on the studies reviewed in the present report, we conclude that the Versius robot can be used safely and effectively in MAS. Conclusions: A review of the published literature revealed that the Versius system is safe and effective in minimal access surgery. However, the data should be viewed with caution until randomized controlled trials (RCTs) have been performed. Studies on the use of this robotic system in oncological surgery must include survival as one of the addressed outcomes.
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