Comparison of robot-assisted and standard laparoscopic procedures in patients with endometrial cancer

Leitao, Mario M.; Gardner, Ginger J.; Briscoe, Gabriel; Santos, Kevin; Jewell, E.; Abu‐Rustum, Nadeem R.; Brown, Carol L.; Chi, D.S.; Sonoda, Yukio; Barakat, Richard R.

doi:10.1016/j.ygyno.2010.12.303

Gynecologic Oncology

2011

DOI: 10.1016/j.ygyno.2010.12.303

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Comparison of robot-assisted and standard laparoscopic procedures in patients with endometrial cancer

Mario M. Leitao

Ginger J. Gardner

Gabriel Briscoe

et al.

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“…8 In addition, the operative times for robotic surgery equaled those of laparoscopy for endometrial cancer after 40 hysterectomies at our institution, which successfully performed 174 minimally invasive hysterectomies for endometrial cancer in 2010 alone. 8 Wright et al 2 defined a high-volume surgeon as one who performed more than 14 hysterectomies per year based on equal tertiles of volume. This is a commonly accepted method to define volume categories in the analysis of these databases.…”

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Potential Pitfalls of the Rapid Uptake of New Technology in Surgery: Can Comparative Effectiveness Research Help?

Leitao

2012

JCO

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See accompanying article on page 783Most of us are aware of the ever-increasing health care costs in the United States and of the ongoing battle taking place in Washington to address this issue. There is a need and demand for comparative effectiveness research (CER) to find more cost-efficient and evidencebased care for our patients. If done correctly, CER can have significant impacts on health care decisions. In 1999, the Institute of Medicine composed a list of 100 priority topics for CER, 1 and one topic on that list was to "compare the effectiveness of robotic assistance surgery and conventional surgery for common operations." 1(p6) Wright et al 2 report the results of their CER regarding robotic versus laparoscopic hysterectomy for endometrial cancer in the article that accompanies this editorial. Their meritorious article provides important information using a validated method and database. I agree with the authors' conclusions that their findings highlight the potential pitfalls of the rapid uptake of new technology; however, there are equally as many pitfalls with conclusions drawn from premature CER studies. Although their report provides important cost information for the learning curve of a complex new surgical technology, it is difficult to extrapolate beyond that.The 2009 Institute of Medicine report 1 called for a comparison of robotic assistance to conventional surgery. At that time, the standard, or conventional, surgery for endometrial cancer was not laparoscopy but laparotomy. The Gynecologic Oncology Group published the results of a large randomized trial comparing laparoscopy with the standard approach of laparotomy (LAP2) at the end of 2009. 3,4 Gynecologic Oncology Group LAP2 confirmed that a laparoscopic approach was superior to laparotomy with the increased operative times greatly outweighed by the benefits of decreased complications and improved quality of life. 3,4 Despite the many reported benefits of laparoscopy, it is still not the standard, or conventional, approach for the majority of hysterectomies performed in the United States. Laparoscopic approaches for hysterectomy have been available for 20 years. 5 There were 518,828 hysterectomies recorded in the 2005 National Inpatient Sample, a national database sponsored by the Agency for Healthcare Research and Quality, of which only 14% were performed via a laparoscopic technique. 6 There are many reasons for the limited adoption of laparoscopy. Perhaps the primary reason is that laparoscopy is difficult to learn and to perform proficiently. There are expert laparoscopists who can perform remarkable tasks with standard laparoscopy, and their skills cannot be minimized. But such experts are not common, and the majority of women will therefore never have the opportunity to benefit from a minimally invasive hysterectomy. I was trained in laparoscopy by expert laparoscopists. I was not, nor were those who trained me, comfortable in offering minimally invasive approaches for certain patients and procedures. The robotic platform has changed...

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Potential Pitfalls of the Rapid Uptake of New Technology in Surgery: Can Comparative Effectiveness Research Help?

Leitao

2012

JCO

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Comparison of robot-assisted and standard laparoscopic procedures in patients with endometrial cancer

Cited by 1 publication

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Potential Pitfalls of the Rapid Uptake of New Technology in Surgery: Can Comparative Effectiveness Research Help?

Potential Pitfalls of the Rapid Uptake of New Technology in Surgery: Can Comparative Effectiveness Research Help?

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