Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials

Chok, Aik Yong; Zhao, Yun; Tan, Ivan En-Howe; Au, Marianne Kit Har; Tan, Emile

doi:10.1007/s00384-023-04361-5

Cited by 16 publications

(5 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is likely due to several factors including of docking time, more technically demanding procedures like intracorporeal suturing and learning curve ( 46 ). Previous studies ( 25 , 38 , 47 – 49 )reported that RACS had longer operation time compared to LACS, which is consistent with our results ( 38 , 48 , 49 ). With regard to surgical time, along with surgeons becoming more familiar with the robot, the learning curve decreases and the differences seen will gradually balance out ( 50 , 51 ).…”

Section: Discussionsupporting

confidence: 93%

Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials

Huang,

Huang

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

IntroductionThere is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS).Materials and methodsThe four databases (PubMed, Embase, Web of Science and Cochrane Library)were comprehensively searched for randomized controlled trials (RCTs) comparing the outcomes of RACS and LACS in the treatment of colorectal cancer from inception to 22 July 2023.ResultsEleven RCTs were considered eligible for the meta-analysis. Compared with LACS,RACS has significantly longer operation time(MD=5.19,95%CI: 18.00,39.82, P<0.00001), but shorter hospital stay(MD=2.97,95%CI:−1.60,−0.33,P = 0.003),lower conversion rate(RR=3.62,95%CI:0.40,0.76,P = 0.0003), lower complication rate(RR=3.31,95%CI:0.64,0.89,P=0.0009),fewer blood loss(MD=2.71,95%CI:−33.24,−5.35,P = 0.007),lower reoperation rate(RR=2.12, 95%CI:0.33,0.96,P=0.03)and longer distal resection margin(MD=2.16, 95%CI:0.04,0.94, P = 0.03). There was no significantly difference in harvested lymph nodes, the time of first flatus, the time of first defecation,the time of first resume diet, proximal resection margin, readmission rates, mortalities and CRM+ rates between two group.ConclusionsOur study indicated that RACS is a feasible and safe technique that can achieve better surgical efficacy compared with LACS in terms of short-term outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023447088.

show abstract

Section: Discussionsupporting

confidence: 93%

Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials

Huang,

Huang

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…With the implementation of minimally invasive surgery in colorectal surgery the abdominal wall blocks should be preferred to thoracic epidural analgesia which can play a negative role on patient's mobilization and recovery 20,21 . Laparoscopy is a cornerstone of the enhanced recovery philosophy as the minimally invasive surgical approach allows to minimize the surgical stress and promotes a fast recovery [22][23][24][25] . Not surprisingly, preoperative CHO load was associated with a fast recovery, in fact previous studies reported that CHO load was associated to reduced insulin resistance, better postoperative glycemic control, and shortened length of hospital stay 22,26 .…”

Section: Discussionmentioning

confidence: 99%

Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway

Ceresoli,

Ripamonti,

Pedrazzani

et al. 2024

Preprint

View full text Add to dashboard Cite

Background. Despite the application of enhanced recovery protocol a considerable proportion of patients has a late recovery. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways. Objective. The aim of this study is to identify possible determinants of late recovery. Design.Retrospective observational study based on a prospectively collected dedicated register. Setting.22 Italian hospital with high volume colorectal surgery and trained in enhanced recovery protocols. Patients.Patients with elective colorectal resection for cancer of benign disease. Main outcome measures. Recovery on postoperative day two. Results. A total of 1536 patients were included in the analysis. The overall median adherence to preoperative and intraoperative enhanced recovery protocols item was 75.0% (66.6%- 83.3%). A late recovery was observed in 488 (31.8%) patients. Multiple regression analysis showed that six enhanced recovery protocols items had an independent positive impact on postoperative recovery: pre-admission counseling (OR 2.596), preoperative carbohydrate drink (OR 1.948), intraoperative fluid infusions <7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia(OR 2.137), removal of naso-gastric tube at the end of surgery (OR 4.939) and successful laparoscopy (OR 2.341). The late recovery rate progressively declined with the increasing adherence to these six positive items reaching 13.0% when all the items were applied (r= -0.99 p<0.001). Limitations. Retrospective analysis of a register including data from many different centers and the large case mix of patients. Conclusions: The implementation of identified items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery.

show abstract

“…One of the controversial and unresolved aspects of robotic surgery is the high economic burden associated with these technologies, leading to increased healthcare costs, especially when compared to open and laparoscopic surgery. This poses challenges in terms of adoption, both for low reimbursement procedures and in low-income countries or those with entirely public health care systems [30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Preclinical Setup Standardization of the Novel HugoTM Robotic Platform for Upper Gastrointestinal Surgery

Bianco,

Pangrazio,

Toti

et al. 2024

Preprint

View full text Add to dashboard Cite

Recent years have seen new robotic platforms coming to the market, among these, the Hugo™ robotic-assisted surgery by Medtronic is one of the latest. The most significant innovation brought by Hugo™ is the new modular design based on four independent arm-carts, allowing for multiple docking options and port placement configurations. This variability can be challenging at the beginning of the experience and therefore, the development of standardized guides of application has the potential to accelerate the learning curve, facilitate adoption, and ultimately improve surgical efficiency. We conducted a preclinical study at the University of Illinois at Chicago, where 22 human cadaver labs were used to perform upper gastrointestinal (UGI) surgeries to test different potential system configurations and to investigate the systems safety and effectiveness. We successfully developed a reproducible arm-carts setups and port placement configurations for UGI procedures, without recording any major collisions, technical issues, or conversions. This demonstrates that Hugo™ is safe and effective in performing UGI surgery. The data obtained from this preclinical study has allowed to standardize the approach to the abdominal upper quadrants with Hugo™. Although it’s a preclinical work, the initial clinical experiences that have been published so far are confirming our results.

show abstract

Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials

Cited by 16 publications

References 62 publications

Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials

Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials

Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway

Preclinical Setup Standardization of the Novel HugoTM Robotic Platform for Upper Gastrointestinal Surgery

Contact Info

Product

Resources

About