Ethical considerations regarding the implementation of new technologies and techniques in surgery

Background and Objectives:The number of robotic colorectal procedures performed has rapidly increased, but there are only sparse data available about the robotic learning curve of expert laparoscopic colorectal surgeons. Methods:In this retrospective study, we reviewed 101 minimally invasive right colectomies consecutively performed by a single surgeon with 20 years of clinical practice fully dedicated to laparoscopic surgery. Thus, the last 59 laparoscopic resections were compared with the first 42 robotic resections. Results:The duration of the procedure was longer in the robotic group, but the conversion rate was the same in both groups. There was no difference between groups in rates of overall and severe postoperative complications, reoperation, hospital length of stay, and readmission. Number of harvested lymph nodes and oncological quality of resection defined by the pathologist were the same. Conclusions:This study suggests that the transition from the right laparoscopic colectomy with extracorporeal anastomosis to the robot-assisted right colectomy with intracorporeal anastomosis when performed by a surgeon with experience in laparoscopic colorectal surgery may not entail any increase on the morbidity rate or reduce the oncologic quality of the resection.

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“…14 This said, one may think that the late introduction of a new modality may bereave the patients of better care. 14,15…”

Section: Discussionmentioning

confidence: 99%

Experience With Transitioning From Laparoscopic to Robotic Right Colectomy

Gerbaud

Valverde

Danoussou

et al. 2019

JSLS

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“…Robotic surgery offers a potential bridge for these downsides, and may shorten the learning curve for both benign and malignant surgical procedures . However, robotic approaches have been challenged because of the perceived expense of the robotic platform …”

Section: Introductionmentioning

confidence: 99%

Evolving application of minimally invasive cancer operations at a tertiary cancer center

Selby

DeMatteo

Tholey

et al. 2017

Journal of Surgical Oncology

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Background Patients and providers are increasingly interested in the utilization, safety, and efficacy of minimally invasive surgery (MIS). We reviewed eleven years of MIS resections (laparoscopic and robotic) for intra-abdominal malignancies. Methods Patients who underwent gastrectomy, distal pancreatectomy, hepatic resection, and colorectal resection between 2004 and 2014 were identified. Cases were categorized as open, laparoscopic, and robotic based on the initial operation approach. Diagnostic laparoscopies were excluded. Results Of the 10,039 patients who underwent the above procedures, between 2004 and 2014, 2,832 (28%) were MIS. In 2004 12% (100/826) of all resections were performed with MIS approaches, rising to 23% (192/821) of all resections by 2009 and 44% (484/1,092) in 2014. The number of open resections has remained largely stable: 726 (88% of all resections) in 2004 and 608 (56% of all resections) in 2014. Initially, laparoscopy experienced incremental adoption. Robotic surgery was implemented in 2009 and is currently the dominant MIS approach, accounting for 76% (368/484) of all MIS resections in 2014. Overall mortality has remained less than 1%. Conclusions While maintaining patient safety, utilization of MIS techniques has increased substantially since 2004, particularly for gastric and colorectal resections. Since 2009 robotic surgery is the predominant MIS approach.

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“…In return, more recently appointed colleagues need to understand that their skill and expertise owe a large debt to the service and speciality developments created by those who preceded them. The ethical and moral balances between making sure a new approach is warranted need objective determination to identify the correct point between 'cutting-edge' pioneering work and 'bleeding-edge' experimentation [4]. More effort is required to analyse and clarify the implementation of new techniques for which follow-through is needed to reduce any laggardly tendency to disregard proven technique advancement [5].…”

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confidence: 99%

Implementation of new technologies

2014

Colorectal Disease

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Perhaps thanks to its detractors, active and passive, laparoscopic colorectal surgery now has the best-validated evidence base, including randomized trials, of any minimally invasive approach for abdominal and gastrointestinal malignancy [1]. Despite clear and consistent proof of short-term benefit and intermediate and long-term oncological safety in a variety of settings, its implementation remains low globally. While the LAPCO programme has had an impressive impact in England [2], where, interestingly, laparoscopic colonic resection has yet to reach 'standard of care' case usage nationally in excess of 50%, what hope have other countries and

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Ethical considerations regarding the implementation of new technologies and techniques in surgery

Cited by 35 publications

References 23 publications

Experience With Transitioning From Laparoscopic to Robotic Right Colectomy

Experience With Transitioning From Laparoscopic to Robotic Right Colectomy

Evolving application of minimally invasive cancer operations at a tertiary cancer center

Implementation of new technologies

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