Incorporation of a robotic surgery training curriculum in acute care surgical fellowship

Haghshenas, Jafar; Florecki, Katherine; Torres, Crisanto M; Manukyan, Mariuxi; Kent, Alistair; Lawrence, Chuck; Sakran, Joseph V.

doi:10.1097/ta.0000000000003996

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…However, these increasing numbers show that hospitals have since invested in training and infrastructure to use RS at a higher level and faster pace. Our data suggest that hospital systems will continue to use the existing pathways as a blueprint to increase robot use and have developed methods to integrate in the acute setting …”

Section: Discussionmentioning

confidence: 96%

“…Our data suggest that hospital systems will continue to use the existing pathways as a blueprint to increase robot use and have developed methods to integrate in the acute setting. 39,40 a All the data except ventral hernia repair laparoscopic annual rates are under the assumption of normal distribution. The results of ventral hernia repair laparoscopic annual rates therefore need to be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Lunardi,

Abou-Zamzam,

Florecki

et al. 2024

JAMA Surg

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ImportanceAlthough robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.ObjectivesTo describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.Design, Setting, and ParticipantsA retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.ExposureSurgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.Main Outcomes and MeasuresThe primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.ResultsDuring the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (−0.48 [95% CI, −0.60 to −0.35] days), inguinal hernia repair (−0.20 [95% CI, −0.30 to −0.10] days), and ventral hernia repair (−0.16 [95% CI, −0.26 to −0.06] days).Conclusions and RelevanceWhile robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Lunardi,

Abou-Zamzam,

Florecki

et al. 2024

JAMA Surg

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“…This study also supports the ongoing development of formal robotic acute care curricula in residency and fellowship training. These structured curricula can provide trainees with didactic and operative knowledge so they can utilize robotic MIS techniques to potentially improve patient outcomes [ 27 ]. One of the challenges of this is overcoming the learning curve associated with robotic surgery with elective cases prior to implementing robotic surgery with acute care surgery patients.…”

Section: Discussionmentioning

confidence: 99%

“…Elective robotic-assisted cholecystectomy (RAC) is commonly introduced to general surgeons early in their adoption of robotics due to its similarities to laparoscopic cholecystectomy [ 3 – 5 ]. With increased elective RAC experience among surgeons, interest in utilizing the robotics platform for emergent/urgent cases has also increased [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of laparoscopic, robotic-assisted, and open emergent/urgent cholecystectomy based on the PINC AI Healthcare Database 2017–2020

Campbell,

Lee,

Liu

et al. 2023

World J Emerg Surg

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Background Robotic-assisted cholecystectomy (RAC) is becoming increasingly common, but the outcomes of emergent/urgent robotic-assisted cholecystectomies compared to emergent laparoscopic (LC) and open cholecystectomies (OC) remain understudied. Methods The PINC AI Healthcare Database was queried to identify adults who underwent emergent or urgent (Em-Ur) cholecystectomy between January 1, 2017, and December 31, 2020. Immediate postoperative and 30-day outcomes were identified including intraoperative complications, transfusion, conversion, postoperative complication, and hospital length of stay. Propensity score matching was done to compare outcomes between Em-Ur robotic-assisted, laparoscopic, and open cholecystectomies Subgroup analyses were performed comparing RAC done with and without fluorescent imaging as well as comparing RAC and LC performed for patients with class 3 obesity (BMI ≥ 40 kg/m2). Results RAC Em-Ur cholecystectomies are being performed with increasing frequency and is the most utilized modality for patients with class 3 obesity. There was no difference in intraoperative complications (0.3%), bile duct injury (0.2%), or postoperative outcomes between RAC and LC. LC had significantly shorter operating room times (96 min (75,128)) compared to RAC (120 min (90,150)). There was a significant lower rate of conversion to open in RAC (1.9%) relative to LC (3.2%) in both the overall population and the class 3 obesity sub-analysis (RAC-2.6% vs. LC-4.4%). There was no difference in outcomes in robotic-assisted cholecystectomies done with and without fluorescent imaging. Conclusions A comparison of propensity score-matched cohorts of emergent/urgent robotic-assisted and laparoscopic cholecystectomy indicates that robotic-assisted cholecystectomy is a safe alternative to laparoscopic cholecystectomy, and that both have superior outcomes to open cholecystectomies.

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Establishment of a 24/7 robotic acute care surgery program at a large academic medical center

Gage,

Neilson,

Pino

et al. 2024

Surg Endosc

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Background For many years, robotic surgery has been an option for various elective surgical procedures. Though robotic surgery has not traditionally been the first choice for acute surgical patients, recent work has shown promise in broader applications. However, there are limited data regarding how to establish an institutional robotics program for higher acuity patients. This project aimed to map a pathway for the creation of an acute care surgery robotic program at a large academic medical center. Methods Various stakeholders were gathered jointly with our surgical faculty: anesthesia, operating room leadership, surgical technologists, circulating nurses, Central Sterile Supply, and Intuitive Surgical Inc. representatives. Staff underwent robotics training, and surgical technologists were trained as bedside first assistants. Nontraditional robotic operating rooms were allocated for coordinated placement of appropriate cases, and pre-made case carts were arranged with staff to be available at all hours. A workflow was created between surgical faculty and staff to streamline add-on robotic cases to the daily schedule. Results Six faculty and two fellows are now credentialed in robotics surgery, and additional surgeons are undergoing training. Numerous staff have completed training to perform operative assistant duties. The operating capacity of robotic acute care surgeries has more than doubled in just one year, from 77 to 172 cases between 2022 and 2023, respectively. Two add-on cases can be accommodated per day. Select patients are being offered robotic surgeries in the acute surgical setting, and ongoing efforts are being made to create guidelines for which patients would best benefit from robotic procedures. Conclusions Launching a successful robotic surgery program requires a coordinated, multidisciplinary effort to ensure seamless integration into daily operations. Additional assistance from outside technology representatives can help to ensure comfort with procedures. Further studies are needed to determine the acute patient population that may benefit most from robotic surgery.

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Incorporation of a robotic surgery training curriculum in acute care surgical fellowship

Cited by 6 publications

References 9 publications

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

A retrospective study of laparoscopic, robotic-assisted, and open emergent/urgent cholecystectomy based on the PINC AI Healthcare Database 2017–2020

Establishment of a 24/7 robotic acute care surgery program at a large academic medical center

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