Introducing robotic surgery into an endometrial cancer service–a prospective evaluation of clinical and economic outcomes in a UK institution

Ind, Thomas; Marshall, Chris; Hacking, Matthew; Harris, M. Jackuelyn; Bishop, Liz; Barton, Desmond P.J.; Bridges, Jackie; Shepherd, John H.; Nobbenhuis, Mariëlle

doi:10.1002/rcs.1651

Cited by 27 publications

(44 citation statements)

References 15 publications

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“…The exact allocation of different costs into each of these categories is described previously. 4 These were allocated into one of nine categories, including costs for wards, high-dependence care, medical staffing, theaters, drugs and pharmacy, blood products, imaging, pathology, and rehabilitation therapy. Outcomes from 24 of the patients unstratified by BMI have been reported in another paper on a different subject.…”

Section: Methodsmentioning

confidence: 99%

“…Outcomes from 24 of the patients unstratified by BMI have been reported in another paper on a different subject. 4 All operations included a hysterectomy and removal of the Fallopian tubes and ovaries. It is policy to perform a limited pelvic lymphadenectomy in patients with more than grade 1 or stage 1a disease although it is often not performed on an individual basis in patients who are elderly or who have excess comorbidity.…”

Section: Methodsmentioning

confidence: 99%

“…3 Recent studies have shown the benefit of introducing a robotic service in primary surgery for endometrial cancer, showing less conversions to laparotomy and a reduction in the number of laparotomies performed. 4,5 Obesity is one of the comorbidities related to an increase in operating time, complications, and length of stay. This study investigated the different outcomes and costs in relation to body mass index (BMI) in a group of endometrial cancer patients who underwent a robotic-assisted laparoscopic hysterectomy.…”

Section: Introductionmentioning

confidence: 99%

“…We have looked at robotically assisted surgery as our own data have shown that it has comparable outcomes to straight stick surgery with some financial benefits to the institution by minimizing the proportion of cases having open surgery. 4 Other authors have also reported clinical benefits for robotic-assisted laparoscopic surgery for primary endometrial cancer. [7][8][9][10] Some authors have reported equal or improved costs for robotic-assisted laparoscopy, 5,11 whereas other studies have shown increased costs when compared to straight stick laparoscopy not taking into account the proportion of cases performed open.…”

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confidence: 99%

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The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

Ind

Marshall

Hacking

et al. 2017

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Abstract:The aim of this study was to compare the financial and clinical outcomes in roboticassisted laparoscopic surgery for primary endometrial cancer between obese and nonobese women. The hospital finance department assessed the total admission costs for robotic surgery for endometrial cancer in 54 women. This included a subanalysis for costs over nine areas (ward and clinics, drugs and pharmacy, medical staff, theaters, blood products, imaging, pathology, rehabilitation therapy, and high dependency costs). Furthermore, a prospective collection of morbidity and surgical outcome data was performed. The study group included 21 nonobese and 33 obese women (body mass index >30). Obese women were more likely to stay for more than one night in hospital (20/ ). There were six Clavien-Dindo grade II complications in the obese group and two in the nonobese group. The average overall costs were £1,852 greater (95% CI £431-£3,277, P=0.012) in the obese group. Diabetes and hypertension were associated with increased costs, but obesity was the only independent variable. In conclusion, greater resource should be allocated to obese women undergoing primary surgery for endometrial cancer.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

Ind

Marshall

Hacking

et al. 2017

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“…Furthermore, a variety of cost factors were included in the calculations. A careful analysis of endometrial cancer from Great Britain, however, has recently reported the contrary (48). There is consensus about the fact that maximum utilization of the system and a well-coordinated team with efficient processes of selection and organization can reduce the costs to the level of open surgical techniques.…”

Section: Cost Efficiency Of Robotic Surgerymentioning

confidence: 99%

Robotic surgery in gynecology

Alkatout

Mettler

Maass

et al. 2016

J Turkish German Gynecol Assoc

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Review 224 Robotic surgery in gynecologyRobotic surgery is a dynamic development for minimally invasive procedures. The specialty of gynecology consistently offers new opportunities for innovative surgical techniques and the advancement of existing therapy approaches (Figure 1). Ever since the American FDA granted approval of the Da Vinci operation robot for gynecological operations in 2005, about three million robotic operations have been performed worldwide. 3500 Da Vinci systems are currently in use: 586 of these in Europe and 77 in Germany (4 th quarter of 2015). According to the figures of Intuitive Surgical, about 600,000 interventions were performed on a worldwide basis in the year 2014, of which 50% were performed in gynecology, approximately 30% in urology, and about 20% in general and chest surgeries. In 2011, the proportion of robotic hysterectomies performed for benign indications in the USA was as high as 27% (1). Currently, we have experience in robotic surgery for the majority of gynecological operations and fields of application. The known advantages of minimally invasive surgery, such as less blood loss, shorter durations of hospital stay, and lower patient morbidity compared to open procedures, have been observed here as well. Better exposure of the operating field by 3D technology and the extension of surgical instruments to 7 degrees of freedom permit the use of minimally invasive surgery, even for complex indications. Robot-assisted manipulation of the instruments permits tremor-free handling and reduces work fatigue for the surgeon, which is very advantageous for the surgeon as well as the patient in long and complex interventions. The possibility of working simultaneously on two parallel consoles shortens the learning curve, reduces complication rates, and facilitates the training of surgeons (2). The advancement of robotic surgery in terms of the Da Vinci Xi permits the variable use of optics in all four trocars (paraaortic lymphadenectomy, omentectomy, or interdisciplinary surgery in the upper abdomen can be performed without re-docking) and ensures markedly greater flexibility due to the optimized geometry of the so-called patient cart. Robotic surgery has been criticized for the fact that it requires the use of larger trocars compared to conventional laparoscopy, and is therefore associated with more numerous and larger cosmetic scars; this is avoided by the smaller trocars now used in robotic surgery (3). The development of the single-site systems signifies further new options for the gynecological surgeon (Figure 2). For instance, freedom of movement is now maximized by the introduction of one or more additional working trocars (4, 5). The low level of postoperative pain appears to be another advantage. It is accompanied by a lesser need for analgesics and even shorter hospital stays compared to traditional laparoscopic surgery. One explanation could be the fact that the abdominal wall need not be used as a counter bearing. The absence of irritation and the advantage of tissue protec...

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Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications

Jørgensen

Mogensen

et al. 2019

JAMA Surg

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IMPORTANCE Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. OBJECTIVE To evaluate the association between the Danish nationwide introduction of minimally invasive robotic surgery (MIRS) and severe complications in patients with early-stage endometrial cancer. DESIGN, SETTING, AND PARTICIPANTS In this nationwide prospective cohort study of 5654 women with early-stage endometrial cancer who had undergone surgery during the period from January 1, 2005, to June 30, 2015, data from the Danish Gynecological Cancer Database were linked with national registers on socioeconomic status, deaths, hospital diagnoses, and hospital treatments. The women were divided into 2 groups; group 1 underwent surgery before the introduction of MIRS in their region, and group 2 underwent surgery after the introduction of MIRS. Women with an unknown disease stage, an unknown association with MIRS implementation, unknown histologic findings, sarcoma, or synchronous cancer were excluded, as were women who underwent vaginal or an unknown surgical type of hysterectomy. Statistical analysis was conducted from February 2, 2017, to May 4, 2018. EXPOSURE Minimally invasive robotic surgery, MILS, or total abdominal hysterectomy. MAIN OUTCOMES AND MEASURES Severe complications were dichotomized and encompassed death within 30 days after surgery and intraoperative and postoperative complications diagnosed within 90 days after surgery. RESULTS A total of 3091 women (mean [SD] age, 67 [10] years) were allocated to group 1, and a total of 2563 women (mean [SD] age, 68 [10] years) were allocated to group 2. In multivariate logistic regression analyses, the odds of severe complications were significantly higher in group 1 than in group 2 (odds ratio [OR], 1.39; 95% CI, 1.11-1.74). The proportion of women undergoing MILS was 14.1% (n = 436) in group 1 and 22.2% in group 2 (n = 569). The proportion of women undergoing MIRS in group 2 was 50.0% (n = 1282). In group 2, multivariate logistic regression analyses demonstrated that a total abdominal hysterectomy was associated with increased odds of severe complications compared with MILS (OR, 2.58; 95% CI, 1.80-3.70) and MIRS (OR, 3.87; 95% CI, 2.52-5.93). No difference was found for MILS compared with MIRS (OR, 1.50; 95% CI, 0.99-2.27). CONCLUSIONS AND RELEVANCE The national introduction of MIRS changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery. This change in surgical approach was associated with a significantly reduced risk of severe complications.

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Introducing robotic surgery into an endometrial cancer service–a prospective evaluation of clinical and economic outcomes in a UK institution

Abstract: Background We have assessed how the introduction of robotics in a publicly funded endometrial cancer service affects clinical and economic outcomes.

Cited by 27 publications

References 15 publications

The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

Robotic surgery in gynecology

Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications

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