Perioperative Risk Assessment in Robotic General Surgery

Abstract

Eight hundred eightyfour consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Main Outcomes Measures: Perioperative morbidity and mortality.Results: During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patientrelated (cardiovascular and renal comorbidities, Ameri-can Society of Anesthesiologists score Ն3, body mass index [calculated as weight in kilograms divided by height in meters squared] Ͻ30, age Ն70 years, and malignant disease) or procedure-related (blood loss Ն500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality.Conclusions: Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery.

Reoperative Partial Nephrectomy—Does Previous Surgical Footprint Impact Outcomes?

“…Likely it is the extent of tissue plane manipulation or dissection, whether open or robotic, that plays a greater role in the surgical footprint as is echoed in prior literature. 10,15 EBL as a factor contributing to increased high grade complications is logical, as many times these patients require considerable intraoperative blood products and fluid resuscitation leading to ICU level care due to longer times weaning ventilation and other secondary issues such as pre-renal acute kidney injury. However, it is unclear if EBL is merely a predictor of the complexity of the operation and may reflect unaccounted for variables such as tumor complexity or perirenal fibrosis.…”

International consensus statement on robotic hepatectomy surgery in 2018

“…For robotic liver/bile duct procedures, the incidence of complications was 26.1%, mortality rate was 3.2%, and conversion rate was 7.6%, which were all above the overall mean values of robotic procedures[19]. Buchs et al[20] analyzed 884 cases of robotic surgery performed at the University of Illinois Hospital between April 2007 and June 2010 and found that hepatectomy was considered as an advanced robotic procedure, and multivariate analysis showed that advanced procedure was a factor significantly associated with a higher risk for complications.…”

Gastrectomía en manga robótica y laparoscópica: Resultados tempranos de un estudio en población mexicana

“…Desde principios de la década de 2000, se ha informado que la cirugía robótica es factible y segura, incluso para procedimientos avanzados y complejos. 4,5 En 2003, Intuitive Surgical (Sunnyvale, CA) se fusionó con Computer Motion (Goleta, CA) creando de manera efectiva un único proveedor robótico. Desde entonces, ha habido avances tecnológicos sustanciales en la plataforma quirúrgica Da Vinci ® destinada principalmente a mejorar la eficiencia operativa.…”