Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases

Altieri, Maria S.; Yang, Jie; Telem, Dana A.; Zhu, Jiawen; Halbert, Caitlin; Talamini, Mark A.; Pryor, Aurora D.

doi:10.1007/s00464-015-4327-2

Cited by 34 publications

(21 citation statements)

References 17 publications

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“… 14 So far, robotic colorectal surgery has been shown to have decreased complications and shorter lengths of stay, compared with conventional laparoscopy. 15 …”

Section: Resultsmentioning

confidence: 99%

First 101 Robotic General Surgery Cases in a Community Hospital

Oviedo

Robertson

Alrajhi

2016

JSLS

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Background and Objectives:The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed.Methods:Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics.Results:Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes.Conclusion:A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.

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“… 14 So far, robotic colorectal surgery has been shown to have decreased complications and shorter lengths of stay, compared with conventional laparoscopy. 15 …”

Section: Resultsmentioning

confidence: 99%

First 101 Robotic General Surgery Cases in a Community Hospital

Oviedo

Robertson

Alrajhi

2016

JSLS

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“…A number of previously published studies on robotic surgery including hysterectomy[ 18 ] prostatectomy[ 19 ], and cholecystectomy[ 20 ], showed that operation time was prolonged. The analysis of surgical outcomes showed that operation time was significantly longer in the RADP group.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes

et al. 2016

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AIMTo compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP).METHODSA literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.RESULTSSeven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.CONCLUSIONRADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required.Core tipTo date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.

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“…However, current evidence of clear clinical benefit over laparoscopy is lacking for most procedures. Robotic surgery may be advantageous for more complex cases in high-volume centers [23] and may prove beneficial in increasing minimally invasive surgery in areas of low laparoscopic penetrance, such as colorectal surgery [24]. A procedure that cannot be otherwise routinely performed in a minimally invasive fashion, but can be accomplished using the robotic platform, is an ideal candidate for the application of this emerging technology.…”

Section: Discussionmentioning

confidence: 99%