Robotic-Assisted versus Laparoscopic Proctectomy with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Analysis of Clinical and Financial Outcomes from a Tertiary Referral Center

Gebhardt, Jasper Max; Werner, Neno; Stroux, Andrea; Förster, Frank; Pozios, Ioannis; Seifarth, Claudia; Schineis, Christian; Kamphues, Carsten; Weixler, Benjamin; Beyer, Katharina; Lauscher, Johannes C.

doi:10.3390/jcm11216561

Cited by 8 publications

(22 citation statements)

References 25 publications

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“…Twelve comparative trials ( 20 - 31 ) and one randomized controlled trial (RCT) ( 19 ) on 16,082 patients were included to conduct this meta-analysis for comparing total cost and operative cost of robotic versus laparoscopic colorectal surgeries, based upon the principles provided by the Cochrane Collaboration. Seven studies were from the USA ( 20 , 22 , 23 , 26 , 28 , 29 , 31 ), two were from Korea ( 19 , 21 ), two were from Italy ( 25 , 27 ), one was from Taiwan region ( 30 ) and one was from Germany ( 24 ). Mean age and gender were also noted in these studies.…”

Section: Resultsmentioning

confidence: 99%

Cost-comparison of robotic versus laparoscopic colorectal resections: a mapped systematic review and meta-analysis of published studies

Singh,

Kaur,

Baig

et al. 2024

Transl Gastroenterol Hepatol

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Background Robotic colorectal resections (RCR) have been gaining popularity recently due to several advantages in addition to oncological safety. The objective of this review is to evaluate the cost comparison of RCR versus laparoscopic colorectal resections (LCR). Methods All types of comparative studies reporting the cost of RCR versus LCR were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 13 studies (one randomised trial and 12 comparative studies) on 16,082 patients undergoing oncological and non-oncological colorectal resections. Eleven studies reported total cost whereas seven studies reported only operative cost. In the random effects model analysis, LCR was associated with the reduced total cost [standardised mean difference −62.34, 95% confidence interval (CI): −75.14 to −49.54, Z=9.55, P<0.001] as well as reduced operative cost (standardised mean difference −4.60, 95% CI: −5.90 to −3.31, Z=6.96, P<0.001) compared to RCR. However, there was significant heterogeneity [Tau 2 =346.74, Chi 2 =29,559.11, df =11 (P<0.001; I 2 =100%); Tau 2 =2.73, Chi 2 =832.21, df =6 (P<0.001; I 2 =99%)] among included studies. Conclusions The LCR seems to be more economical as compared to the RCR in terms of operative cost as well as total cost (operative plus in-patient stay). However, due to statistically significant heterogeneity among included studies and paucity of the randomised trials, these findings should be taken cautiously.

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Section: Resultsmentioning

confidence: 99%

Cost-comparison of robotic versus laparoscopic colorectal resections: a mapped systematic review and meta-analysis of published studies

Singh,

Kaur,

Baig

et al. 2024

Transl Gastroenterol Hepatol

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“…Robotic-assisted surgeries for rectal cancer have been performed regularly since 2016. Using the patient database of our hospital (SAP SE, Walldorf, Baden-Württemberg, Germany) [ 11 ], we identified all adult patients (age ≥ 18 years) with primary sporadic rectal adenocarcinoma who had undergone elective robotic-assisted or laparoscopic surgery between 1 January 2016 and 31 September 2021. One hundred twenty-five consecutive patients were diagnosed with primary sporadic rectal adenocarcinoma (distal extent ≤ 15 cm from the anal verge).…”

Section: Methodsmentioning

confidence: 99%

“…All robotic-assisted surgeries were performed using the Da Vinci X Surgical System (Intuitive Surgical, Mountain View, Sunnyvale, CA, USA). The study was approved by the local ethical review committee (EA4/049/21) and complied with the 1975 Declaration of Helsinki and its subsequent amendments or comparable ethical standards [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…All five participating surgeons were experienced in laparoscopic colorectal surgery but were in the process of learning robotic-assisted rectal surgery [ 11 ]. They finished their basic training on the robotic console in 2015, 2017, 2019, 2020, and 2021 [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Robotic-assisted surgery was performed with fenestrated bipolar forceps in arm 1, robotic camera in arm 2, monopolar curved scissors in arm three, and Cadiere forceps in arm 4 (Intuitive Surgical, Mountain View, Sunnyvale, CA, USA). The rectum was transected at the level of the pelvic floor using a robotic linear stapler (SureForm 45 mm green cartridge; Intuitive Surgical, Mountain View, Sunnyvale, CA, USA) or a linear cutter via a Pfannenstiel incision (TA 30; Medtronic, Dublin, Ireland) [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

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Robotic-Assisted versus Laparoscopic Surgery for Rectal Cancer: An Analysis of Clinical and Financial Outcomes from a Tertiary Referral Center

Gebhardt,

Werner,

Stroux

et al. 2024

JCM

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Background: The popularity of robotic-assisted surgery for rectal cancer is increasing, but its superiority over the laparoscopic approach regarding safety, efficacy, and costs has not been well established. Methods: A retrospective single-center study was conducted comparing consecutively performed robotic-assisted and laparoscopic surgeries for rectal cancer between 1 January 2016 and 31 September 2021. In total, 125 adult patients with sporadic rectal adenocarcinoma (distal extent ≤ 15 cm from the anal verge) underwent surgery where 66 were operated on robotically and 59 laparoscopically. Results: Severe postoperative complications occurred less frequently with robotic-assisted compared with laparoscopic surgery, as indicated by Clavien–Dindo classification grades 3b–5 (13.6% vs. 30.5%, p = 0.029). Multiple logistic regression analyses after backward selection revealed that robotic-assisted surgery was associated with a lower rate of total (Clavien–Dindo grades 1–5) (OR = 0.355; 95% CI 0.156–0.808; p = 0.014) and severe postoperative complications (Clavien–Dindo grades 3b–5) (OR = 0.243; 95% CI 0.088–0.643; p = 0.005). Total inpatient costs (median EUR 17.663 [IQR EUR 10.151] vs. median EUR 14.089 [IQR EUR 12.629]; p = 0.018) and surgery costs (median EUR 10.156 [IQR EUR 3.551] vs. median EUR 7.468 [IQR EUR 4.074]; p < 0.0001) were higher for robotic-assisted surgery, resulting in reduced total inpatient profits (median EUR −3.196 [IQR EUR 9.101] vs. median EUR 232 [IQR EUR 6.304]; p = 0.004). Conclusions: In our study, robotic-assisted surgery for rectal cancer resulted in less severe and fewer total postoperative complications. Still, it was associated with higher surgery and inpatient costs. With increasing experience, the operative time may be reduced, and the postoperative recovery may be further accelerated, leading to reduced surgery and total inpatient costs.

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Implementation of a robotic surgical practice in inflammatory bowel disease

Ferrari,

Nicolaou,

Adams

2024

J Robotic Surg

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BackgroundRobotics adoption has increased in colorectal surgery. While there are well-established advantages and standardised techniques for cancer patients, the use of robotic surgery in in ammatory bowel disease (IBD) hasn't been studied yet. ObjectiveTo evaluate the feasibility and safety of robotic surgery for IBD patients. MethodsProspectively data in IBD patients having robotic resection at Guy's and St Thomas' hospital. All resections performed by a single colorectal surgeon specialised in IBD, utilising Da-Vinci platform. ResultsJuly 2021 to January 2023, 59 robotic IBD cases performed, 14 ulcerative colitis (UC) and 45 Crohn's disease (CD). Average age; CD patients 35, UC 33 years. Average Body mass index (BMI); 23 for CD and 26.9 for UC patients.In total, we performed 31 ileo-caecal resections (ICR) with primary anastomosis (18 Kono-S anastomosis, 6 mechanical anastomosis and 7 ileo-colostomy), of those 4 had multivisceral resections (large bowel, bladder, ovary). Furthermore, 14 subtotal colectomy (1 emergency), 8 proctectomy, 3 panproctocolectomy and 3 ileo-anal J pouch. 18 of the 45 patients (45.0%) with crohn's disease had ongoing stulating disease to other parts of the GI tract (small or large bowel). ICR were performed using different 3 ports position, depending on the anatomy established prior to surgery with magnetic resonance images (MRI). One patient had conversion to open due to anaesthetic problems and one patient required re-operation to refashion stoma. 98.0% cases completed robotically. Median Length of hospital stay (LOS) was 7 days for CD and 7 for UC cases, including LOS in patients on pre-operative parenteral nutrition. ConclusionsRobotic colorectal techniques can be safely used for patients with IBD, even with stulating disease.Future research and collaborations are necessary to standardize technique within institutions.

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Robotic-Assisted versus Laparoscopic Proctectomy with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Analysis of Clinical and Financial Outcomes from a Tertiary Referral Center

Cited by 8 publications

References 25 publications

Cost-comparison of robotic versus laparoscopic colorectal resections: a mapped systematic review and meta-analysis of published studies

Cost-comparison of robotic versus laparoscopic colorectal resections: a mapped systematic review and meta-analysis of published studies

Robotic-Assisted versus Laparoscopic Surgery for Rectal Cancer: An Analysis of Clinical and Financial Outcomes from a Tertiary Referral Center

Implementation of a robotic surgical practice in inflammatory bowel disease

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