Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Abstract

Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.

The Multidisciplinary Approach of Rectal Cancer: The Experience of “COMRE Group” Model

“…In our series, a shorter hospital stay was observed in the RG. These data are in accordance with the literature [ 25 ]. Larger studies have indeed also shown a shorter hospital stay with the laparoscopic approach [ 26 , 27 ].…”

Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis

“…Robotic platforms are also evolving. More agile platforms incorporating navigation systems will likely become available at lower costs [ 33 ]. However, no formal, standard accreditation for robotic surgery exists [ 34 ].…”

Ethical, Legal, and Financial Considerations of Artificial Intelligence in Surgery

“…The results are highly variable with some demonstrating greater cost-effectiveness of robotic surgeries overall and some finding that although the operative costs were higher, they may be mitigated or entirely outweighed when factoring in their associated reduced lengths of stays. [44][45][46][47][48][49] The development of ML algorithms currently being trialed in the health care landscape is often funded by individual researchers and their respective institutional or national research grants. 39 When evaluating the potential for a large-scale transformation of entire health care systems through the integration of AI/ML, due consideration must be offered towards determining which entity will bear this cost-the individual health system, the state, national research funding, and so forth.…”