Setting up a pediatric robotic urology program: A USA institution experience

Murthy, P. Balakrishna; Schadler, Eric D.; Orvieto, Marcelo A.; Zagaja, Gregory P.; Shalhav, Arieh L.; Gundeti, Mohan S.

doi:10.1111/iju.13415

Cited by 17 publications

(15 citation statements)

References 35 publications

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“…Conversely, being able to market the robotic platform may increase patient volume and lead to an increase in revenue. However, Palmer et al estimated that a minimum of three to five robotic cases per week were necessary to profit from robotic surgery [32], which is not the case for pediatric pyeloplasty even in high-volume institutions [5, 10, 33] (although this may be achievable in settings where the robot is shared among pediatric and high-volume adult urologists). There is one scenario in which we may have overestimated robotic costs: we cannot verify whether individual hospitals reported the cost of a single use of a reusable robotic instrument or the aggregate cost each time the instrument was used (10 uses).…”

Section: Discussionmentioning

confidence: 99%

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

100

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Summary Introduction Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. Objective To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. Study design We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U.S. hospitalizations between 2003 and 2015. ICD9 codes and itemized billing were used to abstract our cohorts. Trends in utilization and cost were calculated and then stratified by age. We used propensity scores to weight our cohorts and then applied regression models to measure differences in the probability of prolonged operative time (pOT), prolonged length of stay (pLOS), complications, and cost. Results During the study period 11,899 pyeloplasties were performed: 75% open, 10% laparoscopic, and 15% robotic. The total number of pyeloplasty cases decreased by 7% annually; OP decreased by a rate of 10% while RP grew by 29% annually. In 2015, RP accounted for 40% of cases. The largest growth in RPs was among children and adolescents. The average annual rate of change in cost for RP and OP was near stagnant: −0.5% for open and −0.2% for robotic. The summary table provides results from our regression analyses. RP conferred an increased likelihood of pOT, but a reduced likelihood of pLOS. The odds of complications were equivalent. RP was associated with a significantly higher median cost, but the absolute difference per case was $1060. Discussion Despite advantages in room and board costs for RP, we found that the cost of equipment and OR time continue to make it more expensive. Although the absolute difference may be nominal, we likely underestimate the true cost because we did not capture amortization, hidden or down-stream costs. In addition, we did not measure patient satisfaction and pain control, which may provide the non-monetary data needed for comparative value. Conclusion Despite an overall decline in pyeloplasties, RP utilization continues to increase. There has been little change in cost over time, and RP remains more expensive because of equipment and OR costs. The robotic approach confers a reduced likelihood of pLOS, but an increased likelihood of pOT. Complication rates are low and similar in each cohort.

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Section: Discussionmentioning

confidence: 99%

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

100

View full text Add to dashboard Cite

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“…We have demonstrated this centre's LC objectively, with expectations to reach expert TCT at 33 cases, and equivalence with the open procedure at 26. We suggest that any nascent RAS department can hope to replicate this, with training of a dedicated robotic team, (surgical and scrub), and suitable case selection [2]. With complication rates similar to alternative techniques (Maheshwarim et al [9] and Taktak et al [10]), we have shown that RALP is safe and feasible.…”

Section: Discussionmentioning

confidence: 71%

“…The advantages of robot-assisted surgery (RAS) have been widely documented [1][2][3], with joint articulation allowing enhanced freedom of movement, providing greater accuracy and simplifying complex manoeuvres. The benefits for the operating surgeon are potentially longer lasting, as it is ergonomically superior to laparoscopic surgery and reduces fatigue.…”

Section: Introductionmentioning

confidence: 99%

Urology robotic journey: demonstrating the learning curve in robot-assisted pyeloplasties (RALP)

et al. 2019

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Introduction The advantages of robot-assisted pyeloplasties (RALP) have been widely documented and increasingly familiar. A 'learning curve' (LC) is difficult to define and its objective review remains problematic. We aimed to evaluate the LC, and outcomes, of RALP performed at our newly established robotic centre. Method and materials After the appropriate training, robot-assisted surgery (RAS) commenced at our centre. A prospective database was maintained regarding demographics and intra-operative timings of all cases, post-operative stay and complications. The data were statistically interrogated and linear regression analysis was performed. Results Between April 2014 and September 2018, 29 urological RAS were performed including 23 RALP. The total operating and total console times were significantly decreased over time, with no significant differences seen in length of stay or complication rates. Regression analysis predicted achievement of open pyeloplasty time (148 min) at 26 cases and 'expert' console time (58 min) by case 34. Median length of stay was 2 days and operative success rate 96%. Discussion RAS is proliferating across the globe. LC is difficult to define objectively. We suggest that the points described here in this 'learning journey' can be applied to other nascent departments and that RALP is safe and feasible within a developing urology unit.

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“…Moreover, given the peculiarities of these procedures, the implementation and prevalence of pediatric robotic surgeries require the initiation and maintenance of a successful pediatric robotic urology program. This program should be based on a comprehensive, detail‐oriented plan that accounts for training, oversight, cost, and case volume .…”

Section: Distinctive Robotic Surgeries For Pediatric Patientsmentioning

confidence: 99%

Robotic surgery in pediatric urology: Current status

Mizuno

Kojima

Nishio

et al. 2018

Asian J Endoscop Surgery

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Robot‐assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3‐D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

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Setting up a pediatric robotic urology program: A USA institution experience

Cited by 17 publications

References 35 publications

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Urology robotic journey: demonstrating the learning curve in robot-assisted pyeloplasties (RALP)

Robotic surgery in pediatric urology: Current status

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