The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery

Heemskerk, Jeroen; Bouvy, Nicole D.; Baeten, C. G. M. I.

doi:10.1007/s00464-013-3306-8

Cited by 29 publications

(18 citation statements)

References 124 publications

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“…The added clinical benefits of RARP compared with other treatment options for localised prostate cancer are 'controversial' as a result of 'considerable uncertainty' surrounding the clinical research results and their meaning Novara et al, 2012;Heemskerk et al, 2014;Makarov et al, 2011). The recently-updated Dutch national guidelines on prostate cancer reported a lack of randomised studies comparing surgical and non-surgical treatment modalities (IKNL, 2013).…”

Section: The Case Study Of Da Vinci Robotic Surgerymentioning

confidence: 97%

“…Many respondents recognised it and described it literally as a "pressure" (as opposed to a choice). A remarkable fear of missing out ('use it or loose it') among prospective users d particularly among the Dutch medical society (Heemskerk et al, 2014) d fuelled this process. There was also a feeling of retrospective regret for patients who had undergone ORP in the past.…”

Section: Entrepreneurship-related Affordancesmentioning

confidence: 99%

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Understanding the adoption dynamics of medical innovations: Affordances of the da Vinci robot in the Netherlands

Abrishami

Boer

Horstman

2014

Social Science & Medicine

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Section: The Case Study Of Da Vinci Robotic Surgerymentioning

confidence: 97%

Section: Entrepreneurship-related Affordancesmentioning

confidence: 99%

Understanding the adoption dynamics of medical innovations: Affordances of the da Vinci robot in the Netherlands

Abrishami

Boer

Horstman

2014

Social Science & Medicine

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“…Pediatric surgery is described as an ''orphan'' field for commercial scale innovation due to unappealingly small gross market capacity for which to seek profit through purposefully designed products [13]. Even amongst some adult specialties for which the technology is size appropriate, there has been a recent movement of diminished enthusiasm and even dissonance [12,[14][15][16]. One might interpret this disposition to be consistent with a post-peak phase of the Hype Cycle curve (Fig.…”

Section: Dismissmentioning

confidence: 80%

Robotic surgery in children: adopt now, await, or dismiss?

et al. 2015

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The role of robot-assisted surgery in children remains controversial. This article aims to distil this debate into an evidence informed decision-making taxonomy; to adopt this technology (1) now, (2) later, or (3) not at all. Robot-assistance is safe, feasible and effective in selected cases as an adjunctive tool to enhance capabilities of minimally invasive surgery, as it is known today. At present, expectations of rigid multi-arm robotic systems to deliver higher quality care are over-estimated and poorly substantiated by evidence. Such systems are associated with high costs. Further comparative effectiveness evidence is needed to define the case-mix for which robot-assistance might be indicated. It seems unlikely that we should expect compelling patient benefits when it is only the mode of minimally invasive surgery that differs. Only large higher-volume institutions that share the robot amongst multiple specialty groups are likely to be able to sustain higher associated costs with today's technology. Nevertheless, there is great potential for next-generation surgical robotics to enable better ways to treat childhood surgical diseases through less invasive techniques that are not possible today. This will demand customized technology for selected patient populations or procedures. Several prototype robots exclusively designed for pediatric use are already under development. Financial affordability must be a high priority to ensure clinical accessibility.

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“…One study showed that well-trained laparoscopic surgeons may not really benefit from 3D robot systems if 3D laparoscopy is available 8. Another paper even pointed out that it was about time to start a critical discussion as to whether we should drastically limit, or even abandon the use of robot-assisted laparoscopic surgery and focus on more cost-effective strategies of healthcare improvement in an era of worldwide economic crisis 9. The comparison of robotic and 3D laparoscopic surgery is still needed.…”

Section: Introductionmentioning

confidence: 99%

The learning curves of robotic and three-dimensional laparoscopic surgery in cervical cancer

Li¹,

Jiang³

2016

J. Cancer

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BACKGROUND: The 3D laparoscopy systems and robotic systems have been introduced into clinical practice for a few years. But the comparison of robotic and 3D laparoscopic gynecologic surgery is still needed.OBJECTIVE: To retrospectively compare the learning curves of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer.STUDY DESIGN: The operational duration, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected, learning curves and cost of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer performed by one experienced surgeon were studied.RESULTS: There was one surgeon who performed 37 cases of robotic and 24 cases of 3D laparoscopic hysterectomy and pelvic lymphadenectomy, and the turning point of learning curves was case 13th and case 10th. The differences of duration of operation, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected and perioperative complications were not statistically significant. But the cost of each robotic operation was higher than 3D operation.CONCLUSIONS: The turning point of the learning curve of 3D laparoscopic hysterectomy and pelvic lymphadenectomy is earlier than that of robotic sugery in patients with cervical cancer, and there is no obvious benefit from robotic surgery than 3D surgery in the terms of short-term medical index and hospitalization cost.

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The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery

Cited by 29 publications

References 124 publications

Understanding the adoption dynamics of medical innovations: Affordances of the da Vinci robot in the Netherlands

Understanding the adoption dynamics of medical innovations: Affordances of the da Vinci robot in the Netherlands

Robotic surgery in children: adopt now, await, or dismiss?

The learning curves of robotic and three-dimensional laparoscopic surgery in cervical cancer

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