When the Evidence Basis Breeds Controversies: Exploring the Value Profile of Robotic Surgery Beyond the Early Introduction Phase

Abrishami, Payam; Boer, Albert; Horstman, Klasien

doi:10.1177/1077558719832797

Cited by 9 publications

(6 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nowadays RAS is introduced into a variety of surgical specialities with immense evidence generated solely on Intuitive-Surgical products of 13,500 peer-reviewed articles, averaging one publication every 4 h [ 51 ]. Despite this huge evidence base and the broad application, it is still unknown if RAS overcomes the limitations of conventional approaches [ 51 – 53 ]. Therefore, we aimed to systematically analyse the effectiveness and safety of RAS in 14 thoracic and visceral indications compared to laparoscopic or open surgery.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review

Grössmann-Waniek,

Riegelnegg,

Gassner

et al. 2024

Surg Endosc

View full text Add to dashboard Cite

Background In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery. Methods We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration’s Tool Version 1. Results For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications—recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting. Conclusion In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment. Graphical abstract

show abstract

Section: Discussionmentioning

confidence: 99%

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review

Grössmann-Waniek,

Riegelnegg,

Gassner

et al. 2024

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…With implementation of modern minimally invasive surgical technology, this strategy seems practical because several trials have shown a rapid recovery after minimally invasive surgery. [1][2][3][4][5] Not only is outpatient care after robotic prostatectomy an interest for health care systems, a high rate of patient/family satisfaction (87.5%-100%) has also been reported with this care pathway. 7,16 The International Association for Ambulatory Surgery defines ambulatory surgery (-extended recovery) as overall length of postoperative hospital stay £23 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive surgery has been considered as one of the novel ways for improving the efficiency of health care by offering a shorter hospital stay and a smooth convalescence despite adoption of often ex-pensive and innovative technologies. 1,2 This notion has been shown in robotic radical prostatectomy (RRP) literature, as a widespread standard of care for minimally invasive surgical management of localized prostate cancer. With comparable oncologic and functional outcomes, significant advantages in terms of postoperative recovery parameters have been shown in randomized trials.…”

Section: Introductionmentioning

confidence: 99%

Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care

Aminsharifi

Wilson

Sawczyn

et al. 2020

Journal of Endourology

View full text Add to dashboard Cite

Purpose: To compare the perioperative characteristics of patients receiving outpatient vs inpatient care and to define predictors of inpatient care after single-port extraperitoneal robotic radical prostatectomy (RRP). Patients and Methods: Data on 120 patients who underwent single-port extraperitoneal RRP were collected and categorized into two groups: Group I (n = 98) included patients who received outpatient care (i.e. discharged on postoperative day 0) and Group II (n = 22) comprised patients with inpatient care. Demographics and perioperative data were recorded and analyzed between the two groups. Multivariable binary logistic regression was used to determine factors associated with inpatient care. Results: Most patients (98/120: 81.7%) were discharged in few hours (median: 4.1 hours) after surgery (outpatient care: Group I [n = 98]), whereas others (Group II [n = 22]) received inpatient care (median hospital stay: 25.4 hours); p < 0.00001. Most patients with inpatient care (13/22, 59.1%) were among the first initial 40 cases, whereas 37 out of last 40 patients received outpatient care (p = 0.005). Operative time was significantly shorter in patients with outpatient prostatectomy (p = 0.015). The amount of narcotics per patient (if administered) was also significantly greater in Group II (p = 0.006). With regression analysis, having medical comorbidities (odds ratio [OR]: 3.41 95% confidence interval [CI]: 2.05-5.64; p = 0.014), a longer operative time (OR: 1.15 95% CI: 1.10-1.28, p = 0.017), as well as a higher dose of administered narcotics after operation (OR: 1.31 95% CI: 1.08-1.61, p = 0.005) were significant predictors of inpatient care after single-port extraperitoneal RRP. Conclusion: A safe transition to outpatient care is feasible in patients undergoing single-port extraperitoneal RRP. In addition to associated medical comorbidities, a longer operative time and the amount of received narcotic after procedure were the most significant predictors of prolong hospital stay after single-port extraperitoneal RRP. These later modifiable predictors can be optimized with improvement of surgical techniques, intraoperative and postoperative pain management protocols through quality improvement initiatives.

show abstract

“…In order to increase the transferability of our findings, we attempted to select a diverse set of surgical devices, and a diverse set of participants that worked on different devices 21. These could range from robotic systems such as the Da Vinci System22 to simpler devices like novel surgical sutures 23. These innovations can vary in technical complexity, their impact on the surgical workflow,24 clinical outcomes,25 26 safety issues26 27 and impact on patients’ lives 26.…”

Section: Methodsmentioning

confidence: 99%

Innovators’ views on involving users and patients in surgical device development: a qualitative interview study

et al. 2021

View full text Add to dashboard Cite

ObjectivesInvolving end-users and patients in the development of surgical devices, even when patients are not end-users, is deemed important in policy and in academia since it could improve strategic choices in research and development (R&D). Nonetheless, research into innovators’ views on end-user and patient involvement is rare. This study explores what end-users and patients are being involved by innovators during development, what methods for involvement are being used and what topics are being discussed with these end-users and patients.DesignA qualitative study featuring semi-structured interviews with innovators of surgical devices. Interviews were recorded and a thematic analysis was performed on verbatim transcripts.Participants15 interviews were conducted with 19 innovators of 14 surgical devices.SettingInnovation practices of surgical devices in the Netherlands and Belgium.ResultsEnd-users were engaged in R&D with formal methods and in unsystematic ways. These users all work in the clinical domain, for example, as surgeons or nurses. The innovators engaged users to analyse problems for which a device could be a solution, define functionalities, make design choices, analyse usability, ensure safety and improve aesthetics. Patients were rarely involved. Innovators stated that patients are not considered to be end-users, that physicians can represent patient interests and that involving patients is unethical as false expectations could be raised.ConclusionInnovators involve end-users with methods and unsystematic ways in the development of surgical devices. Despite governmental calls for patient involvement in the development of medical devices and surgical devices, innovators do not generally involve patients.

show abstract

When the Evidence Basis Breeds Controversies: Exploring the Value Profile of Robotic Surgery Beyond the Early Introduction Phase

Cited by 9 publications

References 54 publications

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review

Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care

Innovators’ views on involving users and patients in surgical device development: a qualitative interview study

Contact Info

Product

Resources

About