Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

Rouanet, Philippe; Mermoud, A.; Jarlier, Marta; Bouazza, Nabila; Laine, Aaron; Daudé, H. Mathieu

doi:10.1002/bjs5.50281

Cited by 18 publications

(13 citation statements)

References 21 publications

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“…Various systematic reviews of the literature agree that robotic surgery is associated with a significantly shorter time to oral diet tolerance or first flatus in patients with colorectal cancer 19,20,23 . When associated with ERAS protocols, robotic surgery seems to have an added value in this field 24,25 …”

Section: Resultsmentioning

confidence: 99%

Robotic surgery for colorectal cancer

Ruiz

Escribano

Fernández

et al. 2020

Annals of Gastroent Surgery

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Throughout its more than 20 years of activity, surgical robot systems have been incorporating different improvements that replace the inherent limitations of laparoscopic surgery. Some of these improvements consist of changes in the ergonomics and reproduction of hand movements with articulated instruments. In addition, infrared technology and slimmer arms have been incorporated to facilitate procedures in multiple abdominal quadrants without requiring repositioning. This development in technology has meant that more robotic procedures are performed each year is in general surgery. It has experienced important growth in the colorectal field, where it is shown to be feasible and safe.

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Section: Resultsmentioning

confidence: 99%

Robotic surgery for colorectal cancer

Ruiz

Escribano

Fernández

et al. 2020

Annals of Gastroent Surgery

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“…The reduction in post-operative 30 day complication rate by performing robotic procedures on these patients has also demonstrated a cost saving of £763 vs. open and £161 vs. laparoscopic procedures. Due to the reduction in conversion rates cost modelling revealed a potential saving for £671 when comparing robotic vs. laparoscopic procedures [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Following the introduction of extended user pricing by Intuitive surgical ltd since 2020 the cost of each robotic assisted procedure has reduced further by £219.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Uterine Corpus Cancer Surgery: A 10 Year Retrospective Cohort Study of Robotic Surgery in an NHS Cancer Centre

Uwins

Hablase

Assalaarachchi

et al. 2022

Cancers

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Royal Surrey NHS Foundation Trust introduced robotic surgery for uterine corpus cancer in 2010 to support increased access to minimally invasive surgery, a central element of an enhanced recovery after surgery (ERAS) pathway. More than 1750 gynaecological oncology robotic procedures have now been performed at Royal Surrey NHS Foundation Trust. A retrospective cohort study was performed of patients undergoing surgery for uterine corpus cancer between the 1 January 2010 and the 31 December 2019 to evaluate its success. Data was extracted from the dedicated gynaecological oncology database and a detailed notes review performed. During this time; 952 patients received primary surgery for uterine corpus cancer; robotic: n = 734; open: n = 164; other minimally invasive surgery: n = 54. The introduction of the Da VinciTM robot to Royal Surrey NHS Foundation Trust was associated with an increase in the minimally invasive surgery rate. Prior to the introduction of robotic surgery in 2008 the minimally invasive surgery (MIS) rate was 33% for women with uterine corpus cancer undergoing full surgical staging. In 2019, 10 years after the start of the robotic surgery program 91.3% of women with uterine corpus cancer received robotic surgery. Overall the MIS rate increased from 33% in 2008 to 92.9% in 2019. Robotic surgery is associated with a low 30-day mortality (0.1%), low return to theatre (0.5%), a low use of blood transfusion and intensive care (1.8% & 7.2% respectively), low conversion to open surgery (0.5%) and a reduction in median length of stay from 6 days (in 2008) to 1 day, regardless of age/BMI. Robotic survival is consistent with published data. Introduction of the robotic program for the treatment of uterine cancer increased productivity and was associated with a highly predicable patient pathway of care, for high-risk patients, with reduced demands on health services. Future health care commissioning should further expand access to robotic surgery nationally for women with uterine corpus cancer.

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“…The perineal wound is prone to healing complications, particularly in patients after neoadjuvant treatment [14]. In some centres, abdominoperineal resections are excluded from ERAS protocols [15]. Patients with stomas have to be educated by a stoma care nurse before discharge on how to take care of their stomas and patients with ileostomies are prone to electrolyte abnormalities for a variable period of time in the immediate postoperative period and can only be discharged after this has normalised.…”

Section: Discussionmentioning

confidence: 99%