Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies

Ahmadi, Nima; Mor, Isabella; Warner, Ross

doi:10.1007/s11701-021-01246-z

Cited by 11 publications

(20 citation statements)

References 34 publications

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“…One of the key criticisms of robotic colorectal surgery centres on its lack of cost‐effectiveness; however, there are now emerging data to the contrary [7,28]. Ferri et al demonstrated the cost‐effectiveness of robotic right hemicolectomy with a handsewn ICA compared with laparoscopic right hemicolectomy with a handsewn ECA.…”

Section: Discussionmentioning

confidence: 99%

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A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy

et al. 2022

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There has been a longstanding debate regarding the optimal anastomotic technique in minimally invasive right hemicolectomy, namely intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA) and handsewn or stapled anastomosis. The current evidence base suggests that ICA is associated with faster gastrointestinal recovery, a shorter length of stay and reduced opiate consumption [1]. However, despite these demonstrable benefits, ECA is employed more widely due to its ease of formation. Furthermore, in 2015 the

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Section: Discussionmentioning

confidence: 99%

“…One of the key criticisms of robotic colorectal surgery centres on its lack of cost-effectiveness; however, there are now emerging data to the contrary [7,28]. bias that is reflected in the observed differences between the two population cohorts.…”

Section: Ta B L E 2 Operative and Clinical Outcomesmentioning

confidence: 99%

A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy

et al. 2022

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“…Aspects, which might finally overcome initial economic burdens, include the optimization of the surgical procedure by decreasing the duration over time through surgical team formation and strong adherence to the learning curve as well as the use of more cost-effective techniques and materials (hand-sewn instead of stapler anastomosis, conventional laparoscopic instead of robotic staplers, reduction of robotic ports). However, the most powerful impact from a clinical and economic view have lower complication rates, faster recovery, and shorter length of in-hospital stay after robotic compared with both COS and laparoscopic RC [ 11 , 16 , 20 , 24 ]. Thus, in our study robotic surgery let to a significant reduction in cost-intensive postoperative complications, duration at the intensive care unit, and length of postoperative in-hospital stay by one third from median 12 (COS) to 8 days (both robotic approaches: ECA and ICA, p < 0.01 each in comparison with COS).…”

Section: Discussionmentioning

confidence: 99%

“…However, through increasing numbers and availability of robotic programs, growing experiences with, further development in as well as technical advantages of robotic-assisted surgery over conventional laparoscopy [ 2 , 8 , 12 – 16 ], minimally invasive robotic approaches for RC are constantly evolving and progressively established in the clinical routine [ 9 , 11 , 16 – 18 ]. Although costs of minimally invasive approaches, especially of robotic surgery, are considerably higher compared with COS [ 11 , 17 , 19 , 20 ], some evidences exist in the current literature concerning improved postoperative short-term outcome and morbidity, respectively, of patients after minimally invasive RC with CME [ 11 , 17 , 18 , 20 – 24 ]. Particularly the total minimally invasive approach with intracorporal anastomosis is beneficial considering postoperative pain [ 25 ], surgical site infections [ 22 , 26 ], and complications urging re-interventions [ 22 , 26 , 27 ] and finally results overall in a shorter recovery and decreased postoperative length of hospital stay [ 22 , 25 – 29 ].…”

Section: Introductionmentioning

confidence: 99%

Right colectomy from open to robotic — a single-center experience with functional outcomes in a learning-curve setting

Hirschburger

Schneider

Kraenzlein

et al. 2022

Langenbecks Arch Surg

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Purpose Right colectomy (RC) is a frequently performed procedure. Beneath standard conventional open surgery (COS), various minimally invasive techniques had been introduced. Several advantages had recently been described for robotic approaches over COS or conventional laparoscopy. Nevertheless, novel minimally invasive techniques require continuous benchmarking against standard COS to gain maximum patient safety. Bowel dysfunction is a frequent problem after RC. Together with general complication rates postoperative bowel recovery are used as surrogate parameters for postoperative patient outcome in this study. Methods Retrospective, 10-year single-center analysis of consecutive patients who underwent sequentially either COS (n = 22), robotic-assisted (ECA: n = 39), or total robotic surgery (ICA: n = 56) for oncologic RC was performed. Results The conversion from robotic to open surgery rate was low (overall: 3.2%). Slightly longer duration of surgery had been observed during the early phase after introduction of the robotic program to RC (ECA versus COS, p = 0.044), but not anymore thereafter (versus ICA). No differences were observed in oncologic parameters including rates of tumor-negative margins, lymph node-positive patients, and lymph node yield during mesocolic excision. Both robotic approaches are beneficial regarding postoperative complication rates, especially wound infections, and shorter length of in-hospital stay compared with COS. The duration until first postoperative stool is the shortest after ICA (COS: 4 [2–8] days, ECA: 3 [1–6] days, ICA: 3 [1–5] days, p = 0.0004). Regression analyses reveal neither a longer duration of surgery nor the extent of mesocolic excision, but the degree of minimally invasiveness and postoperative systemic inflammation contribute to postoperative bowel dysfunction, which prolongs postoperative in-hospital stay significantly. Conclusion The current study reflects the institutional learning curve of oncologic RC during implementation of robotic surgery from robotic-assisted to total robotic approach without compromises in oncologic results and patient safety. However, the total robotic approach is beneficial regarding postoperative bowel recovery and general patient outcome.

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“…For right hemicolectomy, there were 436 patients who underwent robotic surgery [8][9][10][11][12][13]. These studies showed robotic surgery to have similar outcomes to laparoscopic surgery [8][9][10][11][12][13].…”

Section: Right Hemicolectomymentioning

confidence: 99%

A Review of Robotic Surgery in Colorectal Surgery

Ravendran¹,

Abiola²,

Balagumar³

et al. 2023

Cureus

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Colorectal surgery is a treatment for colorectal lesions. Technological advancements have given the rise to robotic colorectal surgery, a procedure that limits excessive blood loss via 3D pin-point precision capabilities during surgeries. The aim of this study is to review robotic surgery in colorectal treatment procedures in order to dictate its ultimate merits. This is a literature review utilising PubMed and Google Scholar; it only includes case studies and case reviews related to robotic colorectal surgeries. Literature reviews are excluded. We incorporated abstracts from all articles and full publications were examined to compare the benefits of robotic surgery in colorectal treatments. The number of articles reviewed was 41 literature spanning from 2003 to 2022. We found that robotic surgeries yielded finer marginal resections, greater amounts of lymph node resections and earlier recovery of bowel functions. The patients also spent less time in hospital after surgery. The obstacles on the other hand are it costs longer operative hours and further training, which is expensive. Studies show robotic approach is a choice for treating rectal cancer. However further studies would be needed to conclude the best approach. This is especially true with patients treated for anterior colorectal resections. Based on the evidence it's safe to say that the upsides outweigh the downsides, but advancements and further research in robotic colorectal surgeries are still necessary to reduce operative hours and cost. Surgical societies should also take the initiative and set up effective training programmes for colorectal robotic surgeries, as trained physicians result in better treatment outcomes.

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Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies

Cited by 11 publications

References 34 publications

A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy

A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy

Right colectomy from open to robotic — a single-center experience with functional outcomes in a learning-curve setting

A Review of Robotic Surgery in Colorectal Surgery

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