Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs

Ielpo, Benedetto; Durán, Hipólito; Dı́az, Eduardo; Fabra, Isabel; Caruso, Riccardo; Malavé, L.; Ferri, Valentina; Núñez, Jesús Roberto Garay; Ruiz-Ocaña, A.; Jorge, E; Lazzaro, Sara; Kalivaci, D.; Quijano, Yolanda; Vicente, Emilio

doi:10.1007/s00384-017-2876-7

Cited by 42 publications

(70 citation statements)

References 18 publications

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“…Almost all the studies suggested that robotic TME had definitely higher costs than laparoscopic surgery. 42,44,45,[60][61][62][63][64] In South Korea, Baek et al 60 reported that total hospital charges of robotic rectal surgery are larger than those of laparoscopic rectal surgery (14647 vs 9978, USD, p=0.001). The charge for anesthesia, laboratory, radiology, nursing care, and medical therapy was not different between two groups, but operative charges were significantly higher in the robotic surgery group (8849 vs 2289, USD, p≤0.001).…”

Section: Cost Analysismentioning

confidence: 99%

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Jeon

Park

Baik

2019

J Minim Invasive Surg

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Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.

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Section: Cost Analysismentioning

confidence: 99%

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Jeon

Park

Baik

2019

J Minim Invasive Surg

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“…It is well known that robotic surgery is related to high costs[ 21 ]. Thus, in common practice, patients tend to be accurately selected to maximize the benefits of this mini-invasive technique.…”

Section: Discussionmentioning

confidence: 99%

Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study

Tagliabue¹,

Burati²,

Chiarelli³

et al. 2020

WJGS

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BACKGROUND Several studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Laparoscopic right hemicolectomy (LRH) is considered technically challenging. Robotic surgery has been introduced to overcome this technical limitation, but it is related to high costs. To maximize the benefits of such surgery, only selected patients are candidates for this technique. In addition, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities, who are usually more prone to post-operative complications. AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities. METHODS We retrospectively analyzed 123 minimally invasive procedures (68 LRHs vs 55 RRHs) for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019. The surgical procedures were performed according to standardized techniques. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. Secondary outcomes were time to first flatus (TFF) and time to first stool evacuation. The robotic technique was considered the exposure and the laparoscopic technique was considered the control. Routine demographic variables were obtained, including age at time of surgery and gender. Body mass index and American Society of Anesthesiologists physical status were registered. The age-adjusted Charlson Comorbidity Index (ACCI) was calculated; the tumor-node-metastasis system, intra-operative variables and post-operative complications were recorded. Post-operative follow-up was 180 d. RESULTS LOS, TFF, and time to first stool were significantly shorter in the robotic group: Median 6 [interquartile range (IQR) 5-8] vs 7 (IQR 6-10.5) d, P = 0.028; median 2 (IQR 1-3) vs 3 (IQR 2-4) d, P < 0.001; median 4 (IQR 3-5) vs 5 (IQR 4-6.5) d, P = 0.005, respectively. Following multivariable analysis, the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function; in addition the dichotomous variables of age over 75 years and ACCI more than 7 were significant predictors of hospital stay. No outcomes were significantly associated with Clavien-Dindo grading. Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS (median 6 -IQR 5-8- vs 7 -IQR 6-12- d, P = 0.013) and later TFF (median 2 -IQR 1-3- vs 3 -IQR 2-4- d, P = 0.008), while patients with ACCI more than 7 were only associated with a prolonged hospital stay (median...

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“…In this study, the mean operative time was not signi cantly different between the R-TME and L-TME groups (288.3, 265.0 min), although the operative time of the R-TME group was 23.3 min longer than that of the L-TME group. However, several studies have shown that the da Vinci surgical robot-assisted TME had a signi cant longer operative time than L-TME for rectal cancer [15][16][17]. The reasons below may contribute to this fact: (i) The patients characteristics may be responsible for this fact, such as the higher tumor location in the robotic group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of short-term outcomes between Chinese surgical robot “Micro Hand S” assisted and laparoscopic total mesorectal excision for rectal cancer

Wang¹,

Wang²,

Li³

et al. 2020

Preprint

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Background As the first domestically produced Chinese surgical robot for clinical use, the Micro Hand S robot has been applied to total mesorectal excision (TME) for rectal cancer in our center since 2017. The aim of this study was to evaluate the safety and feasibility of the Micro Hand S robot-assisted TME (R-TME) in comparison with laparoscopic TME (L-TME).Methods Between May 2017 and February 2018, patients who underwent R-TME and L-TME in the Third Xiangya Hospital were prospectively included in this study. The data including intraoperative outcomes, postoperative outcomes, pathological outcomes, and functional outcomes were analyzed and compared.Results Totally, 30 patients underwent L-TME and 21 patients underwent R-TME. The patient characteristics of the two groups were similar. Regarding intraoperative and postoperative outcomes, the R-TME group had significantly less blood loss (95.2 vs. 130.0 ml, p = 0.022), shorter time to first flatus (2.1 vs. 2.9 d, p = 0.017) and first liquid intake (2.8 vs. 3.7 d, p = 0.027) than the L-TME group. There were no significant difference in the operative time, conversion, protective ileostomy, length of hospital stay, pain score, complications, and 30-day mortality between the two groups (p > 0.05). In addition, the pathological and functional outcomes also did not differ significantly.Conclusion The Micro Hand S robot-assisted total mesorectal excision is safe and feasible for rectal cancer. However, prospective and large sample size trials are needed to further confirm this conclusion.Trial registration:Clinicaltrial.gov, NCT02752698, Registered on 27 April 2016, https://clinicaltrials.gov/ct2/show/study/NCT02752698?term=Micro+hand&cntry=CN&draw=2&rank=1

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Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs

Abstract: Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.

Cited by 42 publications

References 18 publications

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study

Comparison of short-term outcomes between Chinese surgical robot “Micro Hand S” assisted and laparoscopic total mesorectal excision for rectal cancer

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