Safety of robotic general surgery in elderly patients

Abstract

As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

Perioperative Risk Assessment in Robotic General Surgery

“…26 Likewise, we have recently shown that robotic general surgery and more specifically robotic pancreaticoduodenectomy can be performed safely in patients older than 70 years. 8,11 Yet, in the present study, using the univariate analysis, age greater than 70 years was found to be a risk factor for increased morbidity and mortality. As a result, it is believed that elderly patients should be considered as a population at risk for complications, even if the multivariate analysis failed to demonstrate an independent relationship.…”

“…The procedures were divided into 3 categories according to surgical complexity (Table 2), using a modified version of the department's own classification: 11 1. A basic procedure is an operation requiring little dissection and/or reconstruction.…”

Robotic surgery for colorectal cancer in the Octogenarians

“…In our study, we observed a lower rate of serious postoperative complications and a shorter LOS in comparison to the published literature, 25 , 30 , 42 which is suggestive of faster recovery and less tissue trauma. There are several studies demonstrating the feasibility, safety, and good short‐term outcomes of robotic surgery in elderly gynaecologic patients, 27,28 but currently there is limited evidence regarding the safety and efficacy of robotic colorectal surgery in elderly cohorts 29,30 …”

Malfunctions of robotic system in surgery: role and responsibility of surgeon in legal point of view

“…The possibility of 3D views and 360° instruments rotation allows for a considerable improvement in clinical practice. Many studies have confirmed the safety and feasibility of Robotic Surgery (RS) in all its applications [ 1 ]. Despite the device being initially meant for cardiac surgery, recent years have witnessed a rapid growth in its application to abdominal surgery by urologists, gynaecologists, and general surgeons.…”