Dataset Information

Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections.

ABSTRACT: Minimally invasive thoracoscopic surgical techniques have grown increasingly popular due to improved outcome measures compared to conventional rib-spreading thoracotomy. However, video-assisted thoracoscopic surgery (VATS) presents with unique technical challenges that have limited its role in certain cases. Here, we discuss our perspectives on the implementation of a successful robotic thoracic program. We will then present the case for how the adoption of robotic assisted thoracic surgery (RATS) provides the benefits of minimally invasive VATS while still retaining the technical finesse of bimanual articulating instruments and 3-dimensional imaging that is a universal component of any open surgery. We will also discuss how to overcome some of the perceived disadvantages to RATS in regard to the higher cost, lack of tactile feedback and potential safety concerns.

SUBMITTER: Mazzei M

PROVIDER: S-EPMC7061192 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections.

Mazzei Michael M Abbas Abbas E AE

Journal of thoracic disease 20200201 2

Minimally invasive thoracoscopic surgical techniques have grown increasingly popular due to improved outcome measures compared to conventional rib-spreading thoracotomy. However, video-assisted thoracoscopic surgery (VATS) presents with unique technical challenges that have limited its role in certain cases. Here, we discuss our perspectives on the implementation of a successful robotic thoracic program. We will then present the case for how the adoption of robotic assisted thoracic surgery (RAT ...[more]

PMID: 32190356

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Project description:Importance:Increasing use of robotic surgery for common surgical procedures with limited evidence and unclear clinical benefit is raising concern. Analyses of population-based trends in practice and how hospitals' acquisition of robotic surgical technologies is associated with their use are limited. Objective:To characterize trends in the use of robotic surgery for common surgical procedures. Design, Setting, and Participants:This cohort study used clinical registry data from Michigan from January 1, 2012, through June 30, 2018. Trends were characterized in the use of robotic surgery for common procedures for which traditional laparoscopic minimally invasive surgery was already considered a safe and effective approach for most surgeons when clinically feasible. A multigroup interrupted time series analysis was performed to determine how procedural approaches (open, laparoscopic, and robotic) change after hospitals launch a robotic surgery program. Data were analyzed from March 1 through April 19, 2019. Exposures:Initiation of robotic surgery. Main Outcomes and Measures:Procedure approach (ie, robotic, open, or laparoscopic). Results:The study cohort included 169?404 patients (mean [SD] age, 55.4 [16.9] years; 90?595 women [53.5%]) at 73 hospitals. The use of robotic surgery increased from 1.8% in 2012 to 15.1% in 2018 (8.4-fold increase; slope, 2.1% per year; 95% CI, 1.9%-2.3%). For certain procedures, the magnitude of the increase was greater; for example, for inguinal hernia repair, the use of robotic surgery increased from 0.7% to 28.8% (41.1-fold change; slope, 5.4% per year; 95% CI, 5.1%-5.7%). The use of robotic surgery increased 8.8% in the first 4 years after hospitals began performing robotic surgery (2.8% per year; 95% CI, 2.7%-2.9%). This trend was associated with a decrease in laparoscopic surgery from 53.2% to 51.3% (difference, -1.9%; 95% CI, -2.2% to -1.6%). Before adopting robotic surgery, hospitals' use of laparoscopic surgery increased 1.3% per year. After adopting robotic surgery, the use of laparoscopic surgery declined 0.3% (difference in trends, -1.6%; 95% CI, -1.7% to -1.5%). Conclusions and Relevance:These results suggest that robotic surgery has continued to diffuse across a broad range of common surgical procedures. Hospitals that launched robotic surgery programs had a broad and immediate increase in the use of robotic surgery, which was associated with a decrease in traditional laparoscopic minimally invasive surgery.

Dataset Information

Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections.

Publications

Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections.

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