Abstract
Background
Robotic surgery offers potential advantages of improved ability to complete procedures using a minimally invasive approach, recovery, and clinical outcomes. It has been previously established that safety net hospitals are outliers for surgical complications. As such, the adoption of new technology may not achieve the same outcomes as other institutions. We hypothesized that, compared to laparoscopic and open surgeries, robotic surgeries have fewer post-operative Clavien-Dindo complications at our safety net hospital.
Methods
All robotic surgeries performed from 2017 to 2019 at a single, safety net hospital were reviewed. Cases were matched 1:3 to laparoscopic controls. Surgeries commonly performed open were additionally matched 1:3 to open counterparts. The primary outcome was Clavien-Dindo complications at 90 days post-operatively. Secondary outcomes included inadvertent enterotomy, conversion to open, operative duration, wound class, surgical site infection (SSI), surgical site occurrence (SSO), length of stay (LOS), reoperation, readmission, and recurrence.
Results
A total of 160 robotic surgeries were included and matched to 480 laparoscopic surgeries and 108 open surgeries. Open surgeries were associated with greater risk of Clavien-Dindo complication (OR = 2.7, p = 0.040, 95% confidence interval 1.0–6.9) than either robotic or laparoscopic surgeries. Robotic cases had increased operative duration when compared to laparoscopic (p < 0.001) but not open cases (p = 0.093). No difference was seen in enterotomy, conversion to open, SSI, SSO, LOS, reoperation, readmission, or recurrence between robotic and laparoscopic, and robotic and open cases.
Conclusion
Robotic surgery is safe and feasible at a safety net hospital. Robotic and laparoscopic surgeries were associated with fewer Clavien-Dindo complications than open surgery, but no differences were seen between robotic and laparoscopic cases. Robotic surgery, compared to both laparoscopic and open surgery, had longer operative durations. Further studies are needed to assess the value of robotic as opposed to laparoscopic surgery in a safety net setting.
Similar content being viewed by others
References
https://www.annualreports.com/HostedData/AnnualReports/PDF/NASDAQ_ISRG_2018.pdf
Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of Robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580
Kim MJ, Park SC, Park JW, Chang HJ, Kim DY, Nam BH, Sohn DK, Oh JH (2018) Robot-Assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 267(2):243–251
Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30(4):1576–1584
Jeong IG, Khandwala YS, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI (2017) Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and Health Care Costs, 2003 to 2015. JAMA 318(16):1561–1568
Hoehn RS, Wima K, Vestal MA, Weilage DJ, Hanseman DJ, Abbott DE, Shah SA (2016) Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg 151(2):120–128
Olavarria OA, Bernardi K, Shah SK, Wilson TD, Wei S, Pedroza C, Avritscher EB, Loor MM, Ko TC, Kao LS, Liang MK (2020) Robotic versus laparoscopic ventral hernia repair: a multicenter, blinded randomized controlled trial. BMJ. https://doi.org/10.1136/bmj.m2457
Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzales JRF, Askenasy EP, Ballecer C, Chong HS, Goldblatt MI, Greenberg JA, Harvin JA, Keith JN, Martindale RG, Orenstein S, Richmond B, Roth JS, Szotek P, Towfigh S, Tsuda S, Vaziri K, Berger DH (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265(1):80–89
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Cherla DV, Holihan JL, Flores-Gonzalez JR, Lew DF, Escamilla RJ, Ko TC, Kao LS, Liang MK (2017) Decreasing surgical site infections after ventral hernia repair: a quality-improvement initiative. Surg Infect 18(7):780–786
Tevis SE, Kennedy GD (2013) Postoperative complications and implications on patient-centered outcomes. J Surg Res 181(1):106–113. https://doi.org/10.1016/j.jss.2013.01.032
Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3(1):e1918911
Cuschieri A (1992) The spectrum of laparoscopic surgery. World J Surg 16:1089–1097
Soper NL, Brunt LM, Kerbl K (1994) Laparoscopic general surgery. N Engl J Med 6:409–419
Funding
This work was supported by a Grant from Intuitive Surgical, Inc. The funding source has no role in study design, collection, analysis and interpretation of data; writing of report; and decision to submit article for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
This work was supported by a Grant awarded to Dr. Holihan from Intuitive Surgical Inc. The content is solely the responsibility of the authors and does not necessarily represent the official views of Intuitive Surgical Inc. Dr. Askenasy reported a research grant from Allergan. The remaining authors (Drs. Dhanani, Olavarria, Millas, Ko and Liang) have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dhanani, N.H., Olavarria, O.A., Millas, S. et al. Is robotic surgery feasible at a safety net hospital?. Surg Endosc 35, 4452–4458 (2021). https://doi.org/10.1007/s00464-020-07948-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07948-z