Abstract
The introduction of robotic surgery in hospitals has raised much debate given the various effects on care, costs, education and medical advancement. Purchasing discussions are often approached with more questions than answers and there is a need for reports that provide a case for whether or not such technologies are advantageous from multiple perspectives, and offer insights into ways such devices can be introduced into a hospital setting. This report provides an evidence-based review of a university-affiliated tertiary care hospital’s 12-year experience with robotic surgery in gynecologic oncology and delves into the various takeaways and challenges of implementing robotic surgery. Key findings were that robotic surgery significantly reduced complication rates, lengths of hospital stays for patients and overall hospital costs. Key obstacles were large upfront costs and the need for significant leadership and collaboration. Ongoing challenges to evaluating robotics include assessing long-term survival data, making comparisons with concurrently changing hospital conditions and determining how data can be generalized to other departments and institutions.
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Study data can be provided upon request. Several details (e.g. the subdivision of hospital costs) are considered confidential and cannot be provided.
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References
Abitbol J, Munir A, How J et al (2020) The shifting trends towards a robotically-assisted surgical interface: clinical and financial implications. Health Policy Technol 9:157–165
Abitbol J, Lau S, Salvador S et al (2019) A three-pronged approach to evaluating robotic surgery. Gynecol Pelvic Med 2:15
Matanes E, Abitbol J, Kessous R et al (2019) Oncologic and surgical outcomes of robotic versus open radical hysterectomy for cervical cancer. J Obstet Gynaecol Can 41(4):450–458
Lau S, Vaknin Z, Ramana-Kumar A et al (2012) Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery. Obstet Gynecol 119(4):717–724
Abitbol J, Gotlieb W, Zeng Z et al (2019) Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer 29(9):1341–1347
Halliday D, Lau S, Vaknin Z et al (2010) Robotic radical hysterectomy: comparison of outcomes and cost. J Robotic Surg 4:211–216
Lavoue V, Zeng X, Lau S et al (2014) Impact of robotics on the outcome of elderly patients with endometrial cancer. Gynecol Oncol 133:566–662
Abitbol J, Cohn R, Hunter S et al (2017) Minimizing pain medication use and its associated costs following robotic surgery. Gynecol Oncol 144(1):187–192
How J, Lau S, Press J et al (2012) Accuracy of sentinel lymph node detection following intra-operative cervical injection for endometrial cancer: a prospective study. Gynecol Oncol 127(2):332–337
Kogan L, Matanes E, Wissing M et al (2020) The added value of sentinel node mapping in endometrial cancer. Gynecol Oncol 158:84–91
Lau S, Buzaglo K, Vaknin Z et al (2011) Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer. Int J Gynecol Cancer 21(4):722–729
Vaknin Z, Perri T, Deland C et al (2010) Outcome and quality of life in a prospective cohort of the first 100 robotic surgeries for endometrial cancer, with focus on elderly patients. Int J Gynecol Cancer 20(8):1367–1373
Leung A, Abitbol J, Ramana-Kumar A et al (2017) Outside the operating room: how a robotics program changed resource utilization on the inpatient ward. Gynecol Oncol 145(1):102–107
Ramirez PT, Frumovitz M, Pareja R et al (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904
Melamed A, Margul DJ, Chen L et al (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379(20):1905–1914
Acknowledgements
We would like to thank the Jewish General Hospital Foundation, which made the implementation of the robotics program possible, and the Israel Cancer Research Foundation, the Susan and Jonathan Wener Fund, the Garber Fund and the McGill University Faculty of Medicine Research Bursary Program who supported the research on the value of robotics.
Funding
Dr. Gomolin received a one-time financial award from the McGill University Faculty of Medicine Research Bursary Program to conduct research on the cost effectiveness of robotic surgery.
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Dr. Gomolin: conceptualization, investigation, and writing. Dr. Gotlieb: conceptualization, investigation, supervision, and writing. Dr. Lau: investigation and writing. Dr. Salvador: investigation and writing. Dr. Racovitan: software, resources, and writing. Dr. Abitbol: investigation, conceptualization, supervision, and writing. All authors read and approved the manuscript.
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Dr. Gotlieb and Dr. Lau obtained travel support to proctor robotic surgery. The remaining authors report no conflicts of interest in this work.
Ethical approval
All the studies from the Jewish General Hospital Division of Gynecologic Oncology referenced in this manuscript received approval from the Institutional Review Board.
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Gomolin, A., Gotlieb, W., Lau, S. et al. Mandate to evaluate robotic surgery implementation: a 12-year retrospective analysis of impact and future implications. J Robotic Surg 16, 783–788 (2022). https://doi.org/10.1007/s11701-021-01327-z
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DOI: https://doi.org/10.1007/s11701-021-01327-z