Robotic Knee Replacement tied to Lower Complication Rate ...

found that a history of congestive heart failure or myocardial infarction, prior thrombosis, perioperative hemoglobin decrease greater than 3.1 g/dL, or preoperative hemoglobin less than 12.0 g/dL were associated with increased perioperative complications. Perioperative morbidity, mortality, and resource utilization were analyzed. Complications of da Vinci robot hysterectomy can include: Vaginal cuff dehiscence. eTable 2). Choice of hysterectomy route should be individualized. Recent reviews report that the in-cidence of vaginal cuff dehiscence increases dispropor-tionately in robotic hysterectomies compared to that in abdominal and vaginal hysterectomies.1-5 In robotic-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical . Found inside – Page 176A recent cost comparison of robotic, laparoscopic, and open hysterectomy for treatment of endometrial cancer found ... the risk of postoperative complications and wound breakdown are particularly high for these women.142,143 SLNB may be ... A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. A robotic hysterectomy may be suggested for patients who have anatomical anomalies and aren't good candidates for a vaginal procedure. Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. The literature has shown that minimally invasive approaches to benign hysterectomy shorten LOS and minimize postsurgical complications, compared to more-invasive open approaches.24 Proceeding in a minimally invasive fashion has allowed a transition from inpatient to outpatient hysterectomies.  et al. A study comparing robotic and laparoscopic hysterectomies found that there was no difference in complication rates or outcomes. As with any type of surgery, risks include adverse reaction to anesthesia, blood clots, infection and bleeding. Found inside – Page 38Current surgical approaches for myomectomy include abdominal, laparoscopic, or robotic. ... 2 Selecting Patients Most Likely backs, not the least of which is an overall complication rate of 17–23 % regardless of approach—abdominal, ... Comparative Effectiveness Research on Robotic Surgery, Joel S. Weissman, PhD; Michael Zinner, MD, Mahiben Maruthappu, FRSA; Antoine Duclos, MD, PhD; Matthew J. Carty, MD, Robotic vs Laparoscopic Hysterectomy—Reply, Jason D. Wright, MD; Dawn L. Hershman, MD, Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease, To register for email alerts with links to free full-text articles, Get unlimited access and a printable PDF ($30.00)—, 2021 American Medical Association. Found inside – Page 502include hysterectomy, bilateral salpingo‐oophorectomy, washings, pelvic and para‐aortic lymph node dissection, ... Minimally invasive techniques have shown similar operative times and complication rates, with less blood loss and shorter ... Recent studies have raised concerns regarding the comparative effectiveness of robotic-assisted surgery for a variety of procedures.25,33 A comparative analysis of robotic-assisted vs laparoscopic hysterectomy for endometrial cancer noted that the 2 procedures were associated with similar morbidity, but robotically assisted hysterectomy was accompanied by substantially greater cost.25 To date, most studies of robotically assisted hysterectomy for benign gynecologic disease have been of limited size and retrospective in nature.3,5-18 A review of published observational data comparing robotic-assisted and laparoscopic hysterectomy noted that clinical outcomes were similar while operative times and costs were higher for robotic procedures.6 A meta-analysis of prospective trials comparing robotic and laparoscopic surgery for benign gynecologic disease found that both procedures were associated with similar outcomes, complications, length of stay, and quality of life.3 We noted that perioperative outcomes were similar for robotic-assisted and laparoscopic hysterectomy.

Do not ignore professional medical advice or delay seeking it because of something you have read. Robotic versus laparoscopic hysterectomy: a review of recent comparative studies. Robotic systems with dual consoles have elevated the training process in residency and fellowship programs, allowing both surgeons and trainees to operate simultaneously. New York352 7th Ave, #1202New York, NY 10001888-787-4379, Rockville3206 Tower Oaks Blvd, #200Rockville, MD 20852888-787-4379, Reston1860 Town Center Dr, #255Reston, VA 20190888-787-4379. In a propensity score-matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Found inside – Page 3They concluded robotic hysterectomy was possible while also achieving minimal blood loss, short hospital stay, and low complication rate. This study compared their robotic data with other major series reported by the time of publication ... While complication rates were similar in the two groups, conversion rates were significantly higher in the conventional laparoscopic cohort. Although low-quality or low-certainty evidence suggests little difference in complication rates between robot-assisted surgery and conventional laparoscopic surgery for benign conditions, high-quality data are not available on patient outcomes, safety, or cost 11.Nevertheless, rapid adoption of robot-assisted technology for gynecologic . In a series of sensitivity analyses, these findings remained largely unchanged (Table 2). We performed a number of sensitivity analyses to examine the accuracy of the coding schema. This requires closure of the upper portion of the vagina, where the cervix used to be. For each patient, a propensity score was generated from logistic regression models that included all of the clinical characteristics (hospital location, teaching status, bed size, region, hospital volume, physician volume, indication for surgery, concomitant procedures, and type of hysterectomy) and demographic characteristics (age, year of diagnosis, race, marital status, insurance status, comorbidity) of interest. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. For robot-assisted surgery to be successful, attention must be placed on proper patient positioning, robotic port placement, and docking. At these hospitals, use of vaginal (19.8% to 18.1%), laparoscopic (28.9% to 24.5%), and abdominal (44.4% to 35.1%) hysterectomy all declined. Approaches to Hysterectomy - Page 4 Unadjusted and propensity score-matched comparison of laparoscopic and robotic-assisted hysterectomy, eTable 3. A report estimating the operating cost of robotic surgery in 2017 yielded a cost per procedure of $3,568. Recovery after robotic hysterectomy is shorter and less painful than after a normal abdominal hysterectomy. Payne TN, Dauterive FR, Pitter MC, J Br Menopause Soc. The database contains comprehensive data for all inpatient admissions from more than 600 acute care hospitals located across the United States. Hospitalization for longer than 2 days was more common in the laparoscopic hysterectomy cohort (24.9% vs 19.6%, P < .001), while rates of transfusion (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16), reoperation (0.1% vs 0.1%; RR, 1.00; 95% CI, 0.26-3.84), nonroutine discharge (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76), and in-hospital mortality were similar (P > .05 for all). These costs decreased to $8174 (IQR, $6319-$11 278) for cases 21-30 and then increased to $8307 (IQR, $6616-$11 058) for cases 31-40 and to $8220 (IQR, $6029-$10 864) for cases after the 40th robotic-assisted hysterectomy. When evaluating only women who underwent a minimally invasive (laparoscopic or robotic-assisted) hysterectomy, year of diagnosis, insurance status, metropolitan location, hospital teaching status, area of residence, and hospital size were associated with use of robotically assisted hysterectomy. The mean BMI was 43 (range 21-71) kg/m. Factors that affect route of surgery include indication for surgery along with uterine size and pathology, pelvic anatomy, and vaginal access. . Q: What are the potential benefits of robotic assisted hysterectomy? 5,6 These results suggest that a more up to date version of sacrocolpopexy (as compared with the open . Customize your JAMA Network experience by selecting one or more topics from the list below.

Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. The median total cost for laparoscopic hysterectomy was $6679 (IQR, $5197-$8673) compared with $8868 (IQR, $6787-$11 830) for robotic-assisted hysterectomy. Obstet Gynecol. Comparative effectiveness of minimally invasive vs open radical prostatectomy. Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA. Robot-assisted radical hysterectomy for early stage cervical cancer was accompanied by similar postoper-ative complication rates (37.6% vs. 37.4%) and costs but shorter hospital stay compared with open radical hysterectomy. This occurred despite the robotic cohort having higher rates of adhesive disease, uteri >250 g, and morbid obesity.18, A growing number of women in the United States are overweight, with 43% of women undergoing benign hysterectomy meeting the definition of obesity with a body mass index (BMI) of ≥30 kg/m2.19 Increasing BMI is known to be associated with longer operative times and increased estimated blood loss (EBL). complication of total hysterectomy. The appropriate training of the Robotic Team is essential to decrease surgical time and complication rates [16,17]. Nezhat C, Lavie O, Lemyre M, Gemer O, Bhagan L, Nezhat C. Laparoscopic hysterectomy with and without a robot: Stanford experience. Sarlos D, Kots LA. Black women (relative risk [RR], 0.86; 95% CI, 0.80-0.93) were less likely than white women to undergo a robotic procedure. . J Br Menopause Soc.

Efficacy of the da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Metrics of resource utilization analyzed included transfusion, reoperation, and length of stay. These results are similar, especially the postoperative complication rates, to those reported by Lönnerfors et al. 10 Injuries generally occur with excessive electrocautery and lasering adjacent to the ureter. The newsletter is provided for general informational purposes only.

Stewart would undergo da Vinci® surgery, a minimally invasive robotic procedure designed for faster recovery. The robotic platform provides a method for gynecologic surgeons to avoid laparotomy and continue with a minimally invasive approach to hysterectomy. JAMA. The performance of concomitant gynecologic procedures, including anterior colporrhaphy, posterior colporrhaphy, salpingo-oophorectomy, and incontinence surgery, were also noted. For each hospital, we noted the quarter in which the first robotically assisted hysterectomy was performed. A 2019 analysis1 by the research team at The Center for Innovative GYN Care included data on more than 2600 cases to compare the surgical outcomes of the most commonly performed hysterectomies. Two separate propensity matches were performed, one for patients who underwent laparoscopic, or robotically assisted hysterectomy and one for women who underwent either abdominal or robotic-assisted hysterectomy. da Vinci Hysterectomy (radical) offers the following potential benefits compared to open surgery: Similar complication rates1,2,4,6,7,8,9 Less estimated blood loss1,2,3,4,6,7,8,9 & fewer transfusions1,2,4,6,7,9 Shorter hospital stay2,3,4,6,7,8,9 Less need for narcotic pain medicine after surgery8,9 da Vinci Hysterectomy (radical) offers the . The robotic platform from Intuitive Surgical Inc., Sunnyvale, CA, the da Vinci Surgical System, is the first telesurgical system approved by the U.S. Food and Drug Administration (FDA).7 Gynecologic indications for robotic use were approved in 2005.7 The da Vinci surgical system is the only FDA-approved robotic platform on the market and, through the years, has undergone several technologic iterations. Propensity score matched comparison of complications and resource utilization for patients who underwent robotic versus abdominal hysterectomy. Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, Vermeulen MJ. Main Outcome Measures Uptake of and factors associated with utilization of robotically assisted hysterectomy. Factors attributed to surgeons not rapidly adopting laparoscopic techniques included diluted training experiences during residency, lack of proctors and mentor surgeons for younger surgeons out of training, and lengthy learning curves required to develop new surgical skills that involved use of rigid instruments with a 2-dimentional camera that required counterintuitive surgical maneuvering.5,6 The advent of robotic surgery provided the opportunity to change the surgical environment radically. Sensitivity analyses were performed by matching different numbers of controls to cases, as well as using different caliper settings. Lower complication rate shorter hospital stay To limit this bias, we analyzed only major perioperative complications that were likely to generate a claim. a comparison of the complication rates. Hysterectomy rates by quarter after the introduction of robotic-assisted hysterectomy are reported at these hospitals. Kollef MH, Hamilton CW, Ernst FR. This surgery can be done through small incisions using a thin, lighted scope with a camera on the end (a laparoscope). Some patients are at greater risk than others for experiencing complications — underlying medical problems, for example, may affect outcomes if they are not taken into account. Robotic hysterectomy is a more preferred procedure than open surgeries because: They cause minimal discomfort. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy. Author Affiliations: Department of Obstetrics and Gynecology (Drs Wright, Ananth, Lewin, Burke, and Herzog and Ms Lu), Department of Medicine (Drs Neugut and Hershman), and Herbert Irving Comprehensive Cancer Center (Drs Wright, Lewin, Neugut, Herzog, and Hershman), Columbia University College of Physicians and Surgeons, New York, New York; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Drs Neugut and Hershman). The median fixed cost for laparoscopic hysterectomy was $3040 (IQR, $2281-$4148) compared with $4002 (IQR, $2868-$5780) for robotic-assisted hysterectomy (P < .001). It is hoped that competition with alternative robotic systems will decrease these costs. The introduction of robotic-assisted hysterectomy was paralleled by a decrease in the rate of abdominal hysterectomy both in hospitals where robotic-assisted hysterectomy was performed and in those where robotic procedures were not performed. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy. The unadjusted rate of complications was 5.5% for women who underwent robotic-assisted hysterectomy vs 5.3% for those who had a laparoscopic procedure (P = .47).


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