1,721,584 research outputs found
The use of da Vinci Xi and the increased surgeon's experience could change the perspective over the cost-benefit ratio of robot-assisted surgery
No full textTo the Editor:
We read with great interest the article by Khorgami et al. entitled “The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample” [1] recently published on Surgical Endoscopy.
The introduction of robotic systems in surgery was intended to overcome the known limitations of conventional laparoscopic surgery, while preserving the advantages of the minimally invasive surgery [2], justifying the growing interest in robotic technology for abdominal surgery worldwide. However, the costs of robot-assisted surgery (RAS) still represent a critical issue for its widespread adoption.
The study of Khorgami et al. is a very well structured retrospective analysis of the 2012–2014 Healthcare Cost and Utilization Project-National Inpatient Sample which is the largest inpatient health care database in the United States, collecting data from more than 7 million hospital admissions annually. A total of 91,630 abdominal major and minor surgeries (87,965 laparoscopic, 3,665 robotic) were analyzed, including cholecystectomy, ventral hernia repair, right and left hemicolectomy, sigmoidectomy, abdominoperineal resection, and total abdominal hysterectomy. The average cost for the laparoscopic group was 4986 versus 5880 for the robotic cases (p < 0.001), suggesting that RAS is more costly when compared to conventional laparoscopic surgery. However, robotic total abdominal hysterectomy showed the lowest increased cost and was the only procedure to be performed more often robotically. This suggests that although RAS costs are higher, the difference may be offset with more routine performance of procedures using the robot.
Some recent published studies of our group on rectal surgery [3,4] support this theory, showing a significant decrease of RAS overall variable costs with surgeon’s experience. This means that a possible major bias of the current economic evaluations such as those of this article, unfavorable to RAS when compared to standard laparoscopy, is that they are referred mainly to results obtained by comparing expert laparoscopists with novice robotic surgeons.
A second possible bias, is that the study of Khorgami et al. refers to the years 2012-2014, when the new da Vinci Xi robotic platform was not available yet. Indeed, recent works have reported that the use of the new da Vinci Xi represents an improvement on its Si predecessor in robot-assisted colorectal resections, being associated with shorter operative time, reduced docking time and higher full robotic resection rates and significantly reducing RAS-associated costs [3-5].
In conclusion, the article by Khorgami et al. deals with a very interesting topic analyzing a huge sample size. However, the use of the new da Vinci Xi platform, as well as of new robots, by robotic surgeons with an adequate experience could nowadays change the perspective over the cost-benefit ratio of RAS
Response to the comment on "pattern of recurrence and survival after D2 right colectomy for cancer: is there place for a routine more extended lymphadenectomy?"
No full textPANCREASECTOMIA SINISTRA ROBOTICA CON RIPARAZIONE VENA SPLENICA
No full textPANCREASECTOMIA SINISTRA ROBOTICA CON RIPARAZIONE VENA SPLENIC
Costs–benefits of robot-assisted colorectal surgery: a different perspective
No full textThe costs of robot-assisted surgery (RAS) still represent a critical issue. Kulaylat et al. reported a propensity-matched study to compare the outcomes of colorectal surgery between a robotic and a laparoscopic group, concluding that RAS was burdened by higher costs. However, authors did not mention what da Vinci system, Si or Xi, they used and this could be crucial, as recently data published by our group on rectal resections showed that the use of the da Vinci Xi and the surgeon’s increased experience could improve the results and significantly reduce the costs of RAS
Use of 3D models for planning, simulation, and training in vascular surgery
No full textDear Editor,
We read with great interest the article by Pugliese et al. entitled “The clinical use of 3D printing in surgery” recently published by Updates in Surgery.
In the past years, 3D printing has seen an almost exponential growth in several fields, including medicine and surgery, as testified by the increasing number of published articles. This success was fostered by technological progresses on manufacturing processes allowing to build layer by layer 3D objects at higher resolution
Should we use virtual simulators for surgical resident selection?
No full textTo the Editor:
we read with great interest the article by Gardner et al. entitled “How Much Are We Spending on Resident Selection?” recently published by Journal of Surgical Education [1].
Gardner et al. put the attention on the importance of a rigorous selection process to identify applicants who will be the best fit for training programs. In this analysis authors revealed the significant time and resources spent for the current resident selection process, with the average program spending approximately $100,000 annually. Moreover, examining the amount of time and efforts dedicated to applicant screening activities, they observed that residency coordinators were shouldering much of the burden, spending over 132 hours on the process.
Gardner et al., rightly, stressed the importance for program leaders to assess the efficacy and efficiency of their current selection procedures and identify additional methodologies to make the process more efficient. A key point of the high costs is the large number of interviews conducted. For these reason, Gardner et al. highlighted the importance of reducing the number of on-site interviews, administering customized assessments to eligible applicants early in the process to help the identification of candidate's potential, fit, and alignment with the program’s values and expectations.
Moreover, according to a survey, 30% of program directors from Fellowship Council in North America believe that graduates entering fellowships cannot independently and safely perform routine operations [2]. Therefore, it is important to adopt more efficient screening tools, such as online assessments, phone or video interviews, or assessment centers, to decrease the burden for both applicants and programs, but also to choose candidates with higher possibilities to become competent surgeons. In this context, the use of simulators could represent a valid option. The use of simulators for the training of surgical resident is increasingly widespread nowadays. However, in our opinion a possible alternative use of surgical simulators could be as tests for resident selection during their initial assessment. Indeed, there is an increasing interest for a reliable test as an objective assessment of the innate ability for psychomotor manipulative skills for surgery and as an integral component of the selection process for the many interns or house officers’ intent on a surgical career. Moreover, the restrictions on working hours in the USA and even more extremely in EU member states has increased the importance of such innate aptitudes for surgery because surgical resident should acquire technical skills quickly, or at least efficiently.
As pointed out by Gardner the selection procedure of surgical residents students is currently very complex because it includes many phases. But it is very important to ensure a high probability of selecting the most promising candidates in view of such high costs.. Unfortunately, at present the selection process does not consider manual dexterity among the determining factors, an increasingly important aspect after the advent of minimally invasive surgery that requires psychomotor skills (hand-eye coordination, lack or reduction of tactile feedback,...). Since virtual simulators are able to objectively evaluate psychomotor competences, an aptitude test based on a virtual simulator may complement the evaluation process. For example, two studies were done using virtual simulators for robotic surgery to evaluate the innate ability for surgery among medical students. [2,3]. Although the two studies differ in design, participants and used simulators, they have found very similar results. In fact the two studies showed almost the same distribution of the three groups with 6.6% and 5.8% exhibiting outstanding performance, and 11.6% and 11.0% with low level ability for manipulative skills compared to their peers. [3]. These data are in agreement with data reported by a study on medical students using a simulator for laparoscopic appendectomy that revealed a 15% of medical students with low aptitude to reach proficiency [4]. Furthermore, the value of simulators as an aptitude test on technical skills has been demonstrated in the Republic of Ireland by a study on candidates entering a higher surgical residency training program (equivalent to a Fellowship in the USA), which confirmed a high correlation between score at surgical simulators and overall assessment, based on education and academic records, progress in clinical surgical performance, research output, and interview assessment [5].
In conclusion, the use of virtual simulators for objective testing could be included to complement the selection process of residents. However, if in the future the simulators were added among the tools for the resident selection, the costs of the purchase of the simulators and of the dedicated personnel should be considered in the total costs. However, thanks to the increasing diffusion of laparoscopy and robotic surgery, the number of simulators for these surgical approaches is constantly growing and this could reduce purchasing costs. Moreover, their use could save on training costs during the residency because it would give the possibility to invest on the most promising candidates and not to invest on those with less potentia
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
New perspectives about the role of robot-assisted surgery for the treatment of endometriosis
No full textWe read with great interest the recently published article by Comptour et al. entitled “Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis”.
Painful gynecological and digestive symptoms of endometriosis have been shown to severely affect the patients’ quality of life (QoL), and various studies have described the benefits of surgery in the treatment of endometriosis, particularly in its worst presentation, namely, Deep Infiltrating Endometriosis (DIE). Comptour et al. have designed a prospective and multicenter cohort study to assess the impact of surgical treatment of endometriosis on quality of life and pain, and their results seem to confirm these benefits
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