A 5-Year Perspective over Robotic General Surgery: Indications Risk Factors and Learning Curves
O. Sgarbură, V. Tomulescu, C. Blajut, I. PopescuOriginal article, no. 5, 2013
Introduction: Robotic surgery has opened a new era in severalspecialties but the diffusion of medical innovation is slower indigestive surgery than in urology due to considerations relatedto cost and cost-efficiency. Studies often discuss the launchingof the robotic program as well as the technical or clinical datarelated to specific procedures but there are very few articlesevaluating already existing robotic programs. The aims of thepresent study are to evaluate the results of a five-year roboticprogram and to assess the evolution of indications in a centerwith expertise in a wide range of thoracic and abdominalrobotic surgery.Material and methods: All consecutive robotic surgery casesperformed in our center since the beginning of the programand prior to the 31st of December 2012 were included in thisstudy, summing up to 734 cases throughout five years ofexperience in the field. Demographic, clinical, surgical andpostoperative variables were recorded and analyzed.Comparative parametric and non-parametric tests, univariateand multivariate analyses and CUSUM analysis wereperformed.Results: In this group, the average age was 50,31 years. Therewere 60,9% females and 39,1% males. 55,3% of all interventionswere indicated for oncological disease. 36% of all cases ofeither benign or malignant etiology were pelvic conditionswhilst 15,4% were esogastric conditions. Conversion wasperformed in 18 cases (2,45%). Mean operative time was179,4Â+-86,06 min. Mean docking time was 11,16Â+-2,82 min.The mean hospital length of stay was 8,54 (Â+-5,1) days. Therewere 26,2% complications of all Clavien subtypes but importantcomplications (Clavien III-V) only represented 6,2%.Male sex, age over 65 years old, oncological cases and roboticsuturing were identified as risk factors for unfavorable outcomes.Conclusions: The present data support the feasibility ofdifferent and complex procedures in a general surgery departmentas well as the ascending evolution of a well-designed andwell-conducted robotic program. From the large variety ofsurgical interventions, we think that a robotic program couldbe focused on solving oncologic cases and different types ofpelvic and gastroesophageal junction conditions, especiallyrectal, cervical and endometrial cancer, achalasia andcomplicated or redo hiatal hernia.
