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01-06-2019

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

Authors: Luca Morelli, Gregorio Di Franco, Valentina Lorenzoni, Simone Guadagni, Matteo Palmeri, Niccolò Furbetta, Desirée Gianardi, Matteo Bianchini, Giovanni Caprili, Franco Mosca, Giuseppe Turchetti, Alfred Cuschieri

Published in: Surgical Endoscopy | Issue 6/2019

Abstract

Background

Robotic-assisted surgery by the da Vinci Si appears to benefit rectal cancer surgery in selected patients, but still has some limitations, one of which is its high costs. Preliminary studies have indicated that the use of the new da Vinci Xi provides some added advantages, but their impact on cost is unknown. The aim of the present study is to compare surgical outcomes and costs of rectal cancer resection by the two platforms, in a single surgeon’s experience.

Methods

From April 2010 to April 2017, 90 robotic rectal resections were performed, with either the da Vinci Si (Si-RobTME) or the da Vinci Xi (Xi-RobTME). Based on CUSUM analysis, two comparable groups of 40 consecutive Si-RobTME and 40 consecutive Xi-RobTME were obtained from the prospectively collected database and used for the present retrospective comparative study. Data costs were analysed based on the level of experience on the proficiency–gain curve (p–g curve) by the surgeon with each platform.

Results

In both groups, two homogeneous phases of the p–g curve were identified: Si1 and Xi1: cases 1–19, Si2 and Xi2: cases 20–40. A significantly higher number of full RAS operations were achieved in the Xi-RobTME group (p < 0.001). A statistically significant reduction in operating time (OT) during Si2 and Xi2 phase was observed (p < 0.001), accompanied by reduced overall variable costs (OVC), personnel costs (PC) and consumable costs (CC) (p < 0.001). All costs were lower in the Xi2 phase compared to Si2 phase: OT 265 versus 290 min (p = 0.052); OVC 7983 versus 10231.9 (p = 0.009); PC 1151.6 versus 1260.2 (p = 0.052), CC 3464.4 versus 3869.7 (p < 0.001).

Conclusions

Our experience confirms a significant reduction of costs with increasing surgeon’s experience with both platforms. However, the economic gain was higher with the Xi with shorter OT, reduced PC and CC, in addition to a significantly larger number of cases performed by the fully robotic approach.

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Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, Sonzogni A, Biffi R (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257:672–678. https://doi.org/10.1097/SLA.0b013e318269d03b CrossRefPubMed

D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168. https://doi.org/10.1007/s10350-004-0711-z CrossRefPubMed

D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27:1887–1895. https://doi.org/10.1007/s00464-012-2731-4 CrossRefPubMed

Morelli L, Ceccarelli C, Di Franco G, Guadagni S, Palmeri M, Caprili G, D’Isidoro C, Marciano E, Pollina L, Campani D, Massimetti G, Di Candio G, Mosca F (2016) Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 31:913–915. https://doi.org/10.1007/s00384-015-2301-z CrossRefPubMed

Delacroix SE, Winters JC (2010) Voiding dysfunction after pelvic colorectal surgery. Clin Colon Rectal Surg 23:119–127. https://doi.org/10.1055/s-0030-1254299 CrossRefPubMedPubMedCentral

Young M, Pigazzi A (2014) Total mesorectal excision: open, laparoscopic or robotic. In: Recent results cancer research, pp 47–55

Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24:2888–2894. https://doi.org/10.1007/s00464-010-1134-7 CrossRefPubMed

Baek J-H, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525. https://doi.org/10.1007/s00464-010-1204-x CrossRefPubMed

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 P, 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 318:1569. https://doi.org/10.1001/jama.2017.7219 CrossRefPubMedPubMedCentral

10.

Wang Y, Zhao G-H, Yang H, Lin J (2016) A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutaneous Tech 26:259–264. https://doi.org/10.1097/SLE.0000000000000263 CrossRef

11.

Li X, Wang T, Yao L, Hu L, Jin P, Guo T, Yang K (2017) The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer. Medicine (Baltimore) 96:e7585. https://doi.org/10.1097/MD.0000000000007585 CrossRef

12.

Cheng CL, Rezac C (2018) The role of robotics in colorectal surgery. BMJ 360:j5304CrossRefPubMed

13.

Hagen ME, Jung MK, Ris F, Fakhro J, Buchs NC, Buehler L, Morel P (2016) Early clinical experience with the da Vinci Xi Surgical System in general surgery. J Robot Surg. https://doi.org/10.1007/s11701-016-0662-0 CrossRefPubMed

14.

Protyniak B, Jorden J, Farmer R (2017) Multiquadrant robotic colorectal surgery: the da Vinci Xi vs Si comparison. J Robot Surg. https://doi.org/10.1007/s11701-017-0689-x CrossRefPubMed

15.

Ozben V, Cengiz TB, Atasoy D, Bayraktar O, Aghayeva A, Erguner I, Baca B, Hamzaoglu I, Karahasanoglu T (2016) Is da Vinci Xi Better than da Vinci Si in robotic rectal cancer surgery? Comparison of the 2 generations of da Vinci systems. Surg Laparosc Endosc Percutaneous Tech 26:417–423. https://doi.org/10.1097/SLE.0000000000000320 CrossRef

16.

Morelli L, Guadagni S, Di Franco G, Palmeri M, Caprili G, D’Isidoro C, Pisano R, Moglia A, Ferrari V, Di Candio G, Mosca F (2015) Use of the new Da Vinci Xi during robotic rectal resection for cancer: technical considerations and early experience. Int J Colorectal Dis 30:1281–1283. https://doi.org/10.1007/s00384-015-2350-3 CrossRef

17.

Morelli L, Guadagni S, Di Franco G, Palmeri M, Caprili G, D’Isidoro C, Cobuccio L, Marciano E, Di Candio G, Mosca F (2017) Use of the new da Vinci Xi® during robotic rectal resection for cancer: a pilot matched-case comparison with the da Vinci Si®. Int J Med Robot Comput Assist Surg 13:e1728. https://doi.org/10.1002/rcs.1728 CrossRef

18.

Morelli L, Di Franco G, Guadagni S, Rossi L, Palmeri M, Furbetta N, Gianardi D, Bianchini M, Caprili G, D’Isidoro C, Mosca F, Moglia A, Cuschieri A (2018) Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 32:589–600. https://doi.org/10.1007/s00464-017-5708-5 CrossRefPubMed

19.

Morelli L, Palmeri M, Guadagni S, Di Franco G, Moglia A, Ferrari V, Cariello C, Buccianti P, Simoncini T, Zirafa C, Melfi F, Di Candio G, Mosca F (2016) Use of a new integrated table motion for the da Vinci Xi in colorectal surgery. Int J Colorectal Dis 31:1671–1673. https://doi.org/10.1007/s00384-016-2609-3 CrossRefPubMed

20.

Palmeri M, Gianardi D, Guadagni S, Di Franco G, Bastiani L, Furbetta N, Simoncini T, Zirafa C, Melfi F, Buccianti P, Moglia A, Cuschieri A, Mosca F, Morelli L (2018) Robotic colorectal resection with and without the use of the new Da Vinci table motion: a case-matched study. Surg Innov. https://doi.org/10.1177/1553350618765540 CrossRefPubMed

21.

Morelli L, Palmeri M, Simoncini T, Cela V, Perutelli A, Selli C, Buccianti P, Francesca F, Cecchi M, Zirafa C, Bastiani L, Cuschieri A, Melfi F (2018) A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table. Surg Endosc. https://doi.org/10.1007/s00464-018-6161-9 CrossRefPubMed

22.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

23.

Morelli L, Guadagni S, Lorenzoni V, Di Franco G, Cobuccio L, Palmeri M, Caprili G, D’Isidoro C, Moglia A, Ferrari V, Di Candio G, Mosca F, Turchetti G (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Colorectal Dis 31:1639–1648. https://doi.org/10.1007/s00384-016-2631-5 CrossRef

24.

Hellan M, Anderson C, Ellenhorn JDI, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173. https://doi.org/10.1245/s10434-007-9544-z CrossRefPubMed

25.

Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamakawa Y (2016) Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701–1710. https://doi.org/10.1007/s00384-016-2653-z CrossRef

26.

Ackerman SJ, Daniel S, Baik R, Liu E, Mehendale S, Tackett S, Hellan M (2018) Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery? J Med Econ 21:254–261. https://doi.org/10.1080/13696998.2017.1396994 CrossRefPubMed

27.

Panteleimonitis S, Pickering O, Abbas H, Harper M, Kandala N, Figueiredo N, Qureshi T, Parvaiz A (2018) Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis 33:1079–1086. https://doi.org/10.1007/s00384-018-3030-x CrossRefPubMedPubMedCentral

28.

Esen E, Aytac E, Ağcaoğlu O, Zenger S, Balik E, Baca B, Hamzaoğlu İ, Karahasanoğlu T, Buğra D (2018) Totally robotic versus totally laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutaneous Tech 28:1. https://doi.org/10.1097/SLE.0000000000000552 CrossRef

29.

Nozawa H, Watanabe T (2017) Robotic surgery for rectal cancer. Asian J Endosc Surg 10:364–371. https://doi.org/10.1111/ases.12427 CrossRefPubMed

30.

Ramji KM, Cleghorn MC, Josse JM, MacNeill A, O’Brien C, Urbach D, Quereshy FA (2016) Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc 30:1337–1343. https://doi.org/10.1007/s00464-015-4390-8 CrossRef

31.

Baek S-J, Kim S-H, Cho J-S, Shin J-W, Kim J (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36:2722–2729. https://doi.org/10.1007/s00268-012-1728-4 CrossRefPubMed

32.

Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS, Lee KY, Kim NK (2014) Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28:2821–2831. https://doi.org/10.1007/s00464-014-3569-8 CrossRefPubMed

33.

Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, Reyes-Díaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM, Padillo J, De la Portilla F (2016) Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Colorectal Dis 31:1807–1815. https://doi.org/10.1007/s00384-016-2660-0 CrossRefPubMed

34.

Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860. https://doi.org/10.1007/s00464-010-1281-x CrossRefPubMed

35.

Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784. https://doi.org/10.1001/archsurg.138.7.777 CrossRef

36.

Patel MN, Hemal A (2017) Does advancing technology improve outcomes? Comparison of the da Vinci Standard/S/Si to the Xi robotic platforms during robotic nephroureterctomy. J Endourol. https://doi.org/10.1089/end.2017.0477 CrossRefPubMedPubMedCentral

Title: Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience
Authors: Luca Morelli
Gregorio Di Franco
Valentina Lorenzoni
Simone Guadagni
Matteo Palmeri
Niccolò Furbetta
Desirée Gianardi
Matteo Bianchini
Giovanni Caprili
Franco Mosca
Giuseppe Turchetti
Alfred Cuschieri
Publication date: 01-06-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6465-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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