Rise of the robots: implementing robotic surgery into the acute care surgery practice.

Autor: Sanderfer VC; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA. van.sanderfer@atriumhealth.org., Jensen S; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Qadri HI; Wake Forest School of Medicine, Academic Medical Education, Winston-Salem, NC, USA., Yang H; Atrium Health, Information and Analytics Services, Charlotte, NC, USA., Benham EC; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Lauer C; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Muir K; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Thomas BW; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Clemens MS; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Maloney SR; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Sherrill WC; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., May AK; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA., Ross SW; Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2025 Jan; Vol. 39 (1), pp. 472-479. Date of Electronic Publication: 2024 Oct 14.
DOI: 10.1007/s00464-024-11266-z
Abstrakt: Objectives: Acute Care Surgery (ACS) admissions and procedures are substantially increasing. ACS disproportionally accounts for a majority of morbidity and mortality among surgical patients. Minimally invasive techniques are associated with improved outcomes and shorter hospital length of stay within the ACS population. While laparoscopy is widespread, ACS surgeons have been slower to adopt the use of robotics. We aimed to evaluate the feasibility of incorporating robotic surgery within ACS practice.
Methods: Robotic General Surgery operations performed by 8 Acute Care Surgeons from 5 local facilities within a large integrated healthcare system were queried over a 15 month period. Patients who underwent emergent, urgent, sub-acute, and elective robotic operations by ACS staff were identified. Demographics collected included age, gender, BMI, and ASA score. Outcomes recorded included procedure classification, total supply and implant charges (TSI), conversion to open, hospital length of stay (LOS), 30 day readmission, and 30 day mortality.
Results: Of 200 operations, the most common were Cholecystectomy (43.5%), Inguinal hernia repair (26.0%), Ventral hernia repair (18.0%), Appendectomy (5.0%), and Sigmoid Colectomy (3.5%). The median (± std dev) age was 48 ± 16.66 years and BMI was 29.9 ± 8.79 kg/m 2 . 46% of cases were sub-acute (n = 92), 33.5% were elective (n = 67), 14% were emergent (n = 28), and 6.5% were urgent (n = 13). Most patients were ASA 2 (107, 46.1%) or ASA 3 (71, 45.9%). The median (IQR) TSI and LOS were $1,770 (889.50) USD and 0.1 (0.9) days. Forty-one inpatient procedures were performed. Median LOS was 3 days and expected LOS was 3.1 days (O:E = 0.96). Five patients were readmitted within 30 days, and there were no deaths within 30 days.
Conclusion: Robotic techniques may be safely implemented by ACS surgeons, potentially benefitting both patient and surgeon. LOS was similar between laparoscopic and robotic cases and only two cases required conversion to an open procedure. Next steps include a multi-center prospective trial comparing robotic to laparoscopic cases.
Competing Interests: Declarations. Disclosures: V. Christian Sanderfer MD, Stephanie Jensen MD MPH, Hisham I. Qadri BS, Hongmei Yang Ph.D, Emily C. Benham MD, Cynthia Lauer MD, Kathryn Muir, MD, Michael S. Clemens MD, Sean R. Maloney MD, William C. Sherrill MD, Addison K. May MD MBA, and Samuel W. Ross MD MPH do not have any conflicts of interest or financial ties to disclose. Bradley W. Thomas MD is a consultant for Zimmer Biomet.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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