Relationship between the volume of robotic-assisted surgery performed and the outcomes achieved

Review of recently published evidence on the relationship between the volume of robotic-assisted surgery (RAS) performed and the outcomes achieved
Scottish Health Technology Group, Healthcare Improvement Scotland 10 February 2021

• An evidence summary on the impact of the number of robotic-assisted procedures (gynaecological, colorectal, urological) per treatment centre/surgeon on the outcomes achieved, and related evidence on the learning curves for these procedures. 
• Only a small number of studies were identified, most of them with methodological issues affecting their validity. Definitions of high and low volumes differ across studies and make comparisons between studies and indications difficult.

Key findings

The rise of robots in surgical environments during COVID-19.

The rise of robots in surgical environments during COVID-19.
Nat Mach Intell 2, 566–572 (2020). https://doi.org/10.1038/s42256-020-00238-2

• The integration of a robot as a shielding layer, physically separating the healthcare worker and patient, is a powerful tool to combat the omnipresent fear of pathogen contamination and maintain surgical volumes. 
• In this Perspective, we outline detailed scenarios in the pre-, intra- and postoperative care, in which the use of robots and artificial intelligence can mitigate infectious contamination and aid patient management in the surgical environment during times of immense patient influx. We also discuss cost-effectiveness and benefits of surgical robotic systems beyond their use in pandemics.

Artificial intelligence and surgical innovation: lower limb arthroplasty

Artificial intelligence and surgical innovation: lower limb arthroplasty.
Br J Hosp Med (Lond). 2020 Oct 2;81(10):1-7. doi: 10.12968/hmed.2020.0309. Epub 2020 Oct 6.

• A review of the use of artificial intelligence and surgical innovation in lower limb arthroplasty, with a particular focus on robotic-assisted surgery in total knee arthroplasty.

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English NHS

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English National Health Service.
Value Health. 2020;23(6):719-726. doi:10.1016/j.jval.2019.11.011

• This study provides estimates of threshold prices for a range of potential improvements in the effectiveness of knee and hip replacement that could be realised from the adoption of computer- and robot-assisted knee and hip replacement.
• At a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY), the threshold price for a 5% improvement in post-primary unrevised quality of life (approximately equivalent to an additional two points in postoperative Oxford Knee Score [OKS]/Oxford Hip Score [OHS]) would be £10 000. The threshold price for a 50% reduction in the risk of revision would be £1000 per procedure.

Abstract

Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes

Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes
Ann Surg Oncol 23 Apr 2020 doi: 10.1245/s10434-020-08475-w.

• Analysis of 982 patients (71 frail and 911 non-frail patients) from Memorial Sloan Kettering Cancer Center, New York, who underwent a robotic surgical procedure May 2007 - December 2016 confirms other research findings that the frail elderly have longer hospital stays and more complications after surgery than the general population.

Abstract

Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR

Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT.
Efficacy Mech Eval 2019;6(10) September 2019

• There is insufficient evidence to conclude that robotic rectal cancer surgery compared with laparoscopic surgery reduces the risk of conversion to laparotomy, and overall it results in comparable outcomes and it was more expensive.

See also:
NIHR Signal Robotic surgery for rectal cancer produces similar results to keyhole surgery

Prostate cancer-detecting probe could make surgery more accurate

Prostate cancer-detecting probe could make surgery more accurate
Imperial College London Press release 5 August 2019

• Researchers at the ICL's Institute of Global Health Innovation (IGHI) will enhance an existing surgical probe developed by Lightpoint Medical, to generate ‘visual heat maps’ of prostate tumours. By combining robotics and medical imaging they will develop a system that will highlight cancerous tissue in real-time on screen in the operating theatre.
• If successful, in future this minimally invasive tool could mean that fewer men need to return to hospital for additional treatment, such as radiotherapy or cancer drugs,

Robotic assisted knee replacement surgery

Surgeons in North East first to use robotic arm in knee replacements
Newcastle Hospitals NHS Foundation Trust 13 June 2019

• Newcastle Hospitals NHS Foundation Trust surgeons are among the first in the country to use robotic assisted knee replacement surgery.
• Currently, between 10-20% of patients who undergo knee surgery are disappointed with the outcome and often need revision surgery. According to Professor Deehan, consultant orthopaedic surgeon, part of the solution to such is tailoring implant position in the joint to match the patient’s soft tissues. Robotic assisted surgery offers the promise of improving the surgeons’ ability to achieve this.”

Robot-assisted surgery in thoracic and visceral indications.

Robot-assisted surgery in thoracic and visceral indications. Collaborative assessment.
EUnetHTA; 6 May 2019. Report No.: OTCA14.

• The diverse range of surgeries included in this review, combined with the lack of reliable evidence for almost all indications, poses difficulties for the analysis and reporting of results. 
• Statements relating to effect can be made for Oesophagectomy, Gastrectomy, Rectal resection and Cholecystectomy.
• Oesophagectomy: robot-assisted surgery probably improves post-operative morbidity/QoL and reduces post-operative complications compared to open surgery (evidence quality: moderate). Intra-operative complications may be reduced with robot-assisted surgery vs. open surgery but here the evidence quality is low.
• Gastrectomy: robot-assisted surgery may reduce postoperative complications vs conventional laparoscopy (evidence quality: low)
• Rectal resection: robot-assisted surgery may improve sexual functioning but worsen sleep disturbances compared with conventional laparoscopy (evidence quality: low); robot-assisted surgery may decrease postoperative complications between 30 days and 6 months, but increase intraoperative complications (evidence quality: low)
• Cholecystectomy: robot-assisted surgery may reduce intraoperative complications and postoperative complications at 30 days compared to laparoscopy (evidence quality: low)

Robot‐assisted surgery in gynaecology

Robot‐assisted surgery in gynaecology
Cochrane Systematic Review 15 April 2019, DOI 10.1002/14651858.CD011422.pub2

• A systematic review of the literature concludes that evidence on the effectiveness and safety of robot‐assisted surgery (RAS) compared with conventional laparoscopic surgery (CLS) for non‐malignant disease (hysterectomy and sacrocolpopexy) is of low certainty but suggests that surgical complication rates might be comparable. Evidence on the effectiveness and safety of RAS compared with CLS or open surgery for malignant disease is more uncertain because survival data are lacking. 
• RAS is an operator‐dependent expensive technology; therefore evaluating the safety of this technology independently will present challenges.

London hospital launches specialist centre for robotic surgery

London hospital launches specialist centre for robotic surgery
Medical Technology 20 February 2019

• The London Clinic has created The London Clinic Centre for Robotics to support consultants to deliver surgical outcomes for patients in varied specialty areas such as urology, orthopaedics, gastrointestinal, colorectal, ENT and gynaecology, with supporting services such as on-site pathology laboratories, 3T MRI, CT scanners and pain control.

The Topol Review - genomics, digital medicine, AI and robotics

The Topol Review

• An independent report on behalf of the Secretary of State for Health and Social Care, 11 February 2019

This report aims to examine

• how technological and other developments (including in genomics, artificial intelligence, digital medicine and robotics) are likely to change the roles and functions of clinical staff in all professions over the next two decades to ensure safer, more productive, more effective and more personal care for patients;

• what the implications of these changes are for the skills required by the professionals filling these roles, identifying professions or sub-specialisms where these may be particularly significant;

• the consequences for the selection, curricula, education, training, development and lifelong learning of current and future National Health Service staff.

Digital healthcare technologies, defined here as genomics, digital medicine, artificial intelligence (AI) and robotics.

The Review proposes three principles to support the deployment of digital healthcare technologies throughout the NHS:

1. Patients need to be included as partners and informed about health technologies, with a particular focus on vulnerable/marginalised groups to ensure equitable access.

2. The healthcare workforce needs expertise and guidance to evaluate new technologies, using processes grounded in real-world evidence.

3. The gift of time: wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interaction with patients.

Digital technologies will have an impact on patients, carers and the wider community, health workforce, and health service leadership.

Recommendations

The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review

The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis.
Int Orthop. 2018 Sep 15. doi: 10.1007/s00264-018-4140-3

• This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery. Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain, quality of life and satisfaction with surgery is unclear. 

Abstract

Patient satisfaction with robotic surgery.

Patient satisfaction with robotic surgery. [Abstract]
J Robot Surg. 2018 Sep;12(3):493-499. doi: 10.1007/s11701-017-0772-3.

• A service evaluation of the robotic-assisted surgery service within the Gynaecology Oncology department at Sheffield Teaching Hospitals, around pre-operative care, post procedural pain, length of stay.Almost all patients (99%) were pleased with the overall care that they received and 91% would recommend robotic-assisted surgery as a modality.

Abstract

Symbitron project - a wearable, assistive exoskeleton

Symbitron project - a wearable, assistive exoskeleton
EU CORDIS June 2018

• The Symbitron project - started in the Netherlands in 2013 and involving an international project team from Switzerland, Italy, Iceland and the UK - has been working to restore partial movement in those with spinal cord injury. 
• It has done this by designing a unique wearable, assistive exoskeleton that helps to activate the neuromuscular system, which is believed to improve motor recovery. Inspired by how the body itself works, this safe, personalised man-machine interface is responsive to both the user and the environment.

Robotic system for joint fractures

Robotic surgery breakthrough
EPSRC 29 June 2018

• A ground-breaking system that enables surgeons to put joint fractures back together using a minimally invasive approach which combines state-of-the-art 3D imaging, pattern recognition and robotic surgery has been developed at the University of Bristol.

Robotic-assisted surgery in ophthalmology

Robotic-assisted surgery in ophthalmology.[PubMed]
Curr Opin Ophthalmol. 2018 May;29(3):248-253. doi: 10.1097/ICU.0000000000000476.

• An overview of the current landscape of robotics in ophthalmology concludes that robotics is still in its infancy in ophthalmology but is rapidly reaching a stage wherein it will be introduced into everyday ophthalmic practice. It will most likely be introduced first for demanding vitreo-retinal procedures, followed by anterior segment applications.

Abstract

Outcomes from the first year of the DaVinci Robot

Outcomes from the first year of the DaVinci Robot
NHS Fab Academy, May 2018

• Lancashire Teaching hospitals has conducted 248 robotic procedures using the DaVinci Xi robotic systems in the first year. Read comments from staff.

Robotics in urology - uses and controversies

Robotics in urology
Annals of the Royal College of Surgeons England, v100(6) Sup, May 2018, pp. 45-54

• Twenty years after it was introduced, robotic surgery has become more commonplace in urology. An examination of its current uses and controversies.

Robotic surgery: new robots

Robotic surgery: new robots and finally some real competition!
World J Urol. 2018 Apr;36(4):537-541. doi: 10.1007/s00345-018-2213-y. Epub 2018 Feb 9.

• A short description of the Senhance Surgical Robotic System and the REVO-I Robot Platform and their pros and cons compared to the Da Vinci system is presented. 
• A discussion about the differences between the three robotic systems now in the market is presented, as well as a short review of the present state of robotic assistance in surgery and the future.