Research Original Investigation
Comparison of Open, Laparoscopic, and Robotic Colectomies
35. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21(10):1701-1708. 36. Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP. Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg. 2012;99(9):1219-1226. 37. Sukumar S, Sun M, Karakiewicz PI, et al. National trends and disparities in the use of minimally invasive adult pyeloplasty. J Urol. 2012;188(3):913-918. 38. Garcia-Ellin JC. Areas of Hispanic concentration: a differentiation of urban subareas in forty US counties. Res Contemp Appl Geography. 2000;24(4):1-23.
39. Hofer MD, Meeks JJ, Cashy J, Kundu S, Zhao LC. Impact of increasing prevalence of minimally invasive prostatectomy on open prostatectomy observed in the national inpatient sample and national surgical quality improvement program. J Endourol. 2013;27(1):102-107.
43. Bertagnolli MM, DeCosse JJ. Laparoscopic colon resection for cancer: an unfavorable view. Adv Surg. 1996;29:155-164.
40. Holzman MD, Eubanks S. Laparoscopic colectomy: prospects and problems. Gastrointest Endosc Clin N Am. 1997;7(3):525-539.
44. Park SY, Choi GS, Park JS, Kim HJ, Choi WH, Ryuk JP. Robot-assisted right colectomy with lymphadenectomy and intracorporeal anastomosis for colon cancer: technical considerations. Surg Laparosc Endosc Percutan Tech. 2012;22(5):e271e276.
41. Hohenberger W, Schneider C, Reymond MA, Scheidbach H, Köckerling F. Laparoscopic resection of colorectal malignancy: an oncological risk? [in German]. Zentralbl Chir. 1997;122(12):1127-1133.
45. Koh DC, Tsang CB, Kim SH. A new application of the four-arm standard da Vinci surgical system: totally robotic-assisted left-sided colon or rectal resection. Surg Endosc. 2011;25(6):1945-1952.
42. Berman IR. Laparoscopic resection for colon cancer: cause for pause. Important Adv Oncol. 1996:231-243.
Invited Commentary
The Robot Has No Role in Elective Colon Surgery James Yoo, MD
The benefits of a minimally invasive approach to elective colon resections have been well established. This is true regardless of whether the resection is done purely laparoscopically, with a hand-assist device, or through a small, strategiRelated article page 177 cally placed incision compared with a more traditional open operation. This conclusion is confirmed once again in this study by Juo et al,1 although patient selection bias has probably exaggerated the benefits. The role of robotics for colon surgery is more controversial. While the robot may have some potential benefit in the pelvis, it is my belief that the robot has no role in elective colon surgery. The benefits of the robot (eg, greater degrees of ARTICLE INFORMATION Author Affiliation: Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles. Corresponding Author: James Yoo, MD, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 ([email protected]).
184
freedom with the articulating instruments, an enhanced 3-dimensional view, and greater surgeon comfort) are so marginal for a colon resection that they do not justify the added cost, which is substantial when you also consider the price tag of a machine, its maintenance, and the training costs for surgeons and support staff. While feasible and safe (and fun), the use of the robot should be discouraged for this indication, particularly in this era of value-based medicine. As with other new minimally invasive approaches, such as single-port surgery, the use of robotics has been highly industry and market driven. While this study and others can demonstrate equivalency in patient outcomes compared with more commonly used, minimally invasive approaches, any added benefit has yet to be proven.
Published Online: December 18, 2013. doi:10.1001/jamasurg.2013.3671. Conflict of Interest Disclosures: None reported.
comprehensive national examination with propensity score matching [published online December 18, 2013]. JAMA Surg. doi:10.1001/jamasurg.2013.3660.
REFERENCES 1. Juo Y-Y, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches? first
JAMA Surgery February 2014 Volume 149, Number 2
Copyright 2014 American Medical Association. All rights reserved.
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Comparison of Open, Laparoscopic, and Robotic Colectomies
35. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21(10):1701-1708. 36. Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP. Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg. 2012;99(9):1219-1226. 37. Sukumar S, Sun M, Karakiewicz PI, et al. National trends and disparities in the use of minimally invasive adult pyeloplasty. J Urol. 2012;188(3):913-918. 38. Garcia-Ellin JC. Areas of Hispanic concentration: a differentiation of urban subareas in forty US counties. Res Contemp Appl Geography. 2000;24(4):1-23.
39. Hofer MD, Meeks JJ, Cashy J, Kundu S, Zhao LC. Impact of increasing prevalence of minimally invasive prostatectomy on open prostatectomy observed in the national inpatient sample and national surgical quality improvement program. J Endourol. 2013;27(1):102-107.
43. Bertagnolli MM, DeCosse JJ. Laparoscopic colon resection for cancer: an unfavorable view. Adv Surg. 1996;29:155-164.
40. Holzman MD, Eubanks S. Laparoscopic colectomy: prospects and problems. Gastrointest Endosc Clin N Am. 1997;7(3):525-539.
44. Park SY, Choi GS, Park JS, Kim HJ, Choi WH, Ryuk JP. Robot-assisted right colectomy with lymphadenectomy and intracorporeal anastomosis for colon cancer: technical considerations. Surg Laparosc Endosc Percutan Tech. 2012;22(5):e271e276.
41. Hohenberger W, Schneider C, Reymond MA, Scheidbach H, Köckerling F. Laparoscopic resection of colorectal malignancy: an oncological risk? [in German]. Zentralbl Chir. 1997;122(12):1127-1133.
45. Koh DC, Tsang CB, Kim SH. A new application of the four-arm standard da Vinci surgical system: totally robotic-assisted left-sided colon or rectal resection. Surg Endosc. 2011;25(6):1945-1952.
42. Berman IR. Laparoscopic resection for colon cancer: cause for pause. Important Adv Oncol. 1996:231-243.
Invited Commentary
The Robot Has No Role in Elective Colon Surgery James Yoo, MD
The benefits of a minimally invasive approach to elective colon resections have been well established. This is true regardless of whether the resection is done purely laparoscopically, with a hand-assist device, or through a small, strategiRelated article page 177 cally placed incision compared with a more traditional open operation. This conclusion is confirmed once again in this study by Juo et al,1 although patient selection bias has probably exaggerated the benefits. The role of robotics for colon surgery is more controversial. While the robot may have some potential benefit in the pelvis, it is my belief that the robot has no role in elective colon surgery. The benefits of the robot (eg, greater degrees of ARTICLE INFORMATION Author Affiliation: Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles. Corresponding Author: James Yoo, MD, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 ([email protected]).
184
freedom with the articulating instruments, an enhanced 3-dimensional view, and greater surgeon comfort) are so marginal for a colon resection that they do not justify the added cost, which is substantial when you also consider the price tag of a machine, its maintenance, and the training costs for surgeons and support staff. While feasible and safe (and fun), the use of the robot should be discouraged for this indication, particularly in this era of value-based medicine. As with other new minimally invasive approaches, such as single-port surgery, the use of robotics has been highly industry and market driven. While this study and others can demonstrate equivalency in patient outcomes compared with more commonly used, minimally invasive approaches, any added benefit has yet to be proven.
Published Online: December 18, 2013. doi:10.1001/jamasurg.2013.3671. Conflict of Interest Disclosures: None reported.
comprehensive national examination with propensity score matching [published online December 18, 2013]. JAMA Surg. doi:10.1001/jamasurg.2013.3660.
REFERENCES 1. Juo Y-Y, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches? first
JAMA Surgery February 2014 Volume 149, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a New York University User on 05/31/2015
jamasurgery.com
