Synapse - Impact of robotic platforms on surgical approach and costs in the management of morbidly obese patients with newly diagnosed uterine cancer

Impact of robotic platforms on surgical approach and costs in the management of morbidly obese patients with newly diagnosed uterine cancer Journal Article

Authors:	Leitao, M. M.; Narain, W. R.; Boccamazzo, D.; Sioulas, V.; Cassella, D.; Ducie, J. A.; Eriksson, A. G. Z.; Sonoda, Y.; Chi, D. S.; Brown, C. L.; Levine, D. A.; Jewell, E. L.; Zivanovic, O.; Barakat, R. R.; Abu-Rustum, N. R.; Gardner, G. J.
Article Title:	Impact of robotic platforms on surgical approach and costs in the management of morbidly obese patients with newly diagnosed uterine cancer
Abstract:	Minimally invasive surgery (MIS) is associated with decreased complication rates, length of hospital stay, and cost compared with laparotomy. Robotic-assisted surgery-a method of laparoscopy-addresses many of the limitations of standard laparoscopic instrumentation, thus leading to increased rates of MIS. We sought to assess the impact of robotics on the rates and costs of surgical approaches in morbidly obese patients with uterine cancer. Patients who underwent primary surgery at our institution for uterine cancer from 1993 to 2012 with a BMI a parts per thousand yen40 mg/m(2) were identified. Surgical approaches were categorized as laparotomy (planned or converted), laparoscopic, robotic, or vaginal. We identified two time periods based on the evolving use of MIS at our institution: laparoscopic (1993-2007) and robotic (2008-2012). Direct costs were analyzed for cases performed from 2009 to 2012. We identified 426 eligible cases; 299 performed via laparotomy, 125 via MIS, and 2 via a vaginal approach. The rates of MIS for the laparoscopic and robotic time periods were 6 % and 57 %, respectively. The rate of MIS was 78 % in this morbidly obese cohort in 2012; 69 % were completed robotically. The median length of hospital stay was 5 days (range 2-37) for laparotomy cases and 1 day (range 0-7) for MIS cases (P < 0.001). The complication rate was 36 and 15 %, respectively (P < 0.001). The rate of wound-related complications was 27 and 6 %, respectively (P < 0.001). Laparotomy was associated with the highest cost. The robotic platform provides significant health and cost benefits by increasing MIS rates in this patient population.
Keywords:	survival; endometrial cancer; laparoscopy; laparotomy; surgery; outcomes; women; oncology-group lap2
Journal Title:	Annals of Surgical Oncology
Volume:	23
Issue:	7
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2016-07-01
Start Page:	2192
End Page:	2198
Language:	English
ACCESSION:	WOS:000377186000012
DOI:	10.1245/s10434-015-5062-6
PROVIDER:	wos
PMCID:	PMC4891264
PUBMED:	26744108
Notes:	Article -- Source: Wos