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Impact of Robotic Platforms on Surgical Approach and Costs in the Management of Morbidly Obese Patients with Newly Diagnosed Uterine Cancer.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2016 Jul; Vol. 23 (7), pp. 2192-8. Date of Electronic Publication: 2016 Jan 07. - Publication Year :
- 2016
-
Abstract
- Background: 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.<br />Methods: Patients who underwent primary surgery at our institution for uterine cancer from 1993 to 2012 with a BMI ≥40 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.<br />Results: 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.<br />Conclusions: The robotic platform provides significant health and cost benefits by increasing MIS rates in this patient population.
- Subjects :
- Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis
Endometrial Neoplasms economics
Endometrial Neoplasms pathology
Female
Follow-Up Studies
Humans
Laparoscopy economics
Length of Stay
Middle Aged
Minimally Invasive Surgical Procedures economics
Obesity, Morbid complications
Obesity, Morbid economics
Obesity, Morbid pathology
Prognosis
Retrospective Studies
Uterine Neoplasms complications
Uterine Neoplasms economics
Uterine Neoplasms pathology
Endometrial Neoplasms surgery
Hysterectomy economics
Lymph Node Excision economics
Obesity, Morbid surgery
Postoperative Complications
Robotic Surgical Procedures economics
Uterine Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 23
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 26744108
- Full Text :
- https://doi.org/10.1245/s10434-015-5062-6