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The MicroHand S robotic-assisted versus Da Vinci robotic-assisted radical resection for patients with sigmoid colon cancer: a single-center retrospective study

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Dong Luo at Universität Heidelberg
Dong Luo
Yunfei Liu
Yunfei Liu
Hongwei Zhu
Hongwei Zhu
Hongwei Zhu
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Xia Li
Xia Li
Xia Li
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Background Sigmoid colon cancer is a lethal disease and has a strong indication for surgery. Robotic-assisted surgery is one of the promising alternative treatment for this disease. Nowadays, the MicroHand S surgical system and the Da Vinci surgical system have been assembled in China. However, there is still no report to study the therapeutic effects of the two robotic-assisted surgical systems. Thus, the purpose of this study was to compare clinical and economic outcomes of patients with sigmoid colon cancer undergoing robot-assisted radical surgery via The MicroHand S or Da Vinci surgical system. Methods The clinical data of 45 patients with sigmoid colon cancer undergoing the MicroHand S or Da Vinci robotic-assisted surgery at The Third Xiangya Hospital of Central South University from January 2017 to January 2019 were retrospectively analyzed. Results Twenty-one patients received MicroHand S robotic-assisted radical surgery and 24 patients received Da Vinci robot-assisted radical surgery. No significant differences were observed in terms of operation time, number of lymph node harvested, blood loss, intestinal exhaust time, time of oral feeding resumption, volume of abdominal cavity 24-h drainage, hospital stay, complication and rate of conversion, removal time of drainage tube and catheter between MicroHand S and Da Vinci group. However, the MicroHand S group had significantly lower hospitalization costs (P = 0.002) and shorter time to get out of bed after surgery (P = 0.04). In addition, no recurrence and metastases were observed in both groups during the follow-up. Conclusions In patients with sigmoid colon cancer, the Da Vinci surgical system did not show obvious clinical advantages compared to the MicroHand S surgical system in surgical outcomes. However, the MicroHand S surgical platform showed advantages in terms of the hospitalization costs and length of postoperative bedtime. The outcome of this study will probably result in a shift to the MicroHand S surgical system as treatment preference in China.
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Vol:.(1234567890)
Surgical Endoscopy (2020) 34:3368–3374
https://doi.org/10.1007/s00464-019-07107-z
1 3
The MicroHand S robotic‑assisted versusDa Vinci robotic‑assisted
radical resection forpatients withsigmoid colon cancer:
asingle‑center retrospective study
DongLuo1 · YunfeiLiu1· HongweiZhu2· XiaLi3· WenzheGao4· XinyuLi4· ShaihongZhu1· XiaoYu1
Received: 20 April 2019 / Accepted: 26 August 2019 / Published online: 3 September 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Background Sigmoid colon cancer is a lethal disease and has a strong indication for surgery. Robotic-assisted surgery is
one of the promising alternative treatment for this disease. Nowadays, the MicroHand S surgical system and theDa Vinci
surgical system have been assembled in China. However, there is still no report to study the therapeutic effects of the two
robotic-assisted surgical systems. Thus, the purpose of this study was to compare clinical and economic outcomes of patients
with sigmoid colon cancer undergoing robot-assisted radical surgery via The MicroHand S or Da Vinci surgical system.
Methods The clinical data of 45 patients with sigmoid colon cancer undergoing the MicroHand S or Da Vinci robotic-assisted
surgery at The Third Xiangya Hospital of Central South University from January 2017 to January 2019 were retrospectively
analyzed.
Results Twenty-one patients received MicroHand S robotic-assisted radical surgery and 24 patients received Da Vinci robot-
assisted radical surgery. No significant differences were observed in terms of operation time, number of lymph node harvested,
blood loss, intestinal exhaust time, time of oral feeding resumption, volume of abdominal cavity 24-h drainage, hospital stay,
complication and rate of conversion, removal time of drainage tube and catheter between MicroHand S and Da Vinci group.
However, the MicroHand S group had significantly lower hospitalization costs (P = 0.002) and shorter time to get out of
bed after surgery (P = 0.04). In addition, no recurrence and metastases were observed in both groups during the follow-up.
Conclusions In patients with sigmoid colon cancer, theDa Vinci surgical system did not show obvious clinical advantages
compared to the MicroHand S surgical system in surgical outcomes. However, the MicroHand S surgical platform showed
advantages in terms of the hospitalization costs and length of postoperative bedtime. The outcome of this study will probably
result in a shift to the MicroHand S surgical system as treatment preference in China.
Keywords Sigmoid colon cancer· Robotic-assisted surgery· The MicroHand S robot· The Da Vinci robot· Surgical
outcomes
Colorectal cancer (CRC) is a common malignant tumor
of the digestive system. It is the fourth most commoncan-
cerdiagnosed amongadultsand the second leading cause
of death related to cancer [1] in the United States. Surgery
is the cornerstone of treatment for CRC [2], but traditional
open abdominal incision is associated with significant mor-
bidity and long period of convalescence. Therefore, patients
and providers are both increasingly interested in the utili-
zation, safety, and efficacy of minimally invasive surgery
(MIS). Since the first successful incorporation of laparos-
copy in colorectal surgery in 1991, MIS has yielded many
tremendous developments in the field of colorectal cancer
[3]. Recently, robotic-assisted surgery has revolutionized
and has expanded the field of MIS beyond laparoscopic
and Other Interventional Te
chniques
Dong Luo and Yunfei Liu have contributed equally to this study.
* Xiao Yu
yuxiaoyx4@126.com
1 Department ofGeneral Surgery, The Third Xiangya
Hospital, Central South University, Changsha, Hunan,
People’sRepublicofChina
2 Department ofGastroenterology, The Third Xiangya
Hospital, Central South University, Changsha, Hunan,
People’sRepublicofChina
3 Department ofEndocrinology, The Third Xiangya
Hospital, Central South University, Changsha, Hunan,
People’sRepublicofChina
4 The Xiangya School ofMedicine, Central South University,
Changsha, Hunan, People’sRepublicofChina
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The Revo-i system was compared to da Vinci Si in RARP, producing similar short-term functional and oncological outcomes [69]. MicroHand Surgical Robot was compared to da Vinci, reporting shorter length of stay and reduced hospital costs in 45 patients undergoing sigmoidectomy, although did not specify the da Vinci generation [63]. It also demonstrated no difference in faecal continence following total mesorectal excision when compared to da Vinci Si [64] (Table 2). ...
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... In 2000, the da Vinci robotic surgical system was approved by the Food and Drug Administration in the US (1), and since Horgan first reported using it in an adrenalectomy in 2001 (2), robotic-assisted surgery has been increasingly used. In the past decade, robot-assisted surgery with the da Vinci surgical system has increased rapidly in mainland China (3), and the average number of procedures per robot is far ahead of that in other developed countries (4). ...
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... For instance, MicroHand S is a robotic system produced in China and has recently entered clinical trials. Some studies have reported good performances and encouraging application prospects [33,34]. Senhance robotic system (TransEnterix Surgical Inc. Morrisville, NC, USA) has been recently introduced in Europe and approved for limited clinical use in the USA. ...
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Cost-benefit analysis of robotic surgery in gynaecological oncology
Article
  • Apr 2017
Robotic approach is a rather new technique which can be used to optimise the management of patients with gynaecological cancer. However, concerns have been raised regarding the cost of such an approach compared to laparoscopic or open techniques. The aim of our chapter is to review the till now data of papers analyzing the cost of robotic gynaecological oncology. A systematic review of the current literature was performed trying to assess the cost of the robotic technique including parameters that affect it and ways to minimize it in favour of the patients and health care systems.
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Evolving application of minimally invasive cancer operations at a tertiary cancer center
Article
  • Mar 2017
  • J SURG ONCOL
Background: Patients and providers are increasingly interested in the utilization, safety, and efficacy of minimally invasive surgery (MIS). We reviewed 11 years of MIS resections (laparoscopic and robotic) for intra-abdominal malignancies. Methods: Patients who underwent gastrectomy, distal pancreatectomy, hepatic resection, and colorectal resection between 2004 and 2014 were identified. Cases were categorized as open, laparoscopic, and robotic based on the initial operation approach. Diagnostic laparoscopies were excluded. Results: Of the 10 039 patients who underwent the above procedures, between 2004 and 2014, 2832 (28%) were MIS. In 2004, 12% (100/826) of all resections were performed with MIS approaches, rising to 23% (192/821) of all resections by 2009 and 44% (484/1092) in 2014. The number of open resections has remained largely stable: 726 (88% of all resections) in 2004 and 608 (56% of all resections) in 2014. Initially, laparoscopy experienced incremental adoption. Robotic surgery was implemented in 2009 and is currently the dominant MIS approach, accounting for 76% (368/484) of all MIS resections in 2014. Overall mortality has remained less than 1%. Conclusions: While maintaining patient safety, utilization of MIS techniques has increased substantially since 2004, particularly for gastric and colorectal resections. Since 2009 robotic surgery is the predominant MIS approach.
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Enhanced Recovery After Surgery: A Review
Article
  • Jan 2017
Importance: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Conclusions and relevance: Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.
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Robotics in general surgery: A systematic cost assessment
Article
  • Dec 2016
The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.
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