Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

Day, E. K., Galbraith, N. J. , Ward, H. J.T. and Roxburgh, C. S. (2023) Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review. Journal of Robotic Surgery, 17(3), pp. 811-826. (doi: 10.1007/s11701-022-01461-2) (PMID:36315379)

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Abstract

As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: “robot*”, “surgery”, “volume” and “outcome” was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Galbraith, Dr Norman and Day, Dr Elizabeth and Roxburgh, Professor Campbell
Authors: Day, E. K., Galbraith, N. J., Ward, H. J.T., and Roxburgh, C. S.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Robotic Surgery
Publisher:Springer
ISSN:1863-2483
ISSN (Online):1863-2491
Published Online:31 October 2022
Copyright Holders:Copyright © 2022 The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature
First Published:First published in Journal of Robotic Surgery 17(3): 811-826
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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