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Robot-assisted Procedures in General Surgery: Cholecystectomy, Inguinal and Ventral Hernia Repairs

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Robot-assisted Procedures in General Surgery: Cholecystectomy, Inguinal and Ventral Hernia Repairs

Prepared by:
Evidence Synthesis Program (ESP) Center
West Los Angeles VA Medical Center
Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director

Recommended citation:
Maggard-Gibbons M, Girgis M, Ye L, Shenoy R, Mederos M, Childers CP, Tang A, Mak SS, Begashaw M, Booth MS, Shekelle PG, Robot-Assisted Procedures in General Surgery: Cholecystectomy, Inguinal and Ventral Hernia Repairs. Los Angeles: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2020.



Download PDF: Complete Report, Executive Summary, Report, Appendices

Introduction

General surgery procedures make up a large volume of operations performed in the US. For example there are approximately 1 million cholecystectomies and 800,000 ventral and inguinal hernia cases performed each year. Within this field we are experiencing dramatic recent growth in the number of robot-assisted cases. Questions about the utility of robot-assisted surgery as compared to laparoscopic and open surgery persist. In particular, does the use of the robot translate to better or similar clinical outcomes for patients? Are operating room times and length of stay comparable or improved with use of robot versus laparoscopic or open techniques? And what are costs of robot-assisted surgery and are they justified? Yet there is no consensus or guidelines on when to use which surgical approach and decisions are left up to individual practitioners or hospital leadership. To help clinicians, patients, and policymakers better assess the appropriateness of robot-assisted compared to other surgical approaches, we were asked to conduct a systematic review of the literature on 3 of the most common general surgery operations: cholecystectomy, inguinal hernia repair, and incisional hernia repair.

Key Questions

KQ1A: What is the clinical effectiveness of robot-assisted surgery compared to conventional laparoscopic surgery for cholecystectomy?

KQ2A: What is the cost-effectiveness of robot-assisted surgery compared to conventional laparoscopic surgery for cholecystectomy?

KQ1B: What is the clinical effectiveness of robot-assisted surgery compared to conventional laparoscopic or open surgery for inguinal hernia repair?

KQ2B: What is the cost-effectiveness of robot-assisted surgery compared to conventional laparoscopic or open surgery for inguinal hernia repair?

KQ1C: What is the clinical effectiveness of robot-assisted surgery compared to conventional laparoscopic or open surgery for ventral hernia surgery?

KQ2C: What is the cost-effectiveness of robot-assisted surgery compared to conventional laparoscopic or open surgery for ventral hernia surgery?

See also

Robot-assisted Procedures in General Surgery: Cholecystectomy, Inguinal and Ventral Hernia Repairs (Management eBrief)

Shenoy R, Mederos M, Ye L, et al. Intraoperative and Postoperative Outcomes of Robot-assisted Cholecystectomy: A Systematic Review. Systematic Reviews. Published online April 23, 2021. doi: https://doi.org/10.1186/s13643-021-01673-x.

Ye L, Tang AB, Shenoy R, et al. Clinical and Cost Outcomes of Robot-Assisted Inguinal Hernia Repair: A Systematic Review. Journal of the American College of Surgeons. 2021;232(5):746-763.e2. DOI: https://doi.org/10.1016/j.jamcollsurg.2020.12.066


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