Here
is a paper touching on two of my favorite subjects, robotic surgery and
misleading abstracts.
It is entitled “Overcoming
the challenges of single-incision cholecystectomy with robotic single-site
technology” was
just published ahead of print in Archives of Surgery. It is a study of 100
robotic single-incision cholecystectomies done by five Italian surgeons.
The conclusion of
the abstract:
“Da Vinci single-site cholecystectomy is an easy and safe procedure
for expert robotic surgeons. It allows the quick overcoming of the learning
curve typical of single-incision laparoscopic surgery and may potentially
increase the safety of this approach.”
From
the full text of the paper, here is a summary of the results of a survey of the
five surgeons who participated in the study.
Rating
single port insertion technical issues using a scale of 1 to 5 with 1 being
easy and 5 being difficult, one surgeon rated it a 2, two said 3 and two said
4.
Regarding the ergonomics
of robotic single-site
vs. standard laparoscopic 4-port cholecystectomy, two surgeons rated robotic
worse and three said equal.
Comparing robotic to
standard laparoscopic 4-port cholecystectomy, all five surgeons said robotic surgery
was more difficult.
All five surgeons
said the robotic procedure was safe based on their having performed a mean of
18 cases with a range of 12 to 42 cases.
The
mean duration of the surgery was 71 minutes, which does not compare favorably
to an operative time of 40 minutes from series of 238 single incision non-robotic
laparoscopic cholecystectomies reported in the Journal of the American Collegeof Surgeons in 2010.
The authors
state, “None
of the considered [operative] times (total time and each of its main components) appeared
to significantly decrease with the number of patients operated on." How is this
statement reconciled with the “quick overcoming of the learning curve typical of single-incision
laparoscopic surgery” mentioned in the conclusion of the abstract? No such
comparison was included in the paper.
This abstract of
this paper, much of which is a survey of only five surgeons with a modest experience in
robotic single-incision cholecystectomy, is misleading. The paper itself
suggests that compared to standard laparoscopic surgery, robotic single-incision cholecystectomy is less
ergonomically comfortable, more difficult and takes longer. To say it is safe
based on a series of 100 cases is premature at best.
For previous posts on
robotic surgery, see the label to the right of this post.
Here is a previous post on misleading
abstracts: "Reading an abstract vs. reading an entire paper."
8 comments:
Might be misleading if they were comparing robotic single incision to standard laparoscopic surgery, but they were comparing it to single-incision laparoscopic surgery.
I disagree. If you look at Table 1, which summarizes the entire gist of the paper, you will see that more than half of the comparisons listed are to 4-port laparoscopic surgery. In addition, two of the 5 surgeons had not even done single-incision laparoscopic cholecystectomy before.
The misleading part is also the abstract's assertion that robotic is easy [their own data says it's not] and safe [an N of 100 cases does not prove safety].
Well, I'll confess that I don't have a subscription to the Archives of Surgery and I'm not quite committed enough to pony up $30, so I'm reliant on you to tell me if there were any meaningful comparisons in the full text of robotic single site surgery to laparoscopic single site surgery. I gather that they also made comparisons to traditional four port laparoscopic surgery, but surely there must have been some text related to single site laparoscopic surgery.
And to be nit-picky, not being as easy as traditional four port laparoscopic surgery does not mean that it's not still easy.
I guess they could have used the term "less easy," but they chose "more difficult" instead. The robotic single-port procedure took 75% longer. To me that suggests significantly more difficult.
I might have made a similar comment on another post at some point -- I'm not a surgeon but I looked into robotic surgery evidence in 2010 when I was working with ABC News, and even the best data (quicker operative times) were misleading -- they measured skin-to-skin, ignoring equipment setup!
MD, Thanks. That is still true. They like to omit the so-called "docking time," which can be more than 20 minutes.
Another misleading detail, is to count the days the patients stay at the hospital. I have personally witnessed how a centre, trying to convince the rest of world of the "fantastic" short hospital duration of treatment following Robotic cystectomies - it turned out that they sent the patients on day 5 or 6 to a resting-home with hospital facilities, nurses and daily medical rounds. The postoperative stay was not different from open cystectomies in any regular centre of the same size keeping the patients full time. That is 10-14 days.
Yes, length of stay is a "soft" endpoint and can easily be influenced by non-medical issues such as you describe. There are also things like "I can't get a ride," "I don't want to go to that rehab center," "I refuse to go home" and so on.
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