DOI QR코드

DOI QR Code

Current Trend of Robotic Thoracic and Cardiovascular Surgeries in Korea: Analysis of Seven-Year National Data

  • Kang, Chang Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Bok, Jin San (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Lee, Na Rae (Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Young Tae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Lee, Seon Heui (Department of Nursing Science, Gachon University College of Nursing) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
  • Received : 2014.10.06
  • Accepted : 2014.12.12
  • Published : 2015.10.05

Abstract

Background: Robotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea. Methods: Data from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study. Results: Of the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery. Conclusion: Trend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed.

Keywords

References

  1. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887-92. https://doi.org/10.1016/S0140-6736(12)60516-9
  2. Cai YX, Fu XN, Xu QZ, Sun W, Zhang N. Thoracoscopic lobectomy versus open lobectomy in stage I non-small cell lung cancer: a meta-analysis. PLoS One 2013;8:e82366. https://doi.org/10.1371/journal.pone.0082366
  3. Mihaljevic T, Jarrett CM, Gillinov AM, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. J Thorac Cardiovasc Surg 2011;141:72-80.e1-4. https://doi.org/10.1016/j.jtcvs.2010.09.008
  4. Lehr EJ, Rodriguez E, Chitwood WR. Robotic cardiac surgery. Curr Opin Anaesthesiol 2011;24:77-85. https://doi.org/10.1097/ACO.0b013e328342052d
  5. Kim DJ, Hyung WJ, Lee CY, et al. Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 2010;139:53-9.e1. https://doi.org/10.1016/j.jtcvs.2009.05.030
  6. Kim JE, Jung SH, Kim GS, et al. Surgical outcomes of congenital atrial septal defect using da VinciTM surgical robot system. Korean J Thorac Cardiovasc Surg 2013;46:93-7. https://doi.org/10.5090/kjtcs.2013.46.2.93
  7. Seong YW, Kang CH, Choi JW, et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg 2014;45:e68-73. https://doi.org/10.1093/ejcts/ezt557
  8. Kent M, Wang T, Whyte R, Curran T, Flores R, Gangadharan S. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg 2014;97:236-42. https://doi.org/10.1016/j.athoracsur.2013.07.117
  9. Swanson SJ, Miller DL, McKenna RJ Jr, et al. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg 2014;147:929-37. https://doi.org/10.1016/j.jtcvs.2013.09.046
  10. Farivar AS, Cerfolio RJ, Vallieres E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database. Innovations (Phila) 2014;9:10-5. https://doi.org/10.1097/IMI.0000000000000043
  11. Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg 2012;36:1608-16. https://doi.org/10.1007/s00268-012-1538-8
  12. Weksler B, Sharma P, Moudgill N, Chojnacki KA, Rosato EL. Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Dis Esophagus 2012;25:403-9. https://doi.org/10.1111/j.1442-2050.2011.01246.x
  13. Weksler B, Tavares J, Newhook TE, Greenleaf CE, Diehl JT. Robot-assisted thymectomy is superior to transsternal thymectomy. Surg Endosc 2012;26:261-6. https://doi.org/10.1007/s00464-011-1879-7
  14. Ruckert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 2011;141:673-7. https://doi.org/10.1016/j.jtcvs.2010.11.042
  15. Mihaljevic T, Koprivanac M, Kelava M, et al. Value of robotically assisted surgery for mitral valve disease. JAMA Surg 2014;149:679-86. https://doi.org/10.1001/jamasurg.2013.5680
  16. Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery 2006;140:263-7. https://doi.org/10.1016/j.surg.2006.05.003
  17. Folliguet T, Vanhuyse F, Constantino X, Realli M, Laborde F. Mitral valve repair robotic versus sternotomy. Eur J Cardiothorac Surg 2006;29:362-6. https://doi.org/10.1016/j.ejcts.2005.12.004
  18. Gao C, Yang M, Wang G, et al. Excision of atrial myxoma using robotic technology. J Thorac Cardiovasc Surg 2010;139:1282-5. https://doi.org/10.1016/j.jtcvs.2009.09.013
  19. Srivastava S, Gadasalli S, Agusala M, et al. Use of bilateral internal thoracic arteries in CABG through lateral thoracotomy with robotic assistance in 150 patients. Ann Thorac Surg 2006;81:800-6. https://doi.org/10.1016/j.athoracsur.2005.08.044
  20. Bonaros N, Schachner T, Lehr E, et al. Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg 2013;95:803-12. https://doi.org/10.1016/j.athoracsur.2012.09.071
  21. Henneman D, Dikken JL, Putter H, et al. Centralization of esophagectomy: how far should we go? Ann Surg Oncol 2014;21:4068-74. https://doi.org/10.1245/s10434-014-3873-5
  22. Stitzenberg KB, Wong YN, Nielsen ME, Egleston BL, Uzzo RG. Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care. Cancer 2012;118:54-62. https://doi.org/10.1002/cncr.26274
  23. Anderson CB, Penson DF, Ni S, Makarov DV, Barocas DA. Centralization of radical prostatectomy in the United States. J Urol 2013;189:500-6. https://doi.org/10.1016/j.juro.2012.10.012