Journal Review (MIS): Evaluating the robotic platform in general surgery: ROLARR & RIVAL

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 5 July 2021

⏱️ 34 minutes

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Summary

Minimally Invasive Surgery Journal Review

Evaluating the Robot Platform for use in General Surgery: ROLARR & RIVAL

The debate about whether or not robotic surgery has a place in mainstream general surgery practice has been raging years with critics highlighting concerns about cost and a lack of high-level evidence showing benefit in patient outcomes while proponents suggest benefits in visualization, dexterity, and ergonomics that have not yet been borne out in rigorous trials. Hosts, Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo use two recent JAMA articles to frame the debate surrounding the platform and offer insight into the future of robotic and minimally invasive surgery.

Learning objectives:

In this episode we review the current landscape of the literature surrounding robot assisted surgery with a particular focus on how to thoughtfully evaluate emerging surgical technologies, the need to consider the broader concept of value rather than simply healthcare costs, and the role of surgeon-focused outcomes including ergonomics.

Selected Articles:

Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial
Link: https://pubmed.ncbi.nlm.nih.gov/29067426/

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial
Link: https://pubmed.ncbi.nlm.nih.gov/32186683/

RIVAL Author Interview with JAMA Surgery:
https://edhub.ama-assn.org/jn-learning/audio-player/18318110

Transcript

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0:00.0	Behind the Knife, the Surgery Podcast, where we take a behind the scenes intimate look at surgery from leaders in the field.
0:23.0	It's great to be with you all. I'm Mike Wycam. I'm a general surgery resident at the University of Washington.
0:28.0	And it's my pleasure to introduce our minimally invasive surgery team, which is comprised of doctors Andrew Wright, Nick Citrulo, and myself.
0:36.0	Dr. Wright is the center for video endoscopic surgery endowed professor, the fellowship director for the advanced minimally invasive surgery program at the University of Washington, as well as the director of our hernia center.
0:48.0	Dr. Citrulo is a fellowship trained minimally invasive surgeon in the director of AppSight and Board Review for our general surgery residency program.
0:57.0	Beyond their titles and responsibilities, both are perennial favorites amongst the residents and medical students at UW.
1:03.0	And I'd like to start by thanking you both for lending your time and expertise to the behind the knife listeners.
1:09.0	This is Andrew Wright. It's a lot of fun being on this podcast because I've been a guest a few times on behind the knife.
1:14.0	It's nice to be on the other side of the microphone as a host now.
1:19.0	I also want to point out that none of the three of us have any relevant conflicts of interest as it regards robotics, colorectal, or hernia surgery.
1:29.0	I also will say that I have a little bit of a personal conflict of interest in that I am well known as a skeptic of the robot who is now starting to use the robot in my clinical practice.
1:40.0	So I'm right in that inflection point of figuring out where this sits in our world and minimally invasive surgery.
1:47.0	So that's why this topic is a personal interest to me.
1:50.0	My name is Nick Citrulo. Thank you, Mike, for introducing myself and Dr. Wright over here.
1:57.0	We are very excited to be taking part in this and helping the great group up behind the knife.
2:03.0	I want to present more topics and get more varied opinions and outputs.
2:08.0	And I'm excited to continue to record these podcasts for you.
2:13.0	Over the coming months, we plan to cover various topics in minimally invasive surgery.
2:17.0	But for our inaugural episode, we are going to discuss robot assisted surgery and how the robotic platform has been evaluated for use in general surgery using two high profile articles from recent years, which we feel are emblematic of the way the robot platform has been evaluated by our field.
2:31.0	The articles are the robot versus laparoscopic resection for rectal cancer, better known as the roller trial by Dr. Jane and colleagues published in Jamis surgery in 2017.
2:42.0	And the robotic inguinal versus trans abdominal laparoscopic inguinal hernia repair or rival study by Dr. Prebu at all, also from Jamis surgery in 2020.
2:53.0	Before we get going with the discussion, I just want to say that while our first selected article, the roller trial is about rectal cancer,
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