World Journal of Colorectal Surgery

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 8  |  Issue : 2  |  Page : 44--46

Current status of robotic colorectal surgery in Australasia: A questionnaire survey of consultant members of the colorectal surgical society of Australia and New Zealand


Kenneth N Buxey1, Francis F Lam2, Graham L Newstead1,  
1 Department of Colorectal Surgery, Prince of Wales Hospital, NSW, Australia
2 Department of Colorectal Surgery, Prince of Wales Hospital Group (Prince of Wales Public and Private Hospital), NSW, Australia

Correspondence Address:
Dr. Kenneth N Buxey
Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW 2031
Australia

Abstract

Background: There has been considerable interest worldwide in the application of a robotic operating platform in the practice of colorectal surgery. Objective: The aim of this study was to evaluate the current uptake of robotic colorectal surgery in Australia and New Zealand. Design: Survey data were obtained from the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) registry of all specialist colorectal surgeons in Australia and New Zealand. Setting: Specialist colorectal surgeons responded to the survey through e-mail contact via an official e-mail from the CSSANZ. Materials and Methods: A questionnaire was distributed to members of the CSSANZ regarding their current robotic surgical practice. Main Outcome Measures: Volume of and nature of robotic surgery being currently undertaken in Australia and New Zealand, with an emphasis on seeking to understand the surgeon and patient factors that would promote robotic practice and also any factors or barriers in the implementation of robotic colorectal surgery being performed. Sample Size: The sample size was 77. Results: Seventy-seven replies were received from a total of 227 surveys. The response rate is similar to other comparable surveys published when the laparoscopic colorectal era was introduced. Most surgeons performed minimally invasive (laparoscopic) surgery; however, only 29% performed any robotic surgery and 50% of these performed <5 cases in the preceding 12 months. Low rectal cancer and rectopexy surgeries were the most frequently performed robotic operations. About 48% of surgeons believed that the robotic platform offers specific patient benefits, and 75% believed that it offers specific benefits to the surgeon. The main reason for consultants not performing robotic procedures was largely related to cost, with training also cited as a barrier. Conclusion: Robotic colorectal surgery is being performed by 29% of colorectal consultants in Australasia, although only a minority of these surgeons have a substantial volume. In the future, a substantial reduction in costs is envisaged, as more companies enter the robotic surgery marketplace and competition drives reduction in costs. This in many ways mirrors the introduction of laparoscopy and we believe as cost comes down, training pathways need to be established to train the next generation of colorectal surgeons robotically. Limitations: Our study is limited by inherent limitations of survey data and the response rate.



How to cite this article:
Buxey KN, Lam FF, Newstead GL. Current status of robotic colorectal surgery in Australasia: A questionnaire survey of consultant members of the colorectal surgical society of Australia and New Zealand.World J Colorectal Surg 2019;8:44-46


How to cite this URL:
Buxey KN, Lam FF, Newstead GL. Current status of robotic colorectal surgery in Australasia: A questionnaire survey of consultant members of the colorectal surgical society of Australia and New Zealand. World J Colorectal Surg [serial online] 2019 [cited 2021 Sep 29 ];8:44-46
Available from: https://www.wjcs.us.com/text.asp?2019/8/2/44/261544


Full Text



 Introduction



Internationally, the application of robotic surgery has gained popularity within the colorectal sphere, most notably for rectal surgery. The Society of American Gastrointestinal and Endoscopic Surgeons has produced a consensus statement on robotic gastrointestinal surgery stating that a robotic platform has the following advantages over a traditional laparoscopic platform:

Superior visualization, including three-dimensional imaging of the operating platformStabilization of instruments within the surgical fieldMechanical advantage over traditional laparoscopyImproved ergonomics for the operating surgeon.

The position statement indicates that the greatest potential benefit of the application lies in single-quadrant surgery where there is a complex reconstructive component with a need for complex suturing and fine dissection. It also acknowledges that a technically exceptional laparoscopic surgeon may derive minimal benefit from such a platform and that a robotic platform might rather serve as an enabling technology allowing surgeons to bring complex minimally invasive procedures to a greater number of patients.

Although robotic colorectal surgery was first described in 2001,[1] the uptake and establishment of the technique in Australasia has taken considerable time. Cited factors include cost, availability of the platform, and availability of a suitable training pathway.[2],[3]

Only limited information about robotic surgery is available from trial data and the ROLARR (Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer) trial, which compared robotic surgery to laparoscopy and concluded that the robotic approach was not cost-effective due to increased operating times and costs associated with robotic instrumentation. The robotic group achieved marginal improvements in quality of life indices, resulting in a high incremental cost-effectiveness ratio for the robotic technique and an overall conclusion that robotic surgery is not cost-effective when compared with laparoscopy.[2]

Nonetheless, there remains considerable interest in the technique, and many believe that it is very valuable particularly in specific operations such as ventral mesh rectopexy and ultralow rectal cancer surgery.

Given the ongoing interest, despite the lack of current high-quality evidence and the aforementioned barriers, we aimed to evaluate the current practice of robotic colorectal surgery among specialist colorectal surgeons in Australasia.

 Materials and Methods



A questionnaire was e-mailed to consultant members of the Colorectal Surgical Society of Australia and New Zealand, the number of which is 227. Participation was voluntary. The questionnaire requested information from members on the practice of robotic colorectal surgery. Each invitation was accompanied by a three-digit random number, which was recorded with the response so as to avoid the potential for duplication. Questions were asked about the types of surgery being performed robotically and the number of such surgeries. Information was also sought around training, proctorship, scope of nonrobotic minimally invasive colorectal surgery being performed, access to robotics, involvement of trainees, perception of strengths, disadvantages of robotic techniques, and perceived needs and pressures to perform this type of surgery. Responses were then collated, analyzed, and presented as descriptive statistics.

 Results



Seventy-seven replies were received from a total of 227 surveys. The response rate is similar to other comparable surveys published when the laparoscopic era was introduced[4],[5] and represents a greater response rate than in published surveys on robotic practice in other specialties.[6] Of the respondents, 29% currently perform robotic colorectal surgery. However, 50% of those who responded acknowledged the performance of [4]

 Conclusion



Only 9 years subsequent to this study, laparoscopy is now clearly the standard of care. This current study serves as a “snapshot” of the current Australasian uptake of robotic colorectal surgery, and similar data gathered in 10 years' time will be interesting to assess the status of the robotic platform. In order for Australasian surgeons to be ready for the potential uptake of robotic surgery, there need to be clear pathways for gaining appropriate training and experience. These need to be factored into the training of the next generation of colorectal surgeons.

Limitations

Our study is limited by inherent limitations of survey data and the response rate. The response rate is, however, comparable with similar literature published both in the colorectal literature when laparoscopic surgery was being established in the United Kingdom and when transoral robotic surgery was first being performed in North America.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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