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 Table of Contents     
INVITED COMMENTARY
Year : 2019  |  Volume : 15  |  Issue : 2  |  Page : 179
 

The debate between use and cost of technology is on-going!


Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India

Date of Submission09-Mar-2018
Date of Acceptance17-Mar-2018
Date of Web Publication12-Mar-2019

Correspondence Address:
Dr. Jaydeep H Palep
Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai - 400 056, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_59_18

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How to cite this article:
Palep JH. The debate between use and cost of technology is on-going!. J Min Access Surg 2019;15:179

How to cite this URL:
Palep JH. The debate between use and cost of technology is on-going!. J Min Access Surg [serial online] 2019 [cited 2019 Dec 7];15:179. Available from: http://www.journalofmas.com/text.asp?2019/15/2/179/233171


The series published by the group talks about the use of the now commonly used da Vinci™ surgical robotic system (Intuitive Surgicals, Inc.) for the excision of GIST, which are fairly large in size and/or difficult located tumours. Since the last two decades, globally, robotic-assisted minimally invasive surgery, especially for abdominopelvic surgeries, has taken off.[1] Its use, especially in oncosurgery, to maintain the principles of resection to obtain negative margins for disease has been well established, more so in uro- and gynaec-oncology in recent times with well-documented literature evidence.[2],[3]

However, the question here is, what is the message we are trying to give to the surgeons out there with respect to this particular issue. The case series is only a retrospective one with 12 cases done. On a comparative note, there is no data for the same provided by the team on their results with conventional laparoscopy. Today, we have technologies such as three-dimensional and 4K high-definition laparoscopy at our disposal which provide the same advantages of vision vis-à -vis the da Vinci™ robot. An experienced laparoscopy team will be able to provide the same or better results at a high-volume centre for the same procedures.[4]

In addition, we are dealing with a malignant disease. A short-term follow-up is inadequate to state that the da Vinci™ robot is superior to any other technique because we are more concerned about long-term results in neoplasms rather than short-term recovery.

The crux of the issue is the cost factor for the use of the da Vinci™ robot, which is still prohibitive around the world. If the system is a public health/government-sponsored health scheme, one can use this technology freely. In most countries globally, the system prevailing is self-paying. This makes conventional laparoscopy a more time-tested and economical option than the robot.[5]

A long-term randomised controlled trial comparing advanced laparoscopic techniques with the da Vinci™ robot needs to be designed in organ-specific procedures like these in order to determine the cost-benefit ratio and even long-term survival options for malignancies.



 
  References Top

1.
Palep JH. Robotic assisted minimally invasive surgery. J Min Access Surg 2009;5:1-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gettman M, Rivera M. Innovations in robotic surgery. Curr Opin Urol 2016;26:271-6.  Back to cited text no. 2
    
3.
Alkatout I, Mettler L, Maass N, Ackermann J. Robotic surgery in gynecology. J Turk Ger Gynecol Assoc 2016;17:224-32.  Back to cited text no. 3
    
4.
Tokas T, Gözen AS, Avgeris M, Tschada A, Fiedler M, Klein J, et al. Combining of ETHOS operating ergonomic platform, three-dimensional laparoscopic camera, and radius surgical system manipulators improves ergonomy in urologic laparoscopy: Comparison with conventional laparoscopy and da vinci in a pelvi trainer. Eur Urol Focus 2017;3:413-20.  Back to cited text no. 4
    
5.
El Hachem L, Andikyan V, Mathews S, Friedman K, Poeran J, Shieh K, et al. Robotic single-site and conventional laparoscopic surgery in gynecology: Clinical outcomes and cost analysis of a matched case-control study. J Minim Invasive Gynecol 2016;23:760-8.  Back to cited text no. 5
    




 

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