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      Roboterassistierte viszeralchirurgische Eingriffe in Deutschland : Eine Analyse zum aktuellen Stand sowie zu Trends der letzten 5 Jahre anhand von StuDoQ|Robotik-Registerdaten Translated title: Robot-assisted visceral surgery in Germany : Analysis of the current status and trends of the last 5 years using data from the StuDoQ|Robotics registry

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          Abstract

          Roboterassistenzsysteme werden in der Viszeralchirurgie seit einigen Jahren zunehmend häufiger eingesetzt. Entsprechend ist auch die Zahl der in Deutschland installierten Systeme rapide gestiegen. Wurden 2018 rund 100 Roboterassistenzsysteme in deutschen Kliniken genutzt, waren es 2022 bereits mehr als 200. Ziel dieser Arbeit war es, den aktuellen Entwicklungsstand und Trends der viszeralchirurgischen Roboterchirurgie in Deutschland darzustellen. Hierzu wurden Daten des StuDoQ|Robotik-Registers analysiert. Des Weiteren erfolgte eine deskriptive Analyse konkomitierender DRG-Daten über das Bundesstatistikamt (Destatis), um die Repräsentativität der StuDoQ|Robotik-Registerdaten besser abschätzen zu können. In beiden Datensätzen nahm die jährliche Zahl an roboterassistierten viszeralchirurgischen Eingriffen in Deutschland stetig zu. Im Vergleich zur DRG-Statistik waren im StuDoQ|Robotik-Register je nach Eingriffsart nur 3,7 % bis maximal 36,7 % aller durchgeführten roboterassistierten Eingriffe dokumentiert. Kolorektale Resektionen waren die häufigsten roboterassistierten Eingriffe (StuDoQ: 32,5 % und 36,7 % vs. DRG-Statistik: 24,2 % und 29,7 %) und wiesen beispielsweise niedrige Mortalitätsraten (StuDoQ: 1 % und 1 % vs. DRG-Statistik: 2,3 % und 1,3 %) auf. Aufgrund der niedrigen Erfassungsquoten roboterassistierter Ösophagus‑, Magen‑, Pankreas- und Lebereingriffe konnten für diese Bereiche keine validen Aussagen aus den StuDoQ-Daten abgeleitet werden. Mit den aktuellen Erfassungsquoten ist die Aussagekraft des StuDoQ|Robotik-Registers für einige Eingriffsarten erheblich einschränkt. In Zukunft sollten daher Wege bzw. Maßnahmen eruiert werden, die zu einer deutlichen Erhöhung der Erfassungsquoten führen.

          Translated abstract

          Robot-assisted systems have been increasingly used in general surgery for several years. Accordingly, the number of systems installed in Germany has also rapidly increased. While around 100 robot-assisted systems were used in German hospitals in 2018, this figure had already risen to more than 200 by 2022. The aim of this article is to present the current state of development and trends in robotic surgery in Germany. For this purpose, data from the StuDoQ|Robotics register were analyzed. Furthermore, a descriptive analysis of concomitant diagnosis-related groups (DRG) data was carried out via the Federal Statistical Office (Destatis), for a better assessment of the representativeness of the StuDoQ|Robotics register data. In both data sets, the annual number of robot-assisted visceral surgery procedures in Germany steadily increased. Compared to the DRG data, only 3.7% up to a maximum of 36.7% of all robot-assisted procedures performed were documented in the StuDoQ|Robotics register, depending on the type of procedure. Colorectal resections were the most frequent robot-assisted procedures (StuDoQ: 32.5% and 36.7% vs. DRG data: 24.2% and 29.7%) and had, for example, low mortality rates (StuDoQ: 1% and 1% vs. DRG data: 2.3% and 1.3%). Due to the low coverage rates of robot-assisted esophageal, gastric, pancreatic and liver interventions, no valid statements could be derived from the StuDoQ data for these areas. With the current coverage rates, the informative value of the StuDoQ|Robotics register is considerably limited for some types of intervention. In the future, measures should therefore be explored that lead to a significant increase in the coverage rates.

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          Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany.

          We aimed to determine the effect of hospital volume on in-hospital mortality, and failure to rescue following major pancreatic resections using hospital discharge data of every inpatient case in Germany.
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            Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection

            Background Commonly in surgical randomised controlled trials (RCT) the experimental treatment is a relatively new technique which the surgeons may still be learning, while the control is a well-established standard. This can lead to biased comparisons between treatments. In this paper we discuss the implementation of approaches for addressing this issue in the ROLARR trial, and points of consideration for future surgical trials. Methods ROLARR was an international, randomised, parallel-group trial comparing robotic vs. laparoscopic surgery for the curative treatment of rectal cancer. The primary endpoint was conversion to open surgery (binary). A surgeon inclusion criterion mandating a minimum level of experience in each technique was incorporated. Additionally, surgeon self-reported data were collected periodically throughout the trial to capture the level of experience of every participating surgeon. Multi-level logistic regression adjusting for operating surgeon as a random effect is used to estimate the odds ratio for conversion to open surgery between the treatment groups. We present and contrast the results from the primary analysis, which did not account for learning effects, and a sensitivity analysis which did. Results The primary analysis yields an estimated odds ratio (robotic/laparoscopic) of 0.614 (95% CI 0.311, 1.211; p = 0.16), providing insufficient evidence to conclude superiority of robotic surgery compared to laparoscopic in terms of the risk of conversion to open. The sensitivity analysis reveals that while participating surgeons in ROLARR were expert at laparoscopic surgery, some, if not all, were still learning robotic surgery. The treatment-effect odds ratio decreases by a factor of 0.341 (95% CI 0.121, 0.960; p = 0.042) per unit increase in log-number of previous robotic operations performed by the operating surgeon. The odds ratio for a patient whose operating surgeon has the mean experience level in ROLARR – 152.46 previous laparoscopic, 67.93 previous robotic operations – is 0.40 (95% CI 0.168, 0.953; p = 0.039). Conclusions In this paper we have demonstrated the implementation of approaches for accounting for learning in a practical example of a surgery RCT analysis. The results demonstrate the value of implementing such approaches, since we have shown that without them the ROLARR analysis would indeed have been confounded by the learning effects. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) registry, ID: ISRCTN80500123. Registered on 27 May 2010.
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              Cost analysis of robotic versus laparoscopic general surgery procedures.

              Robotic surgical systems have been used at a rapidly increasing rate in general surgery. Many of these procedures have been performed laparoscopically for years. In a surgical encounter, a significant portion of the total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track the costs of consumable surgical supplies. We sought to determine the differences in cost of consumables with elective laparoscopic and robotic procedures for our health care organization.
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                Author and article information

                Contributors
                Maximilian.Brunner@uk-erlangen.de
                Journal
                Chirurgie (Heidelb)
                Chirurgie (Heidelb)
                Chirurgie (Heidelberg, Germany)
                Springer Medizin (Heidelberg )
                2731-6971
                2731-698X
                27 July 2023
                27 July 2023
                2023
                : 94
                : 11
                : 940-947
                Affiliations
                GRID grid.5330.5, ISNI 0000 0001 2107 3311, Klink für Allgemein- und Viszeralchirurgie, , Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, ; Krankenhausstraße 12, 91054 Erlangen, Deutschland
                Article
                1940
                10.1007/s00104-023-01940-8
                10587021
                37500803
                6e6c5727-4641-4775-b542-0db935a45b77
                © The Author(s) 2023

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 3 July 2023
                Funding
                Funded by: Friedrich-Alexander-Universität Erlangen-Nürnberg (1041)
                Categories
                Originalien
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2023

                robotische kolorektale chirurgie,robotische hepatopankreatobiliäre chirurgie,robotische chirurgie des oberen gastrointestinaltrakts,studoq-register,krankenhausabrechnungsdaten,robotic colorectal surgery,robotic hepato-pancreato-biliary surgery,robotic surgery of the upper gastrointestinal tract,studoq register,hospital billing data

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