CHEST Guidelines-Response_chest

Response_chest_25 (1)

Pdf Summary

The document discusses studies on robotic-assisted lobectomies in the US, focusing on hospital and surgeon proficiency, costs, and outcomes. The data from the Healthcare Cost and Utilization Project National Inpatient Sample database showed that robotic lobectomies performed in high-volume centers had shorter hospital stays and lower mortality rates. However, a significant portion of these surgeries occurred in low-volume hospitals, which may not provide an accurate representation of potential outcomes due to the lack of experience; a surgeon generally requires about 20 operations to reach proficiency.<br /><br />Swanson et al.'s study found robotic lobectomies to be more costly and time-intensive than video-assisted thoracoscopic surgery without significant improvements in complications or mortality. The limited adoption of robotic technology during 2008-2013 contributes to the prevalence of low-volume centers.<br /><br />Another researcher, Park et al., indicated that robotic lung surgeries could be cost-effective and beneficial, while Nasir et al. found them profitable for hospitals. Despite the promise, the high costs of robots and disposables hinder widespread adoption. However, competition may reduce costs in the future as new companies enter the market.<br /><br />A response letter from Lise N. Tchouta, MD, et al., addresses the findings, emphasizing the significance of considering current practice patterns, which include low-volume centers. They stress the importance of evaluating outcomes at these centers for a complete picture, despite the perception of distorted outcomes. Ultimately, the letter calls for continued data collection to redefine high-volume proficiency definitions as robotic surgery matures. The potential proficiency level is estimated at around 20 procedures, aligning with other studies.<br /><br />This correspondence is part of ongoing discussions on optimizing robotic thoracic surgery, aiming to ensure that efficiency, training, and outcomes keep pace with technological advancements.

Keywords

robotic-assisted lobectomies

hospital proficiency

surgeon proficiency

costs

outcomes

Healthcare Cost and Utilization Project

high-volume centers

low-volume hospitals

video-assisted thoracoscopic surgery

robotic technology adoption