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World Journal of Urology

, Volume 36, Issue 4, pp 595–601 | Cite as

Robotic surgery in public hospitals of Latin-America: a castle of sand?

  • Fernando P. Secin
  • Rafael Coelho
  • Juan I. Monzó Gardiner
  • Jose Gadú Campos Salcedo
  • Roberto Puente
  • Levin Martínez
  • Diana Finkelstein
  • Rair Valero
  • Antonio León
  • Daniel Angeloni
  • José Rozanec
  • Milton Berger
  • Leandro Totti Cavazzola
  • Eliney Ferreira Faria
  • Roberto Días Machado
  • Felipe Lott
  • Franz Campos
  • Jorge G. Morales Montor
  • Carlos Sánchez Moreno
  • Hugo Dávila Barrios
Topic Paper

Abstract

Introduction

There is no information about the evolution of robotic programs in public hospitals of Latin-America.

Objective

To describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date.

Methods

We conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25–75 centiles (IQR) were estimated.

Results

Since 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs.

Conclusion

Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

Notes

Author contributions

FP Secin, protocol/project development, data collection and management, data analysis, and manuscript writing/editing. RC, data collection and management, data analysis, and manuscript editing. JIMG, data collection and management, data analysis, and manuscript editing. JGCS, data collection and management, data analysis, and manuscript editing. RP, data collection and management, and manuscript editing. LM, data collection and management, data analysis, and manuscript editing. DF, data collection and management, data analysis, and manuscript editing. RV, data collection and management, data analysis, and manuscript editing. AL, data collection and management, and manuscript editing. DA, data collection and management, data analysis, and manuscript editing. JR, data collection and management, data analysis, and manuscript editing. MB, data collection and management, data analysis, and manuscript editing. LTC, data collection and management, data analysis, and manuscript editing. EFF, data collection and management, data analysis, and manuscript editing. RDM, data collection and management, data analysis, and manuscript editing. FL, data collection and management, data analysis, and manuscript editing. FC, data collection and management, data analysis, and manuscript editing. JGMM, data collection and management, data analysis, and manuscript editing. CSM, data collection and management, data analysis, and manuscript editing. HDB, project development, data collection, and manuscript editing.

Compliance with ethical standards

Conflict of interest

None reported.

Research involving Human participants or animals

None.

Informed consent

This is retrospective study where no patient information was required, therefore, patient consent was not needed.

References

  1. 1.
    Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA, Camacho I, Coughlin G, Rocco B (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59:702–707CrossRefPubMedGoogle Scholar
  2. 2.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F et al (2001) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 134:663–694CrossRefPubMedGoogle Scholar
  3. 3.
    Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO, Vallancien G (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168:945–949CrossRefPubMedGoogle Scholar
  4. 4.
    Hemal AK, Menon M (2002) Laparoscopy, robot, telesurgery and urology: future perspective. J Postgrad Med 48:39–41PubMedGoogle Scholar
  5. 5.
    Porpiglia F, Morra I, Lucci Chiarissi M, Manfredi M, Mele F, Grande S, Ragni F, Poggio M, Fiori C (2013) Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol 63(4):606–614CrossRefPubMedGoogle Scholar
  6. 6.
    Gardiner RA, Yaxley J, Coughlin G, Dunglison N, Occhipinti S, Younie S, Carter R, Williams S, Medcraft RJ, Bennett N, Lavin MF, Chambers SK (2012) A randomised trial of robotic and open prostatectomy in men with localised prostate cancer. BMC Cancer 25(12):189CrossRefGoogle Scholar
  7. 7.
    Yaxley JW, Coughlin GD, Chambers SK et al (2016) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 388:1057–1066CrossRefPubMedGoogle Scholar
  8. 8.
    Schroeck FR, Jacobs BL, Bhayani SB, Nguyen PL, Penson D, Hu J (2017) Cost of new technologies in prostate cancer treatment: systematic review of costs and cost effectiveness of robotic assisted laparoscopic prostatectomy, intensity-modulated radiotherapy, and proton beam therapy. Eur Urol 72(5):712–735CrossRefPubMedGoogle Scholar
  9. 9.
    Robotic Surgical System for Radical Prostatectomy (2017) OHTAC Recommendation, pp. 1–4. http://www.hqontario.ca/Portals/0/Documents/evidence/reports/recommendation-prostatectomy-1707-en.pdf. Accessed 9 Sep 2017
  10. 10.
    Gil-Villa SA, Campos-Salcedob JG, Zapata-Villalba MA et al (2016) Prostatectomía radical laparoscópica asistida por robot, un año de experiencia en el Hospital Central Militar, reporte de los primeros 55 casos. Rev Mex Urol 76(2):87–93Google Scholar
  11. 11.
    Barbash GI, Glied SA (2010) New technology and health care costs–the case of robot-assisted surgery. N Engl J Med 363(8):701–704CrossRefPubMedGoogle Scholar
  12. 12.
    Ratchanon S, Apiwattanasawee P, Prasopsanti K (2015) A Cost-Utility Analysis of Laparoscopic Radical Prostatectomy and Robotic-Assisted Laparoscopic Radical Prostatectomy in Men with Localized Prostate Cancer in Thailand. J Med Assoc Thai 98(Suppl. 1):S14–S20PubMedGoogle Scholar
  13. 13.
    Ho C, Tsakonas E, Tran K et al (2011) Robot-assisted surgery compared with open surgery and laparoscopic surgery: clinical effectiveness and economic analyses. CADTH Technology Report, No. 137. Ottawa (ON): Canadian Agency for Drugs and Technologies in HealthGoogle Scholar
  14. 14.
    Marino P, Houvenaeghel G, Narducci F et al (2015) Cost-effectiveness of conventional vs robotic-assisted laparoscopy in gynecologic oncologic indications. Int J Gynecol Cancer 25(6):1102–1108PubMedGoogle Scholar
  15. 15.
    Desille-Gbaguidi Hl, Hebert T, Paternotte-Villemagne J, Gaborit C, Rush E, Body G (2013) Overall care cost comparison between robotic and laparoscopic surgery for endometrial and cervical cancer. Eur J Obstet Gynecol Reprod Biol 171(2):348–352CrossRefPubMedGoogle Scholar
  16. 16.
    Basto M, Sathianathen N, Te Marvelde L et al (2016) Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int 117:930–939CrossRefPubMedGoogle Scholar
  17. 17.
    O'Donnell O (2007) Access to health care in developing countries: breaking down demand side barriers. Cad Saude Publica 23(12):2820–2834CrossRefPubMedGoogle Scholar
  18. 18.
    Louie-Johnsun MW, Handmer MM, Calopedos RJ et al (2016) The Australian laparoscopic non robotic radical prostatectomy experience—analysis of 2943 cases (USANZ supplement). BJU Int 118(Suppl 3):43–48CrossRefPubMedGoogle Scholar
  19. 19.
    Steffens D, Thanigasalam R, Leslie S et al (2017) Robotic surgery in uro-oncology: a systematic review and meta-analysis of randomised controlled trials. Urology.  https://doi.org/10.1016/j.urology.2017.03.015 PubMedGoogle Scholar
  20. 20.
    Bochner BH, Sjoberg DD, Laudone VP (2014) A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med 371:389–390CrossRefPubMedGoogle Scholar
  21. 21.
    Juo YY, Mantha A, Abiri A, Lin A, Dutson E (2017) Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc.  https://doi.org/10.1007/s00464-017-5822-4 Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Fernando P. Secin
    • 1
  • Rafael Coelho
    • 2
  • Juan I. Monzó Gardiner
    • 3
  • Jose Gadú Campos Salcedo
    • 4
  • Roberto Puente
    • 5
  • Levin Martínez
    • 6
  • Diana Finkelstein
    • 3
  • Rair Valero
    • 7
  • Antonio León
    • 7
  • Daniel Angeloni
    • 8
  • José Rozanec
    • 9
  • Milton Berger
    • 10
  • Leandro Totti Cavazzola
    • 11
  • Eliney Ferreira Faria
    • 12
  • Roberto Días Machado
    • 12
  • Felipe Lott
    • 13
  • Franz Campos
    • 13
  • Jorge G. Morales Montor
    • 14
  • Carlos Sánchez Moreno
    • 15
  • Hugo Dávila Barrios
    • 7
  1. 1.Hospital Universitario CEMICBuenos AiresArgentina
  2. 2.Universidade de São PauloSão PauloBrazil
  3. 3.Hospital de Trauma Federico Abete, Malvinas ArgentinasBuenos AiresArgentina
  4. 4.Hospital central militarMexico CityMéxico
  5. 5.Hospital Británico de MontevideoMontevideoUruguay
  6. 6.Hospital de Clínicas, Facultad de Medicina - Universidad de la RepúblicaMontevideoUruguay
  7. 7.Hospital Universitario de CaracasCaracasVenezuela
  8. 8.Hospital Escuela de Agudos Dr. Ramón MadariagaMisionesArgentina
  9. 9.Hospital Británico de Buenos AiresBuenos AiresArgentina
  10. 10.Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
  11. 11.Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
  12. 12.Hospital de cáncer de BarretosSan PabloBrazil
  13. 13.Brazilian National Cancer InstituteRio do JaneiroBrazil
  14. 14.Hospital General Dr. Manuel Gea GonzálezMexico CityMéxico
  15. 15.Hospital Regional de Alta Especialidad de ZumpangoZumpango de OcampoMéxico

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