P. R. Armijo1, D. Lomelin2, D. Oleynikov1 1University Of Nebraska College Of Medicine,Surgery,Omaha, NE, USA 2University Of Nebraska College Of Medicine,College Of Medicine,Omaha, NE, USA
Introduction: Advancements in technology have led to an increasing number of robotic surgeries over time, in a wide variety of procedures. The aim of this study is to evaluate the current national trends of open (OVHR), laparoscopic (LVHR) and robotic (RVHR) ventral hernia repair (VHR) and to account for the growth of robotic technique.
Methods: This is a multi-center, retrospective study of patients who underwent VHR from January 2013 to September 2015. The UHC clinical database resource manager (CDB/RM) was queried using ICD-9 procedure codes for OVHR, LVHR and RVHR. Trends were evaluated between and within quarters (Q1 2013 to Q3 2015) and comparisons were made between OVHR and MIS approaches (which included both LVHR and RVHR), and within the MIS group. The last quarter of 2015 was excluded due to changing in the coding system. The data was analyzed using IBM SPSS v.23.0 using linear-by-linear association test.
Results:A total of 63,308 patients underwent VHR from 2013 to 2015 (OVHR: N=50,234; LVHR: N=12,293; RVHR: N=781). During this period, a significant increase of 2.54% was seen in OVHR compared to MIS approaches (graph 1). In the first quarter of 2013, OVHR accounted for 77.87% (N=4,584) of the procedures versus 22.13% of MIS (N=5,887). Whereas, an increase to 80.41% (N=4,183) of OVHR occurred in 2015, compared to a significant decrease of both LVHR and OVHR to 19.59% (N=5,202) in the same time frame (p=0.007). Likewise, an interesting trend was seen within MIS group. RVHR nearly tripled from 4.30% (N=56) in 2013 to 11.97% (N=122) in 2015; whereas LVHR decreased from 95.70% (N=1,247) to 88.03% (N=897) in the same period of time (p<0.001).
Conclusion:In the field of Urology and OB/GYN, growth in robotic surgery has converted open operations to MIS. From the data in this study, it appears that growth in RVHR has come from laparoscopic techniques, and not from open surgery as previously thought. Effects on cost and long term outcomes will need to be studied in order to better understand the impact of this trend.
