Specialties Archives

Surgical Spotlight: Robotic vs. Laparoscopic Sleeve Gastrectomy

Theator on July 23, 2024

Robotic vs. Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy, also known as gastric sleeve surgery, is a frequently performed weight loss surgery that removes 80% of the stomach, leaving a much smaller organ that holds less food and liquid. A further advantage of this procedure is that the portion of the stomach that produces a hunger-inducing hormone is removed, leading to a decreased appetite and improved metabolism.

While this procedure was traditionally performed laparoscopically, in recent years more surgeons are performing robotic-assisted sleeve gastrectomies.

What’s the difference between laparoscopic and robotic-assisted sleeve gastrectomies? We’re glad you asked. In general, the main benefits of robotic-assisted surgery include a clearer view for surgeons, high accuracy of movement, and reduced trauma, meaning less tissue damage, bleeding, and pain.

Does this mean that robotic-assisted sleeve gastrectomy is the better choice? Not necessarily. Read on to find out what we learned from analyzing 505 surgical videos across a health system.

Longer Operative Times

While many aspects of surgical care affect patient outcomes, longer operative times have been associated with increased chances of complications. In the case of sleeve gastrectomy, you likely won’t be surprised to learn which approach is associated with longer operative times (*cough* robotic *cough*). But it may surprise you which procedure step is the biggest contributor to that increase in median operative time.

Download our Spotlight report to learn more.

This is just one of many data points that Theator’s Surgical Intelligence Platform automatically recognizes, analyzes, and delivers back to to health systems in digestible formats so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know more about the differences in operative time between the two approaches? We have the answer. Download the full report here.

Surgical Spotlight: Robotic vs. Laparoscopic Hysterectomy

Theator on July 16, 2024

Robotic vs. Laparoscopic Hysterectomy

Gynecologists were among the second specialty of surgeons to widely adopt a robotic-assisted approach. One of the first robotic-assisted hysterectomies was performed by Dr. Advincula in 2001. Fast forward to 2020, and robotic adoption for hysterectomies has jumped to 30% for benign cases and 65% for oncologic diseases.

So, is laparoscopic “better” than robotic? Or vice-versa? Or, does it depend on the type of case?

We aren’t here to answer that. But, in reviewing 1,795 cases, we did spot a few differences, empowering hospitals and surgeons with real-world data to inform their own, data-driven decisions. Download the report here.

Variability in procedure time

Overall, robotic hysterectomies take 39% longer than laparoscopic cases. In particular, one step accounts for the majority of that increased time adding a median of 18min to cases.

Variability in Surgical Practice to Enhance Quality (SPEQ)

Identification of critical anatomic landmarks is an essential step in preventing surgical complications associated with laparoscopic hysterectomy. For example, one SPEQ – identification of the bilateral ureters – can prevent injury to these structures. And, interestingly, view of ureter was achieved significantly more frequently.

Despite an overall increase in achievement of view of ureter in robotic cases, that wasn’t necessarily true in all of the health systems included in this analysis.

Check out the full report to see variability across and within health systems.

Surgical Best Practice Spotlight: Vaginal Cuff Closure in Minimally Invasive Hysterectomy

Theator on July 11, 2024

Extreme surgical variability exists in minimally invasive hysterectomies

About 600,000 hysterectomies are performed annually in the US, making it one of the most commonly performed surgical procedures, but the surgical practices performed within the procedure are anything but common.

For example, a previous Spotlight analysis surfaced that bilateral view of the ureter, a common surgical practice, is only achieved 54%f of the time. That got us thinking, what additional surgical practices should we be looking at in this procedure?

The answer? Vaginal cuff closure.

Vaginal Cuff Closure: A Surgical Best Practice

Vaginal cuff closure is a surgical best practice in hysterectomies, and multiple techniques and materials can be used to complete this step. Both a one-layer and two-layer technique are used in clinical practice, however, multiple studies indicate that the two-layer technique is associated with lower rates of complications, including:

- Infection
- Hematoma
- Need for blood transfusion
- Cuff complications (biggest contributing factor)

We analyzed 1,767 minimally invasive hysterectomies to find out which vaginal cuff closure techniques surgeons are using today. Download the report here. (It’s free!)

Vaginal cuff dehiscence after hysterectomy

Of the cuff complications noted above, vaginal cuff dehiscence is of particular concern. This refers to the partial or complete separation of previously sutured vaginal cuff edges, a rare but potentially fatal complication following hysterectomy. Importantly, vaginal cuff dehiscence occurs more often with one-layer than two-layer vaginal cuff closure.

Given that the two-layer technique results in decreased rates of vaginal cuff dehiscence, you may think this approach is favored in clinical practice and widely employed by gynecologists. However, our data shows, spoiler alert, that this occurs far less often than bilateral view of the ureter.

Theator’s Spotlight database compiled 1,767 hysterectomy procedures from 170 surgeons at 5 different health systems to investigate how often a two-layer vaginal cuff closure was achieved.

Curious how vaginal cuff closure techniques vary across health systems? How about within the same health system? Us too. We have answers – download the report here.

Surgical Spotlight: Right Hemicolectomy

Theator on May 22, 2024

One colorectal procedure, and the postoperative complications that can happen

Right hemicolectomy is a common colorectal surgical procedure to treat both benign and malignant conditions, including inflammatory bowel disease, colon cancer, and diverticulitis. While surgery is often a necessary step in a patient’s treatment plan, these cases don’t always go as planned.

What do we know about postoperative complications with right hemicolectomy? We know they can occur shortly after surgery or later in the postoperative course. We also know that early complications include:

- Anastomotic leaks
- Infections
- Bowel obstruction
- Bleeding
- Cardiopulmonary complications

Many factors can impact whether or not a patient experiences a complication. When looking at the right hemicolectomy surgery itself, there are 6 surgical practices Theator automatically identifies and annotates, all associated with reducing the risk of one or more postoperative complications.

Reducing anastomotic leaks in right hemicolectomies

Let’s dive into one complication, in particular. Anastomotic leaks occur in 6.4% to 8.8% of cases and can contribute to postoperative mortality and the need for revisional surgeries. Anastomotic leaks also increase healthcare costs and can lead to worse functional and oncologic outcomes for patients. Surgeons and hospital administrators want to reduce these, first and foremost to help patients.

What can surgeons do during surgery to reduce the risk of postoperative leaks?

Some literature suggests that performing the anastomosis in right hemicolectomy intracorporeally instead of extracorporeally is associated with several improved outcomes. This includes potentially lower rates of anastomotic leak and reduced rates of incisional hernias, open conversion, reoperation, blood loss, and incision length.

So, we asked the question – how often is intracorporeal anastomosis performed across health systems? The answer is less than you think.

Download our Spotlight report.

How often is intracorporeal anastomosis performed in right hemicolectomies?

We did an analysis of 389 right hemicolectomies, how often do you think intracorporeal anastomosis was performed? Flip this card to find out...

Intracorporeal anastomosis was only performed in 54% of cases.

In spite of its reduction of risks, intracorporeal anastomosis was performed in only 54% of the 389 right hemicolectomies analyzed.

Get our right hemicolectomy report >

Theator’s Spotlight database has compiled nearly 400 right hemicolectomy procedures from 6 different health systems to investigate.

This is just one of many surgical practices that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know how the adoption of this surgical practice varied between the 6 health systems? What about between hospitals within the same health system? We have answers. Download the full report here.

Surgical Spotlight: Cholecystectomy

Theator on May 14, 2024

Cholecystectomy Insights

Over 500,000 cholecystectomies are performed each year, making it one of the most common surgical procedures. Notably, most cholecystectomies are performed laparoscopically. The most common indication for laparoscopic cholecystectomy is cholelithiasis, but there are additional indications for the procedure in both symptomatic and asymptomatic patients.

Surgical complications occur in some patients who undergo cholecystectomy and include:

- Bile leaks
- Common bile duct injuries
- Hemorrhages
- Retained gallstones
- Wound infections

Although rates of bile duct injuries have decreased during the three decades that laparoscopic cholecystectomies have been performed, they remain a potentially significant and life-threatening complication.

Importantly, the effects of bile duct injuries can be long-lasting and include biliary strictures, cholangitis, cirrhosis, and portal hypertension. In addition to these outcomes’ physical and emotional burden, a substantial cost is also associated with this potentially avoidable complication.

For more laparoscopic cholecystectomy insights, download our procedure spotlight report.

How often is the critical view of safety achieved in cholecystectomies?

We did an analysis of 5,298 cholecystectomies, how often do you think the critical view of safety was achieved?
Flip this card to find out...

ONLY 34%

Achieving the critical view of safety (CVS) in laparoscopic cholecystectomies is widely documented in peer-reviewed journals to reduce the risk of bile duct injury. Despite this, it’s achieved in only 34% of cases.
Download our cholecystectomy report for more insights.

Get the Cholecystectomy Report >

Surgical Practice in Laparoscopic Cholecystectomy

A surgical best practice for preventing bile duct injuries includes the Critical View of Safety technique, which involves purposeful identification three components, one of which is the view of the cystic duct and cystic artery to avoid injury to these structures. The median success rate using this technique for the prevention of bile duct injuries is 95.8%.

Despite utilization of the Critical View of Safety being recommended for over 20 years, Theator’s Surgical Intelligence database of over 5,000 cholecystectomies performed at 15 health systems indicates this is only achieved 34% of the time. Furthermore, there is significant variation across healthcare systems and even within healthcare systems in the adoption of this surgical best practice.

Curious to know what other insights we’ve seen in our database of cholecystectomies? Download the full report here

Surgical Intelligence and Gynecologic Surgery

Theator on April 29, 2024

What Are The Advantages of AI in Gynecologic Surgery?

As the role of AI-enabled tools in surgical care expands, clinical research continues to validate the benefits of integrating streamlined AI technologies into operating rooms. In gynecology, surgical AI integration has the potential to improve quality of care and patient outcomes. A win-win.

What is Surgical Intelligence?

Surgical Intelligence is the analysis of surgical video data using AI that can surface insights that aren’t possible with manual data analysis alone. Its ability to identify specific and actionable measures to improve patient outcomes is why this technology is the future of surgical care.

Why Surgical Intelligence for gynecologic surgery?

Surgical Intelligence offers a number of advantages for clinicians and patients related to gynecologic surgeries.

Surgical step identification:

The ability of AI to identify the steps of a surgical procedure by analyzing video data is the first step toward harnessing this data to support clinicians and improve outcomes.

Specific to laparoscopic hysterectomy, available AI technologies demonstrated a 92% concordance between human and AI-directed annotation of surgical steps in one study, while a separate study found a similar 93% concordance rate between humans and AI-enabled technology in annotation of surgical steps.

The ability of AI to detect surgical steps significantly cuts down on the amount of time that would be required for humans to manually perform this task. This, in turn, allows for recorded surgical videos to be used more effectively to bolster the knowledge base and skill set of trainees.

Continuous quality improvement:

AI demonstrates a high rate of accuracy in identifying the surgical steps of a laparoscopic hysterectomy. This is notable because when AI is able to correctly identify these steps and landmarks in real time, it can then be trained to provide clinical decision support at the point of care.

For example, identification of the ureters is a critical step to avoid ureteral injury in laparoscopic hysterectomy. However, this step isn’t universally performed during this procedure. By surfacing this information to a hospital’s gynecology department, a proactive, data-driven quality initiative can be implemented to drive adoption of this surgical practice—therefore increasing the safety of laparoscopic hysterectomy procedures.

Outcomes assessment:

Because Surgical Intelligence integrates with patient outcomes data, it offers the opportunity to link what happens in the OR to outcomes such as infections, readmissions, reoperations, and increased length of stay. This allows healthcare organizations to identify systemic and individual areas for quality improvement.

Surgical Intelligence represents the future of care in all surgical specialties. By effectively and efficiently identifying procedural steps, AI-enabled tools have the power to assist clinicians with making evidence-based decisions at the point of care. Furthermore, they can link this data to patient outcomes to identify how intraoperative events affect what happens after surgery. The potential benefits of this technology for gynecologic (and all other) surgeries are significant, and staying ahead of the curve with Surgical Intelligence will benefit surgeons and patients alike.

Surgical Spotlight: Laparoscopic Hysterectomy

Theator on April 17, 2024

Laparoscopic Hysterectomy Insights

Laparoscopic hysterectomy is performed for a variety of indications, the most common of which is symptomatic uterine fibroids. In just over two decades, hysterectomies in the US went from being performed via an open abdominal approach in 70% of cases to being performed laparoscopically 70% of the time.

The laparoscopic approach to hysterectomy offers a number of advantages over open abdominal hysterectomy, including reductions in:

- Recovery time
- Pain
- Blood loss
- Costs

However, like all surgical procedures, laparoscopic hysterectomy has a risk of complications including:

- Urinary tract injury
- Bowel injury
- Vascular injury
- Bleeding

Readmission within 30 days following laparoscopic hysterectomy occurs in 2.6% of patients, with most of these occurring within the first 15 postoperative days. Surgical site infection (28.3%) is the most common reason for readmission. Notably, 51.9% of complications following laparoscopic hysterectomy are related to infections, surgical injuries, and wound complications, which are all potentially preventable outcomes.

These complications can affect patients both physically and emotionally, as well as increase the cost of care.

For more laparoscopic hysterectomy insights, download our procedure spotlight report.

Surgical Practices in Laparoscopic Hysterectomy

Identification of critical anatomic landmarks is an essential step in preventing surgical complications associated with laparoscopic hysterectomy. For example, identification of the bilateral ureters can prevent injury to these structures.

However, this step isn’t universally performed by all surgeons, and rates of bilateral ureter identification vary by institution. Theator’s Surgical Intelligence database has compiled more than 1150 laparoscopic hysterectomies to date from 9 different health systems, and we’ve found rates as low as 37% and as high as 72% for identification of both ureters at different institutions.

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know what other insights we’ve seen in our database of laparoscopic hysterectomies? Download the full report here

Surgical Spotlight: Sleeve Gastrectomy

Theator on April 2, 2024

Sleeve Gastrectomy Insights

Obesity is a public health crisis in the US, affecting more than one third of adults. In addition to diet and exercise, medications and surgical procedures are effective obesity treatments for eligible patients, and laparoscopic vertical sleeve gastrectomy is the most commonly performed weight loss surgery in the world.

Theator’s Surgical Intelligence database has compiled more than 700 sleeve gastrectomy procedures to date from 10 different health systems.

Like all surgical procedures, sleeve gastrectomy has potential complications, including:

Bleeding (1.16 – 4.94 %)
Leakage (1 – 4%)
Acute pancreatitis (1.04%)
Venous thromboembolism (0.06 – 2.20%)

30-day readmission occurs in 3.89% of patients following sleeve gastrectomy. The most common reasons for readmission after bariatric surgery include:

Nausea/vomiting (14.05%)
Abdominal pain (12.14%)
Dehydration (10.78%)

Importantly, international best practice guidelines for sleeve gastrectomy note that a lack of standardization can lead to poor outcomes, and if surgeons consistently followed surgical practice techniques, surgical outcomes would be better.

For more sleeve gastrectomy insights, download our procedure spotlight report.

Surgical Practices in Sleeve Gastrectomy

Guidance on surgical practices for sleeve gastrectomy continues to evolve as the body of research on this topic grows. This is excellent news for patients, as the more practices are standardized based on clinical evidence, the better outcomes will be.

For example, staple line reinforcement may reduce the risk of bleeding along the suture line and other perioperative complications. Notably, there is no current evidence to support one staple line reinforcement technique over another, so techniques vary by surgeon and across institutions.

Curious to know what other insights we’ve seen in our database of gastric sleeve surgeries? Download the full report here.

Surgical Spotlight: Robot-Assisted Radical Prostatectomy

Theator on February 5, 2024

Robot-Assisted Radical Prostatectomy Insights

Prostate cancer is the second most common cancer in men, with an estimated 288k new cases diagnosed in the US every year, and an estimated 34k deaths per year as a result of it.

Robot-assisted radical prostatectomy (RARP) has been a treatment option for men with intermediate to high-risk prostate cancer since 2001. Theator’s Surgical Intelligence database has compiled more than 750 RARP procedures to date, from 6 different health systems.

Like any surgical procedure, RARP has potential complications, including:

- bleeding/vascular complications (1.9-6.8% of cases)
- urinary incontinence (4-31% of cases)
- erectile dysfunction (10% of cases)

In the 5 years following RARP, 17% of patients are readmitted. The most common reasons are:

- Urinary obstruction (73%)
- Urinary infection (13.5%)
- Bleeding (6%)

In addition to the physical and emotional impact on patients in these cases, hospitals incur significant costs.

For more RARP insights, download our procedure spotlight report >>

Surgical Practices in Robot-assisted Radical Prostatectomies

You might think a surgery that has been done for decades would be standardized with surgeons from all over the world performing the same steps and same surgical practices. Unfortunately, this is far from the truth.

Not only are surgical practices not agreed upon, there’s very little data to support which approach or which techniques consistently optimize outcomes.

For example, one surgical practice, bladder neck suture, is performed 9% of the time at one health system, and 50% of the time at another. Which begs the question: why the variability?

This is just one metric that Theator’s Surgical Intelligence Platform recognizes and analyzes across a health system and connects it to outcomes, so hospital administrators and surgeons alike can take a data-driven approach to improving the quality of surgery.

Curious to know what other insights we’ve seen in our database of RARP surgeries? Download the full report here