Surgical Spotlight 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: Transurethral Resection of Bladder Tumor

Theator on June 6, 2024

We analyzed 1,177 TURBTs to find out how often the ureteral orifices were visualized before and after resection of the bladder tumor. The result was less than you think.

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.

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 gastric sleeve surgeries? Download the full report here.