|Year : 2019 | Volume
| Issue : 2 | Page : 179
The debate between use and cost of technology is on-going!
Jaydeep H Palep
Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
|Date of Submission||09-Mar-2018|
|Date of Acceptance||17-Mar-2018|
|Date of Web Publication||12-Mar-2019|
Dr. Jaydeep H Palep
Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai - 400 056, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Palep JH. The debate between use and cost of technology is on-going!. J Min Access Surg 2019;15:179
The series published by the group talks about the use of the now commonly used da Vinci™ surgical robotic system (Intuitive Surgicals, Inc.) for the excision of GIST, which are fairly large in size and/or difficult located tumours. Since the last two decades, globally, robotic-assisted minimally invasive surgery, especially for abdominopelvic surgeries, has taken off. Its use, especially in oncosurgery, to maintain the principles of resection to obtain negative margins for disease has been well established, more so in uro- and gynaec-oncology in recent times with well-documented literature evidence.,
However, the question here is, what is the message we are trying to give to the surgeons out there with respect to this particular issue. The case series is only a retrospective one with 12 cases done. On a comparative note, there is no data for the same provided by the team on their results with conventional laparoscopy. Today, we have technologies such as three-dimensional and 4K high-definition laparoscopy at our disposal which provide the same advantages of vision vis-à -vis the da Vinci™ robot. An experienced laparoscopy team will be able to provide the same or better results at a high-volume centre for the same procedures.
In addition, we are dealing with a malignant disease. A short-term follow-up is inadequate to state that the da Vinci™ robot is superior to any other technique because we are more concerned about long-term results in neoplasms rather than short-term recovery.
The crux of the issue is the cost factor for the use of the da Vinci™ robot, which is still prohibitive around the world. If the system is a public health/government-sponsored health scheme, one can use this technology freely. In most countries globally, the system prevailing is self-paying. This makes conventional laparoscopy a more time-tested and economical option than the robot.
A long-term randomised controlled trial comparing advanced laparoscopic techniques with the da Vinci™ robot needs to be designed in organ-specific procedures like these in order to determine the cost-benefit ratio and even long-term survival options for malignancies.
| ¤ References|| |
Palep JH. Robotic assisted minimally invasive surgery. J Min Access Surg 2009;5:1-7.
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