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Smart bandage could promote better, faster healing

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Someday, a smart bandage could heal chronic wounds or battlefield injuries.
Researchers from the University of Nebraska-Lincoln, Harvard Medical School and MIT have designed a smart bandage that could eventually heal chronic wounds or battlefield injuries with every fibre of its being.
The bandage consists of electrically conductive fibres coated in a gel that can be individually loaded with infection-fighting antibiotics, tissue-regenerating growth factors, painkillers or other medications.
A microcontroller no larger than a postage stamp, which could be triggered by a smartphone or other wireless device, sends small amounts of voltage through a chosen fibre. That voltage heats the fibre and its hydrogel, releasing whatever cargo it contains.
A single bandage could accommodate multiple medications tailored to a specific type of wound, the researchers said, while offering the ability to precisely control the dose and delivery schedule of those medications. That combination of customization and control could substantially improve or accelerate the healing process, said Ali Tamayol, assistant professor of mechanical and materials engineering at Nebraska.
“This is the first bandage that is capable of dose-dependent drug release,” Tamayol said. “You can release multiple drugs with different release profiles. That’s a big advantage in comparison with other systems. What we did here was come up with a strategy for building a bandage from the bottom up.
“This is a platform that can be applied to many different areas of biomedical engineering and medicine.”
The team envisions its smart bandage being used initially to treat chronic skin wounds that stem from diabetes. More than 25 million Americans – and more than 25 percent of U.S. adults 65 and older – could suffer from such wounds. The Centers for Disease Control and Prevention has estimated that diabetes cases will double or triple by the year 2050.
Those wounded in combat might also benefit from the bandage’s versatility and customizability, Tamayol said, whether to stimulate faster healing of bullet and shrapnel wounds or prevent the onset of infection in remote environments.
“Soldiers on the battlefield may be suffering from a number of different injuries or infections,” he said. “They might be dealing with a number of different pathogens. Imagine that you have a variable patch that has antidotes or drugs targeted toward specific hazards in the environment.”
Existing bandages range from basic dry patches to more advanced designs that can passively release an embedded medication over time. To evaluate the potential advantages of their smart bandage, Tamayol and his colleagues at Harvard ran a series of experiments.
In one, the researchers applied a smart bandage loaded with growth factor to wounded mice. When compared with a dry bandage, the team’s version regrew three times as much of the blood-rich tissue critical to the healing process.
Another experiment showed that an antibiotic-loaded version of the bandage could eradicate infection-causing bacteria. Collectively, Tamayol said, the experiments also demonstrated that the heat needed to release the medications did not affect their potency.
Though the researchers have patented their design, it will need to undergo further animal and then human testing before going to market. That could take several years, though the fact that most of the design’s components are already approved by the Food and Drug Administration should streamline the process, Tamayol said.

University of Nebraska-Lincoln
news.unl.edu/newsrooms/today/article/smart-bandage-could-promote-better-faster-healing/

Novel immunotherapy technology for prostate cancer

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A study led by scientists at The Wistar Institute describes a novel immunotherapeutic strategy for the treatment of cancer based on the use of synthetic DNA to directly encode protective antibodies against a cancer specific protein. This is the first application of the new technology, called DNA-encoded monoclonal antibody (DMAb), for cancer immunotherapy.
Prostate cancer is the second most common cancer in men worldwide. Traditional treatments are invasive and can impair the quality of life of patients, underscoring the need for alternative therapeutic strategies, including immunotherapy. One of the immunotherapeutic approaches that has been explored thus far relies on the use of monoclonal antibodies that specifically target a protein present on the surface of prostate cancer cells called prostate specific membrane antigen (PSMA) to elicit an anti-tumour immune response and control the cancer. Although promising, this strategy is limited by the production cost required to make these therapeutic antibodies. Additionally, multiple infusions are often required to achieve efficacy.
Wistar researchers devised a novel DNA-based approach in which an engineered DNA plasmid is constructed and used to deliver the instructions to make the desired anti-PSMA antibody so that the therapy can be generated in the patient’s body in a sustained manner. This research has important implications for the use of DNA-encoded monoclonal antibody technology as a platform for delivering the next generation of immunotherapies for cancer and many human diseases.    
“This is an important demonstration of the possibilities opened up for immunotherapy by DMAb technology to direct in vivo production of antibodies of major relevance to human cancer,” said David B. Weiner, Ph.D., executive vice president of The Wistar Institute, director of The Wistar Institute Vaccine & Immunotherapy Center, W.W. Smith Charitable Trust Professor in Cancer Research, and senior author of the study. “There is a great need for such new approaches for prostate disease as well as many other cancers. As recent data suggest, PSMA is an important cancer antigen expressed on many human prostate, bladder, renal as well as ovarian cancers, so additional study of the possible benefits of this therapy are important.”
The new technology was tested in mice for the ability to generate antibodies in their blood stream that would target human PSMA as well as target PSMA-positive tumours. Results showed that antibodies were able to bind to the cancer cells and recruited specific immune cells called natural killer cells, resulting in shrinkage of the tumour, significantly improving survival.
“Our data provide proof of concept that DMAb engineered DNA plasmids can be successfully used to target important cancers,” said Kar Muthumani, M.Sc., Ph.D., assistant professor in the Translational Tumor Immunology Program at Wistar, member of the Vaccine & Immunotherapy Center and lead author of the study. “The unique features of our synthetic DNA-based system make it a promising novel approach for cancer therapy, alone or in combination with other treatments.”
This work was supported in part by the W.W. Smith Charitable Trust Professorship, a Basser Foundation award and a DARPA award. This study was conducted in collaboration with Inovio Pharmaceuticals, Inc., which also provided funding for some of the work.

The Wistar Institute
www.wistar.org/news-and-media/press-releases/wistar-scientists-develop-novel-immunotherapy-technology-prostate-canc

Molecular beacon signals low oxygen with ultrasound

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Areas of hypoxia, or low oxygen in tissue, are hallmarks of fast-growing cancers and of blockages or narrowing in blood vessels, such as stroke or peripheral artery disease. University of Illinois researchers have developed a way to find hypoxic spots noninvasively in real time.
The researchers developed an oxygen-sensitive molecular beacon that emits ultrasound signals in response to light, a process called photoacoustic imaging – a less invasive, higher resolution and less costly method than the current clinical standard, which uses radioactive molecules and positron emission tomography scans. In a paper the researchers demonstrated the probe’s ability to image hypoxic tumours and constricted arteries in mice.
“We could give a doctor a three-dimensional, real-time view into the tissue to guide surgical procedures and treatment plans,” said chemistry professor Jefferson Chan, the leader of the study. Graduate student Hailey Knox and bioengineering professor Wawrzyniec Lawrence Dobrucki were co-authors of the paper.
“The ability to detect this in a way that doesn’t require surgery or doesn’t rely on indirect methods is really powerful, because you can actually see it as it’s developing,” Chan said.
Current methods for detecting hypoxia in tissue can only identify chronic hypoxia, and thus cannot help doctors find aggressive cancers or acute conditions like a stroke that require immediate intervention, Chan said. Such methods are limited to invasive procedures involving large electrode needles or indirect imaging with radioactive probes, which has the added challenges of off-target activation and interference.
The molecular probes Chan’s group developed only become active when oxygen is lacking. When excited by light, they produce an ultrasound signal, allowing direct 3-D imaging of hypoxic areas. They tested the system on cell cultures, and then in live mice with breast cancer and mice with constricted arteries in their legs.
“The system that we used in this study is a preclinical system for animals. However, in a clinical setting, you can take a regular ultrasound machine and equip it with a light source – you can buy LEDs for around $200 that are powerful enough and safe for clinical applications,” Chan said. Physicians would administer the photoacoustic molecules to the patient, either by injecting into a vein or directly to a tumour site, then use the modified ultrasound machine to visualize the area of interest.
The researchers found that their photoacoustic method could find hypoxia mere minutes after a mouse’s artery was constricted, showing promise for quickly finding stroke sites or blood clots in deep tissue. In the mice with cancer, the probes enabled detailed, 3-D ultrasound imaging of hypoxic tumours.
University of Illinoishttps://tinyurl.com/ycreuahp

‘Diabetes and HbA1c testing’ guide published by EKF

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EKF Diagnostics, the global in vitro diagnostics company, has published a guide to ‘Diabetes and HbA1c testing’ which can be found at EKF’s new Diabetes Portal (www.ekfdiagnostics.com/diabetes-portal.html). This new educational guide draws on EKF’s expertise in the diagnosis and monitoring of diabetes and associated conditions. It provides an overview of the global diabetes ‘epidemic’, symptoms and complications, through to discussion on methods for diagnosis and monitoring using both glucose and HbA1c testing, with consideration given to factors influencing their measurement.
Diabetes is a growing issue, particularly in developing countries, with five million people dying from diabetes related complications in 2015 alone. Although not an ‘epidemic’ in the conventional sense, there are currently 415 million people living with diabetes and this is predicted to grow to 642 million by 2040. Approximately 46% of people living with diabetes are doing so without a full and proper diagnosis with subsequent complications, and associated healthcare costs.
There are multiple options for the diagnosis of diabetes, most of which involve measuring the level of glycemic control a person exhibits. In addition to methods such as fasting plasma glucose and two-hour plasma glucose, another option is to use glycated hemoglobin (HbA1c) which reflects average plasma glucose over an 8-12 week period. As well as lab-based testing, WHO has approved HbA1c for diabetes diagnosis with a Point of-Care-Testing (POCT) device, providing the test is undertaken by a trained professional adhering to an appropriate External Quality Assurance scheme and using a methodology traceable to the IFCC reference method. POCT HbA1c testing gives a strong indication of both diabetes and pre-diabetes within a timeframe that enables immediate intervention.
Since it is not impacted by the same issues as blood glucose monitoring, HbA1c testing is fast becoming the preferred technique for diabetes and pre-diabetes diagnosis and monitoring. There are situations where use of HbA1c is not appropriate though. EKF’s new Guide includes discussion on both glucose and HbA1c testing and where factors may influence measurement of both diagnostic markers.
“The often ‘low to no’ maintenance approach to disease management of diabetes is not only dangerous but can also significantly contribute to ongoing healthcare costs. At present, approximately 12% of global health expenditure is spent on diabetes, and without significant changes to the way patients and health systems monitor glycemic control this will surely rise,” said Gavin Jones, Global Product Manager for Diabetes Care at EKF Diagnostics. “To enhance patient outcomes and reduce the cost for long-term healthcare of the diabetic and pre-diabetic population, we aim to improve patient access to diabetes care techniques, whatever their location. This can be achieved by providing affordable, easy-to-use POCT analysers and chemistry assays for both diabetes diagnosis and monitoring.”
EKF’s expertise and product range cover all aspects of diabetes care, from research and hospital laboratories to diabetes clinics, emergency rooms and GP surgeries. Products include the Biosen C-Line glucose analyser, which uses chip sensor technology to provide low cost, fast and lab accurate glucose results. Quo-Test and Quo-Lab point-of-care HbA1c analysers that deliver results meeting NGSP and IFCC POC requirements in four minutes. And lastly, to aid the diagnosis and monitoring of diabetes related conditions such as ketoacidosis, EKF offers Beta-Hydroxybutyrate LiquiColor Reagent and the handheld STAT-Site M β-HB strip-based analyser.
www.ekfdiagnostics.com

Study of four common conditions finds ICU use didn’t improve mortality rates

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With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage and found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU.
The study examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary: diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions.
“The study findings suggest that optimizing the value of ICU care will require assessments of systematic institutional factors that may lead clinicians to overutilize ICU care,” said Dong W. Chang, MD, an LA BioMed researcher and corresponding author of the study. “In addition, overuse of ICUs among patients who can likely be treated in non-ICU settings may lead to inappropriately aggressive care and misallocation of resources away from patients who may truly need critical care services.”
“This study begins to tell the story of how the inappropriate use of ICUs can be harmful for patients and costly for the healthcare system,” said Dr. Chang. “But the story is incomplete, and we need more information on the mechanisms that drive some hospitals to use their ICUs more readily. In the meantime, hospital policies and institutional protocols in non-ICU settings that lead to overutilization of ICU care should be examined because they represent the best opportunities for reducing invasive procedures and lowering costs while ensuring the best possible care for the patient.”

LA BioMed http://tinyurl.com/y78d2xnq

Promising results for patients with endoscopic treatments

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Simpler, easier method for performing biopsy can improve patient care
A simpler biopsy procedure than the one traditionally used can give equally good results while reducing stress for patients and workers, and allowing for faster diagnosis, according to a study.
During various procedures performed by gastrointestinal endoscopists, small tissue samples are taken from the patient for examination, which is known as biopsy. The traditional endoscopic forceps biopsy method can be labour intensive as well as stressful for the workplace environment.
With this method, each specimen is removed and placed in fixative vial for identification. This is labour intensive, adding to the length of the procedure and the time under sedation. Biopsy samples from each site are filtered to remove fixative, inspected to record specimen number and size, and transferred to a container to undergo several more processing steps before being mounted on slides to be examined for abnormalities or disease.
According to the study authors, diagnosis is delayed by this complex and costly protocol. In addition, staff may be affected by ergonomic stress and workplace risk from exposure to sharps, toxic fixative, infectious material, and soil.
The researchers aimed to test a faster way of collecting, handling and processing the samples to slides through a method called endoscopic multiple biopsy (MB).
MB uses a single endoscope pass within the patient to obtain up to 25 biopsy specimens during withdrawal of the endoscope. These are collected and stored in a plastic chamber inside the removable metal tip of the endoscope. After completing the biopsy series, the metal tip is cut off, immersed in fixative, and sent to pathology. There, the plastic storage chamber’s design supports rapid logging of specimens, diagnosis by frozen section and microwave (one hour) or routine paraffin processing (four to six hours) of the specimen tissue.
For the study, biopsies were performed during colonoscopy, upper GI endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). The blinded retrospective study compared 125 colon surveillance biopsies in 15 patients who underwent MB with 15 patients who underwent forceps biopsies performed on the same day.
The researchers found that the processed MB specimens were not significantly different from batched processed forceps biopsy specimens for depth, orientation (done manually), fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller but had better epithelial (cellular covering) preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal.
The authors concluded that single-pass MB reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better cellular preservation, although 26% smaller. In pathology, the plastic chamber reduces work and workplace risk. MB speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing (microscopic examination of biopsy samples for signs of or disease). They encourage larger studies at multiple centers to determine the value of MB for diagnosing a larger set of GI diseases.

American Society for Gastrointestinal Endoscopy
www.asge.org/home/about-asge/newsroom/news-list/2017/08/04/august-gie-studies-show-promising-results-for-patients-with-endoscopic-treatments

Vaginal mesh ban ‘a retrograde step’, surgeons say

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Banning vaginal mesh implants would remove an important treatment for some women suffering from a prolapse, says the Royal College of Obstetricians and Gynaecologists. Some women benefit from the implants and should have a choice, it said.
The health watchdog NICE is expected to recommend that the implants be banned. Around 800 women are taking legal action against the NHS and mesh manufacturers, saying they have suffered from painful complications.
When a prolapse occurs, doctors sometimes insert a mesh into the wall of the vagina to act as scaffolding to support organs – such as the uterus, bowel and bladder – which have fallen out of place. Hundreds of women have reported problems with this plastic mesh, which is made of polypropylene.
Prof Linda Cordozo says banning vaginal mesh is not a good idea.  However another smaller device made from the same material, called a tape, which is used to stem the flow of urine from a leaking bladder, has a much lower risk of complications.
Prof Linda Cardozo, a surgeon at King’s College Hospital in London, said there was a misconception that all types of mesh were a problem. She explained that she was not in favour of banning the use of mesh for prolapses.
“I don’t think a total ban on anything is a good idea. It stifles the opportunity to offer the minority something that might benefit them,” she said.
Draft guidelines from NICE say the implants should only be used for research – and not routine operations.
But Prof Cardozo said that a ban would stop any further research as well.
“If mesh is banned, there will be no more clinical trials,” said the professor.
“Banning it is a retrograde step – we will go back to how we were a century ago when we couldn’t offer women a range of options.”
Prof Cardozo pointed out that artificial hips and knees were not perfect when they were first introduced, but thanks to further research and progress they ended up improving lives.
“We need to be very careful that [mesh] is used in the right women by the right doctors… who have explained the risk-benefit ratio and all other types of treatment,” she added.
Some doctors did not have the skills or training to put in vaginal meshes, and the devices have been overused, the professor has argued.
She also said the debate over vaginal mesh was making some women who had had surgery unnecessarily anxious.
“They are panicking because they believe something terrible may be happening inside their body as a result of tape or mesh, but most women are problem-free,” said Prof Cardozo.

BBChttps://tinyurl.com/ybmcbqz3

MEDICAL FAIR THAILAND sets new record

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MEDICAL FAIR THAILAND 2017 concluded its most successful edition to date. It saw 830 companies from 66 countries, 18 national pavilions and country groups, and welcomed more than 9,000 quality trade visitors from over 70 countries.

There were many opportunities for networking and business matching, with 13,000 meetings requested through the free business matching service. MEDICAL FAIR THAILAND also hosted many industry-leading concurrent conferences and seminars that were well-attended throughout the three days with 650 attendees.

Mr. Gernot Ringling, Managing Director of Messe Düsseldorf Asia, organizer of MEDICAL FAIR THAILAND said: “The exhibition is a record-breaking edition, with a strong showcase of innovations from leading exhibitors as well as highly satisfied visitors. MEDICAL FAIR THAILAND certainly serves the booming medical market of Southeast Asia. We also welcomed 25% more visitors than for the 2015 edition, of which 33% were from overseas, indicative of the increasing interest from regional healthcare professionals. ”

The increased representation from Thai companies was testament to the relevance of the event for local businesses to springboard their commercial offerings on an international platform.
Commenting on their second participation at the exhibition Ms. Theeraporn Thiramonth, Project Coordinator, Innovation Strategy Department, National Innovation Agency (NIA), said, “All the innovative products we showcased throughout MEDICAL FAIR THAILAND 2017, whether medical device, diagnostic device, or telemedicine, have been internationally certified, in compliance with international standards, so can be distributed throughout Asia, as well as Europe and the US.” The NIA is a public organization under the Ministry of Science and Technology, with the mandate to assist private companies to develop their innovations and products, and supporting them to successful commercial launch.

For French company Clariance specializing in the manufacture of spinal implants, according to Sales Director Mr. Marc-Antoine Lemaire, the exhibition was the event of choice to explore ways of expanding their business in the Asian market, and “a region where there is huge potential for growth. We found MEDICAL FAIR THAILAND 2017 incredibly useful in networking with Southeast Asian decision-makers and meeting potential partners and distributors, especially in Thailand.”

MEDICAL FAIR THAILAND 2017 also saw first-time group participation from Canada, the European Union, India, the Netherlands and Russia.  Expressing his tremendous satisfaction with the exhibition, Mr. Rajiv Nath, Forum Coordinator for the Association of Indian Medical Device Industry (AiMED) said: “We are very happy to bring an Indian delegatation to the exhibition and be part of the growth story of Thailand.  We came to bring affordable and safe healthcare to Thailand and I am very sure we will be back again in 2019 with a pavilion of at least 300 sqm.  We look forward to working with the people of Thailand and the medical community of Thailand.”

Dr. Tan Kok Yang, Head & Senior Consultant from Singapore’s Khoo Teck Puat Hospital, who also spoke at the Advanced Rehab Technology Conference (ARTeC), said, “The co-location of a conference such as ARTeC with an exhibition like MEDICAL FAIR THAILAND is definitely good synergy and a relevant platform for physicians and those involved in allied healthcare. Overall, there is a good attendance at the conference and the exhibition offers a good range of products and solutions, particularly those related to rehab care.”
www.medicalfair-thailand.com

Researchers discover that MRI can measure kidney scarring and predict future kidney function

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Researchers from St. Michael’s Hospital have made what are believed to be two world first discoveries: an MRI can measure kidney damage and can predict future kidney function within one year while avoiding needle biopsies.
The researchers used a specific magnetic resonance imaging test called an elastogram to measure kidney scarring in 17 people who had kidney transplants, according to the study.
An elastogram maps the stiffness of tissue using MRI to determine the presence of scarring, according to Dr. Anish Kirpalani, the study’s lead author, a radiologist and a scientist in the Li Ka Shing Knowledge Institute of St. Michael’s.
Scarring is a major cause of kidney transplant failure.
“Healthy kidney is soft, whereas scar tissue is stiffer,” said Dr. Darren Yuen, a transplant nephrologist and scientist in the Keenan Research Centre for Biomedical Science of St. Michael’s. “We needed a way to measure how soft or stiff your kidney is without actually going inside the body. Using the MRI elastogram, we were able to measure kidney stiffness, which gave us an indication of how much scarring there was.”
Scarring is irreversible and can cause progressive kidney injury that can eventually lead to kidney failure. Diabetes, high blood pressure and kidney transplant rejection all cause scarring.
Needle biopsy is the current “gold standard” way to assess kidney scarring. A long needle is inserted into the kidney and a sample about the size of a mechanical pencil tip is removed. The procedure requires pain medications, can be associated with bleeding and requires a day off of work, according to the authors.
The study found that the MRI results were not only comparable to the results of a kidney biopsy, but the test was able to detect a high variability in the amount and location of scarring throughout the entire organ.
“The MRI allowed us to get a full picture of the kidney, whereas with a biopsy we would only see a tiny piece,” said Dr. Kirpalani.
“We were able to tell that in some parts of the kidney it’s very stiff, and in others, it’s not stiff at all, which is information we couldn’t get from a biopsy.”
The researchers also found that kidney stiffness predicted how well the kidney would be working one year after the MRI. They found that those with higher levels of stiffness in their kidneys had a greater loss of kidney function, while those with softer kidneys did not.
This shows that MRI can accurately predict future kidney function, according to the authors, which may be particularly helpful for kidney transplant patients.

St. Michael’s Hospital
www.stmichaelshospital.com/media/detail.php?source=hospital_news/2017/0830a

Robot-assisted surgery for kidney removal associated with longer operating times, higher cost

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Robot-assisted laparoscopic surgery to remove a patient’s entire kidney requires slightly longer operating times and results in increased costs compared with the use of traditional laparoscopic surgery, according to a large, multiyear analysis conducted by researchers at the Stanford University School of Medicine.
However, the two approaches have comparable patient outcomes and lengths of hospital stay, the study showed. Laparoscopic surgery is a minimally invasive procedure in which surgical operations are done through small incisions. The removal of the entire kidney is called a radical nephrectomy.
“Although the laparoscopic procedure has been standard of care for a radical nephrectomy for many years, we saw an increase in the use of robotic-assisted approaches, and by 2015 these had surpassed the number of conventional laparoscopic procedures,” said Benjamin Chung, MD, associate professor of urology. “We found that, although there was no statistical difference in outcome or length of hospital stay, the robotic-assisted surgeries cost more and had a higher probability of prolonged operative time.”
The discrepancy may be due to the time needed for robotic operating room setup or due to a surgeon being in the earlier part of his or her learning curve, resulting in a subsequent increase in operating room and instrumentation costs, the researchers speculated.
Surgical robots are helpful because they offer more dexterity than traditional laparoscopic instrumentation and use a three-dimensional, high-resolution camera to visualize and magnify the operating field. Some procedures, such as the removal of the prostate or the removal of just a portion of the kidney, require a high degree of delicate manoeuvring and extensive internal suturing that render the robot’s assistance invaluable. But Chung and his colleagues wondered whether less technically challenging surgeries, such as the removal of a whole kidney, may not benefit as significantly from a robot’s help.
The researchers analysed data from 416 hospitals across the country from 2003 to 2015. They found that in 2003 about 65 percent of patients with kidney tumours that necessitated the removal of the entire organ underwent an open surgical procedure. About 34 percent had their kidney removed using a laparoscopic procedure, and only the remaining 1.5 percent of cases were conducted with robot-assisted surgery. By 2015, the proportion of patients who underwent the open procedure had decreased to about 50 percent, but the use of robot-assisted laparoscopic surgery for the remaining cases had surpassed that of traditional laparoscopic surgery, 27 percent to 23 percent.
When they pooled the data across the years, the researchers found that among nearly 24,000 patients, almost 19,000 underwent a traditional laparoscopic procedure and about 5,000 underwent a robotic-assisted procedure. They found that 46.3 percent of those patients whose surgeon used the robot had a total procedure time of more than four hours. In contrast, about 28.5 percent of the patients whose surgeon used the conventional laparoscopic procedure were in the operating room for more than four hours.
On average, the total hospital cost (including the cost of supplies, room and board, pharmaceuticals and operating room time) for the robot-assisted procedure exceeded that of the traditional laparoscopic procedures by about $2,700 per patient. The researchers speculated that the increased cost may be due to longer times spent in the operating room and the disposable instruments upon which surgical robots rely.
The increase in robot-assisted surgery for many procedures may be due to a variety of factors, the researchers said. The technology clearly benefits patients for certain types of surgeries. In other situations, there may be an expectation on the part of the hospital or the surgeons themselves to justify the large initial investment in purchasing the robot by using it for many types of procedures. And, regardless of the procedure, use of the robotic platform can assist the surgeon in many ways to make the operation more comfortable for the surgeon. Finally, patients themselves may view robot-assisted surgery as more technologically advanced.
Chung noted that the study covers a time period when many physicians were just learning to use the robots for this type of procedure; as time passes, it’s possible the operating time will decrease and that the cost differences between the two procedures will narrow. But for now, the study suggests that robot-assisted surgery isn’t always the right choice.
Stanford Medicine med.stanford.edu/news/all-news/2017/10/robot-assisted-surgery-for-kidney-removal-linked-to-longer-times.html

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