University of Central Florida Undergraduate Research Journal - A Practicality Analysis Pertaining to Minimally <br/> Invasive Robot-Assisted Urologic Surgery
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An original research based, mathematical tool was used by the team to assess practicality. This exploratory assessment tool consisted of the following criteria: quantitative patient costs, estimated peri-operative blood loss (EBL), operative duration, and length of hospital stay. Qualitative data, such as the opinions of experienced surgeons within the field, were included in the manuscript, but did not contribute to the practicality scores within the tables. For each of the three procedures, both the da Vinci® robotic technique as well as the gold standard technique were scored in the four aforementioned categories. Each procedure was selected because of the diverse challenges they present, which allowed for a more comprehensive analysis. Patient costs, estimated peri-operative blood loss, operative duration, and length of hospital stay were selected to determine the practicality of each method due to their regular occurrence in the literature related to urologic surgery outcomes. Additionally, these criteria are common to the three procedures that were evaluated, whereas other outcome variables within the literature may only be relevant to procedures involving cancer surgery or reconstruction.

Each of the four criteria has previously been cited throughout the literature involving surgery outcomes and are thus of importance to this study. Poorly controlled surgical blood loss can contribute to increases in postoperative mortality, major morbidity, and length of hospital stay.13 Additionally, excess surgery duration is frequently cited as a major risk factor for postoperative complications.14 While length of hospital stay may not be independent from perioperative blood loss, operative duration, and cost, it is of great importance to overall surgical success because reduced hospital stay has been shown to result in significant cost savings without increasing morbidity.15 Within this pilot scoring tool, each of the four categories within the data set are scored with a value between 1-5 (Table 2). A lower assigned number value correlates with a more practical value. For example, a score of 1 represents the most desirable value in each criterion category, whereas a score of 5 represents a larger and less optimal value. Within the category of estimated blood loss (EBL), a 1 corresponds to less than 150 mL and a 5 corresponds to more than 300 mL of blood. Operative duration is analyzed in the same way, with a score of 1 representing a brief procedure shorter than 120 minutes and a score of 5 representing a procedure over 210 minutes. Additionally, length of hospital stay was analyzed, using less than one day as the ideal value of 1 and a stay longer than 2.6 days as the least desirable outcome. Cost was the final quantitative criterion analyzed. A cost of $5,500 or less corresponds to a score of 1, whereas a score of 5 is assessed to a procedure costing over $10,000. (Table 2 describes the intervals in which the data have been divided.) A final mean practicality score will be calculated in Table 3 by taking an average of each of the four category scores. If the calculated mean practicality score is less than the more traditional laparoscopic method, it will be considered more practical. It is important to note that the mean scores are meant to be utilized as a within comparison between two identical procedure types performed using two different techniques. The 5-point score standardization scale located in Tables 2 and 4 has strictly been utilized for greater ease of understanding. Therefore, the mean practicality score of one type of procedure bears no relevance to the mean practicality score of another. This study does not compare practicality between two different types of procedures. All specific numerical statistics pertaining to observed perioperative and postoperative outcomes can be located in Table 3, while mean practicality results can be located in Table 4.

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