Ann Surg Treat Res.  2014 Jan;86(1):7-15. 10.4174/astr.2014.86.1.7.

Which method of pancreatic surgery do medical consumers prefer among open, laparoscopic, or robotic surgery? A survey

• Kwon W
• Jang JY
• Park JW
• Han IW
• Kang MJ
• Kim SW

• KMID: 2266900
• DOI: http://doi.org/10.4174/astr.2014.86.1.7

Abstract

PURPOSE
The consumers' preferences are not considered in developing or implementing new medical technologies. Furthermore, little efforts are made to investigate their demands. Therefore, their preferred surgical method and the factors affecting that preference were investigated in pancreatic surgery.
METHODS
Six-hundred subjects including 100 medical personnel (MP) and 500 lay persons (LP) were surveyed. Questionnaire included basic information on different methods of distal pancreatectomy; open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS). Assuming they required the operation, participants were told to indicate their preferred method along with a reason and an acceptable cost for both benign and malignant conditions.
RESULTS
For benign disease, the most preferred method was LS. Limiting the choice to LS and RS, LS was preferred for cost and well-established safety and efficacy. OS was favored in malignant disease for the concern for radicality. Limiting the choice to LS and RS, LS was favored for its better-established safety and efficacy. The majority thought that LS and RS were both overpriced. Comparing MP and LP responses, both groups preferred LS in benign and OS in malignant conditions. However, LP more than MP tended to prefer RS under both benign and malignant conditions. LP thought that LS was expensive whereas MP thought the cost reasonable. Both groups felt that RS was too expensive.
CONCLUSION
Though efforts for development of novel techniques and broadening indication should be encouraged, still more investments and research should focus on LS and OS to provide optimal management and satisfaction to the patients.

Keyword

Pancreas; Surgery; Consumer satisfaction; Survey

MeSH Terms

Consumer Satisfaction
Humans
Investments
Laparoscopy
Methods
Pancreas
Pancreatectomy
Surveys and Questionnaires

Figure

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  Fig. 1 Laparoscopic surgery is the most preferred method in benign disease cases, whereas open surgery the first choice in malignant disease cases.

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  Fig. 2 Main considerations in choosing the preferred method of surgery according to disease type are summarized.

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  Fig. 3 (A) Laparoscopic surgery is the most preferred by both medical personnel and lay persons in benign disease cases. (B) In malignant cases, open surgery is the method of choice in both groups.

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  Fig. 4 The difference in the most influential factor in deciding the surgical method between medical personnel and lay persons in benign (A) and malignant (B) conditions is illustrated.

Reference

1. Litynski GS. Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe (1987-1988). JSLS. 1999; 3:163–167.

2. Kang CM, Kim DH, Lee WJ. Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc. 2010; 24:1533–1541.

3. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005; 241:232–237.

4. Colon Cancer Laparoscopic or Open Resection Study Group. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009; 10:44–52.

5. Lee SE, Jang JY, Lim CS, Kang MJ, Kim SW. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol. 2011; 17:174–180.

6. Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol. 2008; 15:800–806.

7. Horiguchi A, Uyama I, Miyakawa S. Robot-assisted laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2011; 18:287–291.

8. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg. 2004; 239:14–21.

9. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg. 2007; 142:823–826.

10. Shin CM, Lee YJ, Suh HS, Jang BH, Park J, Son HJ, et al. A health technology assessment for clinical effectiveness of robotic surgery in Korea. Seoul: National Evidence-based Healthcare Collaborating Agency;2011.

11. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960; 20:37–46.

12. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174.

13. Armstrong BK, White E, Saracci R. Principles of exposure measurement in epidemiology. New York: Oxford University Press;1992.

14. Gagner M, Pomp A. Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg. 1997; 1:20–25.

15. Melvin WS, Needleman BJ, Krause KR, Ellison EC. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A. 2003; 13:33–36.

16. Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010; 24:1646–1657.

17. Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg. 2009; 16:731–740.

18. Kang CM, Kim DH, Lee WJ, Chi HS. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc. 2011; 25:2004–2009.

19. Willingham FF, Gee DW, Sylla P, Kambadakone A, Singh AH, Sahani D, et al. Natural orifice versus conventional laparoscopic distal pancreatectomy in a porcine model: a randomized, controlled trial. Gastrointest Endosc. 2009; 70:740–747.

20. Barbash GI, Glied SA. New technology and health care costs: the case of robot-assisted surgery. N Engl J Med. 2010; 363:701–704.