Introduction

The research article titled “Comparative outcomes of Palmer, Umbilical Veress needle, and open entry techniques in robotic-assisted surgery: a propensity-matched analysis of 9482 patients” explores the complication rates associated with different entry techniques used in robotic-assisted surgeries. The study, authored by Ahmed Eraky and colleagues, investigates the Palmer Veress needle insertion, umbilical Veress needle insertion, and the open Hasson technique to establish pneumoperitoneum, a crucial step in these surgical procedures.

Study Design and Methodology

The study utilized a retrospective cohort design that included 9,482 patients who underwent robotic surgery for urologic conditions. To facilitate a fair comparison between the three surgical entry techniques, the authors employed propensity score matching, ensuring that the cohorts were well-balanced in terms of demographic and clinical characteristics. The primary outcomes measured were complication rates, classified using the Clavien–Dindo system, and logistic regression was used to analyse predictors of complications, including the number of needle attempts and the presence of adhesions.

Key Findings

A total of 1,016 patients were matched for the analysis, with 508 patients in both the Palmer and umbilical groups. The study found that umbilical insertion was associated with a higher rate of complications compared to Palmer insertion, with an odds ratio (OR) of 2.14, indicating a statistically significant difference (p = 0.033). Additionally, patients who required more than four needle attempts during the procedure experienced significantly higher complication rates (OR 15.43, p = 0.002). The presence of severe adhesions was identified as a strong predictor of complications, with an OR of 16.57 (p = 0.002).

In a multivariate analysis, however, the choice of entry technique lost its independent significance concerning complications, suggesting that factors such as needle attempts and adhesion severity played a more critical role in determining surgical outcomes. This indicates that surgical entry complications in robotic-assisted surgery are more influenced by these intraoperative factors rather than the specific entry technique employed.

Discussion and Implications

The findings from this study challenge the notion that one surgical entry method is inherently safer than the others. Instead, the authors emphasize the importance of tailoring surgical plans to the individual patient’s characteristics, particularly their surgical history and potential for adhesions. They advocate for minimizing needle attempts during the establishment of pneumoperitoneum to reduce complication rates.

Moreover, the authors recommend incorporating preoperative imaging techniques to assess the likelihood of adhesions, which could guide surgeons in selecting the most appropriate entry technique. This individualized approach could enhance patient safety and improve surgical outcomes.

Conclusions

In summary, the study concludes that surgical entry complications in robotic-assisted surgery are significantly influenced by the number of needle attempts and the presence of adhesions rather than the choice of entry technique itself. Therefore, adopting a more personalized approach in planning surgical interventions and reducing the number of needle attempts could lead to improved patient outcomes.

READ MORE… https://link.springer.com/article/10.1007/s11701-024-02208-x