The Feasibility and Future Prospects of Robot-Assisted Surgery in Gastric Cancer: Consensus Comments from the National Evidence-based Collaborating Agency Round-Table Conference / 보건행정학회지

To establish an appropriate policy for robotic surgery in Korea, the National Evidence-based Collaborating Agency (NECA) and the Korean Society of Health Policy and Administration held a round-table conference (RTC) to gather opinions through a comprehensive discussion of scientific information in gastric cancer. The NECA RTC is a public discussion forum wherein experts from diverse fields and members of the lay public conduct in-depth discussions on a selected social issue in the health and medical field. For this study, representatives from the medical field, patient groups, industry, the press, and policy makers participated in a discussion focused on the medical and scientific evidence for the use of robotic surgery in gastric cancer. According to the RTC results, robotic surgery showed more favorable results in safety and efficacy than open surgery and it is similar to laparoscopy. When the cost-effectiveness of robotic surgery and laparoscopy is compared, robotic surgery costs are higher but there was no difference between the two of them in terms of effectiveness (pain, quality of life, complications, etc.). In order to resolve the high cost issue of the robotic surgery, a proper policy should be implemented to facilitate the development of a cost-effective model of the robotic surgery equipment. The higher cost of robotic surgery require more evidence of its safety and efficacy as well as the cost-effectiveness issues of this method. Discussions on the national insurance coverage of robotic surgery seems to be necessary in the near future.

Safety of Comprehensive Aortic Root and Valve Repair Surgery: A Retrospective Outcomes Research by National Evidence-Based Health Care Collaborating Agency, Korea

Comprehensive aortic root and valve repair (CARVAR) is a recently introduced surgical technique for aortic valve disease. The National Evidence-based Health Care Collaborating Agency was offered by the ministry of Health and Welfare, Korea to perform a restrospective outcome analysis for this surgical procedure. The aims of this study were to evaluate the safety of patients who underwent CARVAR surgery and to provide a rationale for further prospective randomized study. During the period of March 2007 to November 2009, 397 patients received this procedure and enrolled in this study. Clinical events including major bleeding, endocarditis, re-operation and death were followed-up till March 2010 by medical records. During the follow-up periods, 1-year cumulative incidence of major bleeding, re-operation, endocarditis and death were 3.55, 5.65, 5.05 and 5.33%/year respectively. This study showed that the CARVAR technique is not beneficial, and is indeed even more harmful than conventional valve replacement surgery.