Background:
Use of robot-assisted surgery has increased dramatically since its advent in the 1980s, and nearly all surgical subspecialties have adopted it. However, whether it has advantages compared with laparoscopy or open surgery is unknown.
Purpose:
To assess the quality of evidence and outcomes of robot-assisted surgery compared with laparoscopy and open surgery in adults.
Data Sources:
PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2021.
Study Selection:
Randomized controlled trials that compared robot-assisted abdominopelvic surgery with laparoscopy, open surgery, or both.
Data Extraction:
Two reviewers independently extracted study data and risk of bias.
Data Synthesis:
A total of 50 studies with 4898 patients were included. Of the 39 studies that reported incidence of Clavien–Dindo complications, 4 (10%) showed fewer complications with robot-assisted surgery. The majority of studies showed no difference in intraoperative complications, conversion rates, and long-term outcomes. Overall, robot-assisted surgery had longer operative duration than laparoscopy, but no obvious difference was seen versus open surgery.
Limitations:
Heterogeneity was present among and within the included surgical subspecialties, which precluded meta-analysis. Several trials may not have been powered to assess relevant differences in outcomes.
Conclusion:
There is currently no clear advantage with existing robotic platforms, which are costly and increase operative duration. With refinement, competition, and cost reduction, future versions have the potential to improve clinical outcomes without the existing disadvantages.
Primary Funding Source:
None. (PROSPERO: CRD42020182027)
References
- 1. Eubanks S, Swanström LL, Soper NJ. Mastery of Endoscopic and Laparoscopic Surgery. Lippincott Williams & Wilkins; 2000. Google Scholar
- 2. Intuitive Surgical. Annual Report 2019. Accessed at www.annualreports.com/HostedData/AnnualReportArchive/i/NASDAQ_ISRG_2019.pdf on 14 July 2020. Google Scholar
- 3.
Feldstein J ,Schwander B ,Roberts M ,et al . Cost of ownership assessment for a da Vinci robot based on US real-world data. Int J Med Robot. 2019;15:e2023. [PMID:31215714 ] doi:10.1002/rcs.2023 CrossrefMedlineGoogle Scholar - 4.
Liberati A ,Altman DG ,Tetzlaff J ,et al . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65-94. [PMID:19622512 ] LinkGoogle Scholar - 5. Society of American Gastrointestinal and Endoscopic Surgeons. SAGES/MIRA Consensus Document on Robotic Surgery. 2021. Accessed at www.sages.org/publications/guidelines/consensus-document-robotic-surgery on 15 June 2020. Google Scholar
- 6. SAGES da Vinci Safety and Effectiveness Subcommittee. da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA). 24 July 2015. Accessed at www.sages.org/publications/tavac/tavac-analysis-davinci-surgical-system on 15 June 2020. Google Scholar
- 7. OpenPaymentsData.CMS.gov website. Accessed at https://openpaymentsdata.cms.gov on 1 July 2020. Google Scholar
- 8.
Dindo D ,Demartines N ,Clavien PA . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13. [PMID:15273542 ] CrossrefMedlineGoogle Scholar - 9.
Mangram AJ ,Horan TC ,Pearson ML ,et al . Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97-132. [PMID:10196487 ] CrossrefMedlineGoogle Scholar - 10. Higgins JPT, Thomas J, Chandler J, et al, eds. Cochrane Handbook for Systematic Reviews of Interventions. Accessed at https://training.cochrane.org/handbook/current on 7 June 2020. Google Scholar
- 11.
Cadière GB ,Himpens J ,Vertruyen M ,et al . Evaluation of telesurgical (robotic) Nissen fundoplication. Surg Endosc. 2001;15:918-23. [PMID:11605106 ] CrossrefMedlineGoogle Scholar - 12.
Draaisma WA ,Ruurda JP ,Scheffer RC ,et al . Randomized clinical trial of standard laparoscopic versus robot-assisted laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2006;93:1351-9. [PMID:17058295 ] CrossrefMedlineGoogle Scholar - 13.
Morino M ,Pellegrino L ,Giaccone C ,et al . Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg. 2006;93:553-8. [PMID:16552744 ] CrossrefMedlineGoogle Scholar - 14.
Nakadi IE ,Mélot C ,Closset J ,et al . Evaluation of da Vinci Nissen fundoplication clinical results and cost minimization. World J Surg. 2006;30:1050-4. [PMID:16736336 ] CrossrefMedlineGoogle Scholar - 15.
Müller-Stich BP ,Reiter MA ,Wente MN ,et al . Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial. Surg Endosc. 2007;21:1800-5. [PMID:17353978 ] CrossrefMedlineGoogle Scholar - 16.
Müller-Stich BP ,Reiter MA ,Mehrabi A ,et al . No relevant difference in quality of life and functional outcome at 12 months' follow-up-a randomised controlled trial comparing robot-assisted versus conventional laparoscopic Nissen fundoplication. Langenbecks Arch Surg. 2009;394:441-6. [PMID:19165497 ] doi:10.1007/s00423-008-0446-8 CrossrefMedlineGoogle Scholar - 17.
Sanchez BR ,Mohr CJ ,Morton JM ,et al . Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:549-54. [PMID:16925289 ] CrossrefMedlineGoogle Scholar - 18.
Pietrabissa A ,Pugliese L ,Vinci A ,et al . Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc. 2016;30:3089-97. [PMID:26497946 ] doi:10.1007/s00464-015-4601-3 CrossrefMedlineGoogle Scholar - 19.
Kudsi OY ,Castellanos A ,Kaza S ,et al . Cosmesis, patient satisfaction, and quality of life after da Vinci single-site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc. 2017;31:3242-50. [PMID:27864724 ] doi:10.1007/s00464-016-5353-4 CrossrefMedlineGoogle Scholar - 20.
Wang G ,Jiang Z ,Zhao J ,et al . Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: a randomized clinical trial. J Surg Oncol. 2016;113:397-404. [PMID:27100025 ] doi:10.1002/jso.24146 CrossrefMedlineGoogle Scholar - 21.
Chen S ,Zhan Q ,Jin JB ,et al . Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial. Surg Endosc. 2017;31:962-71. [PMID:27402095 ] doi:10.1007/s00464-016-5046-z CrossrefMedlineGoogle Scholar - 22.
Pan HF ,Wang G ,Liu J ,et al . Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech. 2017;27:428-33. [PMID:29211699 ] doi:10.1097/SLE.0000000000000469 CrossrefMedlineGoogle Scholar - 23.
Grochola LF ,Soll C ,Zehnder A ,et al . Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 2019;33:1482-90. [PMID:30218263 ] doi:10.1007/s00464-018-6430-7 CrossrefMedlineGoogle Scholar - 24.
Prabhu AS ,Carbonell A ,Hope W ,et al . Robotic inguinal vs transabdominal laparoscopic inguinal hernia repair: the RIVAL randomized clinical trial. JAMA Surg. 2020;155:380-7. [PMID:32186683 ] doi:10.1001/jamasurg.2020.0034 CrossrefMedlineGoogle Scholar - 25.
Olavarria OA ,Bernardi K ,Shah SK ,et al . Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ. 2020;370:m2457. [PMID:32665218 ] doi:10.1136/bmj.m2457 CrossrefMedlineGoogle Scholar - 26.
Petro CC ,Zolin S ,Krpata D ,et al . Patient-reported outcomes of robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: the PROVE-IT randomized clinical trial. JAMA Surg. 2021;156:22-9. [PMID:33084881 ] doi:10.1001/jamasurg.2020.4569 CrossrefMedlineGoogle Scholar - 27.
Dhanani NH ,Olavarria OA ,Holihan JL ,et al . Robotic versus laparoscopic ventral hernia repair: one-year results from a prospective, multicenter, blinded randomized controlled trial. Ann Surg. 2021;273:1076-80. [PMID:33630447 ] doi:10.1097/SLA.0000000000004795 CrossrefMedlineGoogle Scholar - 28.
Lu J ,Zheng CH ,Xu BB ,et al . Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg. 2021;273:858-67. [PMID:32889876 ] doi:10.1097/SLA.0000000000004466 CrossrefMedlineGoogle Scholar - 29.
Baik SH ,Ko YT ,Kang CM ,et al . Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1601-8. [PMID:18270772 ] doi:10.1007/s00464-008-9752-z CrossrefMedlineGoogle Scholar - 30.
Park JS ,Choi GS ,Park SY ,et al . Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg. 2012;99:1219-26. [PMID:22864881 ] doi:10.1002/bjs.8841 CrossrefMedlineGoogle Scholar - 31.
Jayne D ,Pigazzi A ,Marshall H ,et al . Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318:1569-80. [PMID:29067426 ] doi:10.1001/jama.2017.7219 CrossrefMedlineGoogle Scholar - 32.
Kim MJ ,Park SC ,Park JW ,et al . Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg. 2018;267:243-51. [PMID:28549014 ] doi:10.1097/SLA.0000000000002321 CrossrefMedlineGoogle Scholar - 33.
Park JS ,Kang H ,Park SY ,et al . Long-term oncologic after robotic versus laparoscopic right colectomy: a prospective randomized study. Surg Endosc. 2019;33:2975-81. [PMID:30456502 ] doi:10.1007/s00464-018-6563-8 CrossrefMedlineGoogle Scholar - 34.
Morino M ,Benincà G ,Giraudo G ,et al . Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc. 2004;18:1742-6. [PMID:15809781 ] CrossrefMedlineGoogle Scholar - 35.
Nix J ,Smith A ,Kurpad R ,et al . Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196-201. [PMID:19853987 ] doi:10.1016/j.eururo.2009.10.024 CrossrefMedlineGoogle Scholar - 36.
Bochner BH ,Dalbagni G ,Sjoberg DD ,et al . Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042-50. [PMID:25496767 ] doi:10.1016/j.eururo.2014.11.043 CrossrefMedlineGoogle Scholar - 37.
Bhattu AS ,Ganpule A ,Sabnis RB ,et al . Robot-assisted laparoscopic donor nephrectomy vs standard laparoscopic donor nephrectomy: a prospective randomized comparative study. J Endourol. 2015;29:1334-40. [PMID:26414847 ] doi:10.1089/end.2015.0213 CrossrefMedlineGoogle Scholar - 38.
Khan MS ,Gan C ,Ahmed K ,et al . A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2016;69:613-21. [PMID:26272237 ] doi:10.1016/j.eururo.2015.07.038 CrossrefMedlineGoogle Scholar - 39.
Yaxley JW ,Coughlin GD ,Chambers SK ,et al . Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388:1057-66. [PMID:27474375 ] doi:10.1016/S0140-6736(16)30592-X CrossrefMedlineGoogle Scholar - 40.
Parekh DJ ,Reis IM ,Castle EP ,et al . Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet. 2018;391:2525-36. [PMID:29976469 ] doi:10.1016/S0140-6736(18)30996-6 CrossrefMedlineGoogle Scholar - 41.
Coughlin GD ,Yaxley JW ,Chambers SK ,et al . Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018;19:1051-60. [PMID:30017351 ] doi:10.1016/S1470-2045(18)30357-7 CrossrefMedlineGoogle Scholar - 42.
Bochner BH ,Dalbagni G ,Marzouk KH ,et al . Randomized trial comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: oncologic outcomes. Eur Urol. 2018;74:465-71. [PMID:29784190 ] doi:10.1016/j.eururo.2018.04.030 CrossrefMedlineGoogle Scholar - 43.
Ma W ,Mao Y ,Zhuo R ,et al . Surgical outcomes of a randomized controlled trial compared robotic versus laparoscopic adrenalectomy for pheochromocytoma. Eur J Surg Oncol. 2020;46:1843-7. [PMID:32723609 ] doi:10.1016/j.ejso.2020.04.001 CrossrefMedlineGoogle Scholar - 44.
Würnschimmel C ,Di Pierro GB ,Moschini M ,et al . Robot-assisted laparoscopic partial nephrectomy vs conventional laparoscopic partial nephrectomy: functional and surgical outcomes of a prospective single surgeon randomized study. J Endourol. 2020;34:847-55. [PMID:32486864 ] doi:10.1089/end.2020.0143 CrossrefMedlineGoogle Scholar - 45.
Khan MS ,Omar K ,Ahmed K ,et al . Long-term oncological outcomes from an early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2020;77:110-8. [PMID:31740072 ] doi:10.1016/j.eururo.2019.10.027 CrossrefMedlineGoogle Scholar - 46.
Venkatramani V ,Reis IM ,Castle EP ,et al . Predictors of recurrence, and progression-free and overall survival following open versus robotic radical cystectomy: analysis from the RAZOR trial with a 3-year followup. J Urol. 2020;203:522-9. [PMID:31549935 ] doi:10.1097/JU.0000000000000565 CrossrefMedlineGoogle Scholar - 47.
Paraiso MFR ,Jelovsek JE ,Frick A ,et al . Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118:1005-13. [PMID:21979458 ] doi:10.1097/AOG.0b013e318231537c CrossrefMedlineGoogle Scholar - 48.
Sarlos D ,Kots L ,Stevanovic N ,et al . Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2012;120:604-11. [PMID:22914470 ] doi:10.1097/AOG.0b013e318265b61a CrossrefMedlineGoogle Scholar - 49.
Paraiso MF ,Ridgeway B ,Park AJ ,et al . A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. Am J Obstet Gynecol. 2013;208:368.e1-7. [PMID:23395927 ] doi:10.1016/j.ajog.2013.02.008 CrossrefMedlineGoogle Scholar - 50.
Anger JT ,Mueller ER ,Tarnay C ,et al . Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123:5-12. [PMID:24463657 ] doi:10.1097/AOG.0000000000000006 CrossrefMedlineGoogle Scholar - 51.
Lönnerfors C ,Reynisson P ,Persson J . A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy. J Minim Invasive Gynecol. 2015;22:78-86. [PMID:25045857 ] doi:10.1016/j.jmig.2014.07.010 CrossrefMedlineGoogle Scholar - 52.
Mäenpää MM ,Nieminen K ,Tomás EI ,et al . Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Am J Obstet Gynecol. 2016;215:588.e1-588.e7. [PMID:27288987 ] doi:10.1016/j.ajog.2016.06.005 CrossrefMedlineGoogle Scholar - 53.
Mäkelä-Kaikkonen J ,Rautio T ,Pääkkö E ,et al . Robot-assisted vs laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Dis. 2016;18:1010-5. [PMID:26919191 ] doi:10.1111/codi.13309 CrossrefMedlineGoogle Scholar - 54.
Mäkelä-Kaikkonen JK ,Rautio TT ,Koivurova S ,et al . Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. Int Urogynecol J. 2016;27:1837-45. [PMID:27250828 ] CrossrefMedlineGoogle Scholar - 55.
Deimling TA ,Eldridge JL ,Riley KA ,et al . Randomized controlled trial comparing operative times between standard and robot-assisted laparoscopic hysterectomy. Int J Gynaecol Obstet. 2017;136:64-9. [PMID:28099699 ] doi:10.1002/ijgo.12001 CrossrefMedlineGoogle Scholar - 56.
Soto E ,Luu TH ,Liu X ,et al . Laparoscopy vs. robotic surgery for endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril. 2017;107:996-1002.e3. [PMID:28238489 ] doi:10.1016/j.fertnstert.2016.12.033 CrossrefMedlineGoogle Scholar - 57.
Salehi S ,Åvall-Lundqvist E ,Legerstam B ,et al . Robot-assisted laparoscopy versus laparotomy for infrarenal paraaortic lymphadenectomy in women with high-risk endometrial cancer: a randomised controlled trial. Eur J Cancer. 2017;79:81-9. [PMID:28463759 ] doi:10.1016/j.ejca.2017.03.038 CrossrefMedlineGoogle Scholar - 58.
Illiano E ,Ditonno P ,Giannitsas K ,et al . Robot-assisted vs laparoscopic sacrocolpopexy for high-stage pelvic organ prolapse: a prospective, randomized, single-center study. Urology. 2019;134:116-23. [PMID:31563536 ] doi:10.1016/j.urology.2019.07.043 CrossrefMedlineGoogle Scholar - 59.
Narducci F ,Bogart E ,Hebert T ,et al . Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: results of the randomized ROBOGYN-1004 trial. Gynecol Oncol. 2020;158:382-9. [PMID:32467054 ] doi:10.1016/j.ygyno.2020.05.010 CrossrefMedlineGoogle Scholar - 60.
Laitakari KE ,Mäkelä-Kaikkonen JK ,Pääkkö E ,et al . Restored pelvic anatomy is preserved after laparoscopic and robot-assisted ventral rectopexy: MRI-based 5-year follow-up of a randomized controlled trial. Colorectal Dis. 2020;22:1667-76. [PMID:32544283 ] doi:10.1111/codi.15195 CrossrefMedlineGoogle Scholar - 61.
Pernar LIM ,Robertson FC ,Tavakkoli A ,et al . An appraisal of the learning curve in robotic general surgery. Surg Endosc. 2017;31:4583-96. [PMID:28411345 ] doi:10.1007/s00464-017-5520-2 CrossrefMedlineGoogle Scholar - 62.
Patel SV ,Yu D ,Elsolh B ,et al . Assessment of conflicts of interest in robotic surgical studies: validating author's declarations with the Open Payments database. Ann Surg. 2018;268:86-92. [PMID:28700443 ] doi:10.1097/SLA.0000000000002420 CrossrefMedlineGoogle Scholar - 63.
Futoma J ,Simons M ,Panch T ,et al . The myth of generalisability in clinical research and machine learning in health care. Lancet Digit Health. 2020;2:e489-e492. [PMID:32864600 ] doi:10.1016/S2589-7500(20)30186-2 CrossrefMedlineGoogle Scholar - 64.
Rothwell PM . Factors that can affect the external validity of randomised controlled trials. PLoS Clin Trials. 2006;1:e9. [PMID:16871331 ] CrossrefMedlineGoogle Scholar - 65.
Sheetz KH ,Norton EC ,Dimick JB ,et al . Perioperative outcomes and trends in the use of robotic colectomy for Medicare beneficiaries from 2010 through 2016. JAMA Surg. 2020;155:41-9. [PMID:31617874 ] doi:10.1001/jamasurg.2019.4083 CrossrefMedlineGoogle Scholar - 66.
Spitz S . Canada lags in using robotic surgery. CMAJ. 2013;185:E305-6. [PMID:23529970 ] doi:10.1503/cmaj.109-4429 CrossrefMedlineGoogle Scholar
Author, Article and Disclosure Information
Affiliations:
McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
Baylor College of Medicine, Houston, Texas (M.L.)
Dell Medical School at the University of Texas, Austin, Texas (A.B.H.)
University of Houston, HCA Kingwood, Kingwood, Texas (M.K.L.).
Note: Dr. Dhanani attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-7006.
Reproducible Research Statement: Study protocol, statistical code, and data set: Available from Dr. Dhanani (e-mail, naila.
Corresponding Author: Naila H. Dhanani, MD, Lyndon B. Johnson Hospital, Department of Surgery, 5656 Kelley Street, Houston, TX 77026; e-mail, naila.
Current Author Addresses: Drs. Dhanani, Olavarria, Bernardi, Lyons, and Holihan: Lyndon B. Johnson Hospital, Department of Surgery, 5656 Kelley Street, Houston, TX 77026.
Dr. Loor: Baylor Medicine at McNair Campus, 7200 Cambridge Street, Houston, TX 77030.
Dr. Haynes: UT Health Austin Clinics, Health Transformation Building, 1601 Trinity Street, Building A, Austin, TX 78712.
Dr. Liang: 22999 Highway 59 North, Building B, Suite 220, Kingwood, TX 77339.
Author Contributions: Conception and design: N.H. Dhanani, K. Bernardi, N.B. Lyons, J.L. Holihan, M. Loor, M.K. Liang.
Analysis and interpretation of the data: N.H. Dhanani, O.A. Olavarria, K. Bernardi, J.L. Holihan, A.B. Haynes, M.K. Liang.
Drafting of the article: N.H. Dhanani, O.A. Olavarria, K. Bernardi, N.B. Lyons, M.K. Liang.
Critical revision of the article for important intellectual content: N.H. Dhanani, K. Bernardi, N.B. Lyons, J.L. Holihan, M. Loor, A.B. Haynes, M.K. Liang.
Final approval of the article: N.H. Dhanani, O.A. Olavarria, K. Bernardi, N.B. Lyons, J.L. Holihan, M. Loor, A.B. Haynes, M.K. Liang.
Provision of study materials or patients: N.H. Dhanani, M.K. Liang.
Statistical expertise: N.H. Dhanani, O.A. Olavarria, K. Bernardi, M.K. Liang.
Administrative, technical, or logistic support: N.H. Dhanani, O.A. Olavarria, M.K. Liang.
Collection and assembly of data: N.H. Dhanani, O.A. Olavarria, K. Bernardi, N.B. Lyons, J.L. Holihan, M.K. Liang.
This article was published at Annals.org on 29 June 2021.
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
*All comments submitted after October 1, 2021 and selected for publication will be published online only.