Study Finds Few Benefits To Robotic Surgery Compared to Traditional Surgical Methods

Despite the prevailing belief that robotic surgery is superior to other forms of surgery, a new study suggests robot surgery outcomes may be no better than more traditional surgical procedures. .

Death rates, complication rates and long-term outcomes were all similar among patients undergoing robotic surgery, laparoscopic surgery and open surgery, according to the findings published in the August issue of the Annals of Internal Medicine.

Researchers at Lyndon B. Johnson Hospital, in Houston, analyzed data from more than 50 controlled studies with nearly 5,000 patients. Studies included surgeries conducted since the creation of robotic surgery in the 1980s through April 2021. Researchers focused on three types of surgery: robotic, laparoscopic, and open surgery.

Robotic surgery is performed by doctors while controlling a machine using joysticks and foot controls, while viewing the surgical site through a high definition monitor which provides a 3D image of the procedure. Laparoscopic surgery uses small incisions to complete the surgical tasks, and during open surgery the surgeon enters the body through a large incision.

The majority of studies showed no difference between intraoperative complications, long-term outcomes, and conversion rates, or when patients undergo one type of surgery, but complications typically require the surgeon to convert to open surgery.

Of the 39 studies that reported complications, only 10% showed fewer complications with robot-assisted surgery.

Furthermore, robot-assisted surgery had longer operation times than laparoscopy, but no obvious difference was seen when compared to open surgery. About 9% of laparoscopies lead to complications needing further surgical interventions, while 8% of robotic surgeries had complications. The complication rate was nearly identical.

Similarly, life threatening complications ranged from 0% to 2% for robot-assisted surgery, 0% to 3% for laparoscopy, and 1% to 4% for open surgeries. Complication rates were similar for each type of surgery.

The need to switch from robot-assisted surgery to open operations occurred in 8% of surgeries. The need to switch from laparoscopic surgery to open surgery in 12% of surgeries.

Additionally, long term outcomes focusing on mortality were reported in eight studies. Death rates among robotic surgeries were 3%, 5% for open surgeries, and no deaths reported among laparoscopic surgeries.

Robotic surgery is often marketed as a more advanced and beneficial procedure, usually coming at much higher costs, and providing greater profits for hospitals. Although some surgeons claim robotic surgeries allow for more precision, shorter recovery time, and improved patient outcomes, the findings of this new study indicated there are no difference in outcomes.

The study did find that robotic surgeries take longer, however. Gynecological robotic surgeries take roughly 265 minutes on average The maximum amount of time for laparoscopic surgeries is 226 minutes. Open surgery only took an average of 187 minutes.

While robotic surgeries offer benefits to the surgeon, such as fewer hours standing on their feet or using precision tools which can fatigue a surgeon, robotic surgeries are far more expensive. The average set up cost for robotic surgery is $2 million and there is currently one robotic company that has dominant market presence in the US, driving surgical prices even higher. It is so expensive, most hospitals cannot use these surgeries.

Previous studies have also found that robotic surgery is complicating training for new medical residents. Residents often must be removed from the machine when a mistake is made requiring hands-on training instead.

“There is currently no clear advantage with existing robotic platforms, which are costly and increase operative duration,” the researchers concluded. “With refinement, competition and cost reduction, future versions have the potential to improve clinical outcomes without the existing disadvantages.”

Researchers advised patients not to focus on the type of surgery they will have, but instead focus on the surgeon who will perform it. It is more important to select an experienced surgeon with a specialization in a particular field rather than picking a technique.