trends in robotic surgery

US researchers investigated the trends in robotic surgery use for common surgical procedures.

In robotic surgery, a surgeon performs a surgical procedure by remotely operating robotic surgical equipment from a computer consul, rather than operating directly on the patient. Robotic surgical equipment includes hi-tech camera systems that give the surgeon 3D visuals of the operation site and surgical tools that can be manipulated very precisely. Robotic surgery is mostly used for “minimally invasive surgery”, performed through small incisions in the body. This type of surgery causes less damage to the body than traditional open surgery and means that patients recover more quickly.

Robotic surgical equipment was approved for use in the US in 2000 and is used in a wide range of procedures. However, the equipment is expensive and it is still unclear whether robotic surgery has any benefits over other minimally-invasive surgical techniques, such as laparoscopic surgery (in which the surgeon manually operates surgical tools through small incisions). There is only limited information on the patterns of robotic surgery use since its introduction. Researchers at the University of Michigan investigated the trends in robotic surgery use for common surgical procedures and recently published their findings in the Journal of the American Medical Association.

Robotic surgery use on the rise across a range of surgical procedures

The researchers studied data collected between 2012 and 2018 from 73 hospitals in Michigan State, USA, including almost 170,000 surgical patients. They looked at surgical approaches – robotic, laparoscopic, or open surgery – for inpatient and outpatient general surgery procedures. To ensure accuracy, information was taken directly from the surgeon’s operative reports rather than from the computer medical coding systems.

Overall, the use of robotic surgery increased from 1.8% of general surgical procedures in 2012 to 15.1% in 2018 (an 8.4-fold increase). For some types of surgery the magnitude of increase was greater. For example in inguinal hernia repair, robotic surgery use increased from 0.7% to 28.8% (a 41.1-fold increase). The increases in robotic surgery occurred rapidly in the first few years after a hospital launched a robotic surgery program. The proportion of hospitals and surgeons using robotic surgery also increased, from 8.7% of surgeons in 2012, to 35.1% of surgeons in 2018. The use of both open surgery and laparoscopic surgery declined after hospitals began performing robotic surgery (open surgery from 44.8% to 40.6%, laparoscopic surgery from 53.2% to 51.3%).

Robotic surgery use should be monitored to ensure it is used appropriately

The trends observed suggest that robotic surgery use is increasing across a range of general surgical procedures. This was associated with a decrease in traditional minimally-invasive laparoscopic surgery. However, there is still only limited evidence from clinical trials that robotic surgery has any clear benefits over other minimally-invasive surgical approaches. The discrepancy between the rapid adoption of robotic surgery and as yet unclear clinical benefits shows that it is essential to collect information about how robotic surgery is being used.  “These findings highlight a need to continually monitor the diffusion of robotic surgery to ensure that enthusiasm for a new technology does not outpace the evidence needed to use it in the most effective clinical contexts,” commented the authors.

 

Written by Julie McShane, MA MB BS

 

Reference: Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 2020;3(1):31918911.

Image by Sasin Tipchai from Pixabay

 

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