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If you need kidney or rectal surgery, is robot-assisted surgery better?

Posted Friday, November 10, 2017 by Tyler Goldberg-Hoss

You may have heard by now: robot-assisted surgeries are a real thing. Since the early 2000s, hospitals have been buying these million dollar plus robots, such as the daVinci Surgical System, to assist surgeons in minimally invasive surgeries such as gallbladder removals. These robots use the same or similar access points as a laparoscopic surgery (small holes in the abdomen, through which cameras and other tools are inserted to do the surgery).

When surgeons use these robotic devices, instead of holding on to the tools themselves in a patient’s body (like in a traditional laparoscopic surgery), they manipulate controls outside of the patient’s body, and those controls correspond to movements of surgical tools in the body. While there have been critics of the use of these robots – citing the steep learning curve for surgeons, and the cost – it appears these robots are here to stay, at least in the short term.

Recently The Journal of the American Medical Association (JAMA) investigated the utility of robot-assisted surgeries in the context of both kidney surgery and rectal surgery. They were particularly looking at how the results differed from traditional laparoscopic techniques.

The study looking at kidney surgery found that, between 2003 and 2015 the use of robotic-assisted surgery surged from 1.5% to 27%. There was no significant difference from the perspective of patient safety (similar complication rates), robot-assisted procedures typically took longer and cost more.

Another study looked at the differences between the two approaches in rectal surgery, and in particular, whether there was a difference in the rates of times when surgeons needed to convert the minimally invasive procedure (using just the small holes) to a laparotomy (a large incision through the abdominal wall to gain access to the abdominal cavity).

There are many reasons that laparoscopic surgeries, including those with and without robotic-assistance, are favored in many cases. These reasons include less chance of bleeding, typically shortened recovery time, less scarring, and less postoperative pain.

In that context, all things being equal, surgeons (and patients) who initially start with a minimally invasive technique would prefer not to convert to a laparotomy if possible.

The study found that there was no difference between traditional laparoscopic surgeries and robot-assisted surgeries in the rate such surgeries convert to laparotomies.

These two studies indicate that, while there is potential for robot-assisted surgery to be beneficial to patients in the future, at present, at least in the context of kidney and rectal surgery, no benefit clearly exists.

You can read about the two studies here:

Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015

Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer

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