Robotic Surgery Gaining Popularity for Common Surgical Procedures

By Will Boggs MD

January 22, 2020

NEW YORK (Reuters Health) - The use of robotic surgery for common surgical procedures increased more than eight times from 2012 to 2018, according to data from the Michigan Surgical Quality Collaborative clinical registry.

"It is interesting to us that laparoscopic cases are being replaced by robotic ones at an equal or greater rate than open cases," Dr. Kyle H. Sheetz of the University of Michigan School of Medicine, in Ann Arbor, told Reuters Health by email. "This counters a common narrative that robotic surgery facilitates more minimally invasive surgery, which potentially justifies the higher costs. But this theory may not be true if robotics is replacing cases that are already being done in the traditional laparoscopic minimally invasive fashion."

Many have raised concerns about the rapid growth of robotic surgery, with its substantially higher costs (compared with laparoscopic surgery) and limited evidence to support its use, as well as little theoretical benefit or clinical rationale in some areas.

From 2012 to 2018, Dr. Sheetz and his colleagues found, the use of robotic surgery for all general surgery procedures increased 8.4-fold, from 1.8% to 15.1% of cases.

At the same time, the use of laparoscopic surgery declined from 55.8% to 52.6%, and the use of open surgery declined from 42.4% to 32.4%, the team reports in JAMA Network Open.

The trends in robotic-surgery use were similar across procedures, although the magnitudes differed. The use of robotic surgery for inguinal-hernia repair increased from 0.7% to 28.8% during this period, whereas its use for complex cancer resections only increased from 2.1% to 3.9%.

Between 2012 and 2018, the number of hospitals performing any robotic general surgery increased from 52 to 73, and the number of surgeons performing any robotic general surgery increased from 759 to 828.

At the 23 hospitals that began performing robotic surgery during this period, the use of robotic surgery increased from 3.1% in the first year to 13.1% by the fourth year. Their use of laparoscopic surgery decreased from 53.2% to 51.3% after they began performing robotic surgery, reversing a trend toward greater use of laparoscopic surgery in earlier years.

"There are important and unanswered questions about the comparative short-term safety and long-term effectiveness of robotic operations compared to laparoscopic ones," Dr. Sheetz said. "This has important implications for things like evidence-based coverage design."

"Right now it's unclear if the higher hospital costs associated with robotic surgery are being passed on to patients," he said. "If robotic operations are comparatively no better, this would directly impact the value of surgical care being provided."

"New medical technologies are everywhere," Dr. Sheetz said. "There are clear opportunities for better collaboration between practicing physicians, government regulators or policymakers, and private sector innovators. It's on all of us to make sure that we add value to an already expensive and complex healthcare system."

SOURCE: JAMA Network Open, online January 10, 2020.