For kidney patients, surgical outcomes were similar whether a human or a machine wielded the scalpel
When it comes to some operations, surgical robots may not be worth the extra time or money.
Researchers compared patients who underwent traditional laparoscopy to have a kidney removed — surgery involving several small incisions rather than one large cut — with patients who received robot-assisted laparoscopies. Although the two groups had similar complication rates and hospital stay lengths, robotic procedures took longer and cost more per patient, researchers report in the Oct. 24 JAMA.
In a robot-assisted operation, the surgeon uses a console to control robotic arms wielding surgical tools (SN: 11/12/16 p. 18). Surgical robots are increasingly being used for procedures such as tumor removal and organ transplants because the machines help doctors maneuver more precisely.
Benjamin Chung, a urological oncologist at Stanford University Medical Center, and his colleagues analyzed nearly 24,000 kidney removal surgeries in 416 hospitals across the United States from 2003 to 2015. In 2003, only 39 of these patients received robot-assisted surgeries; in 2015, that number was up to 862 — higher than the number of hand-performed laparoscopies seen in the same year.
But Chung and colleagues’ analysis casts doubt on the cost-effectiveness of those high-tech operations. Robot-assisted laparoscopies were almost twice as likely as traditional procedures to take longer than four hours. And robot assistance boosted the average hospital cost from $16,851 to $19,530 — probably because of extra operating room time and the cost of robot maintenance.
Another study in the Oct. 24 JAMA reports that rectal cancer patients who had conventional laparoscopic and robot-assisted surgery experienced similar complication rates and postoperative quality of life. But robot-assisted operations took about 37 minutes longer on average and hiked the average cost from $12,556 to $13,668.
These results don’t surprise Gabi Barbash, a research physician at the Weizmann Institute of Science in Rehovot, Israel, who was not involved in the work. Other studies have indicated that robot-assisted laparoscopies for colon, gallbladder and uterus removal take longer or cost more than traditional procedures, without much payoff in terms of patient health.
Surgical robots constitute “an amazing technology,” Barbash says, and they’re invaluable for some notoriously tricky procedures, like prostate removal. But simpler procedures, such as kidney removal, may not call for a robot in the OR.
I.G. Jeong et al. Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. JAMA. Vol. 318, October 24, 2017, p. 1561. doi:10.1001/jama.2017.14825.
D. Jayne 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. Vol. 318, October 24, 2017, p. 1569. doi:10.1001/jama.2017.7219.
M. Rosen. For robots, artificial intelligence gets physical. Science News. Vol. 190, November 12, 2016, p. 18.