From the Journals

Adoption of robotic-assisted surgery uneven across specialties


Key clinical point: Robotic-assisted surgery is currently most prominent in urologic, gynecologic, and endocrine surgery.

Major finding: Procedures performed with robotic assistance increased from 6.8% to 17% over a 5-year period.

Data source: Analysis of data from 936,188 patients from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database.

Disclosures: Investigators reported no conflicts of interest.



Robotic-assisted laparoscopy is on the rise but its spread is uneven across specialties and procedures, findings of a large national study of surgical technology show.

The trend favoring robotic-assisted surgery is especially apparent for urologic, gynecologic, and endocrinologic procedures, according to a study of data drawn from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) conducted by Yen-Yi Juo, MD, of George Washington University, Washington, and his colleagues (Surg Endosc. 2017 Aug 25. doi: 10.1007/s00464-017-5822-4).

Proportion of robotic-assisted laparoscopic procedures
The three specialties with the highest proportion of robotic-assisted surgeries were urology (34.1%), gynecology (11.0%), and endocrine-related surgery (9.4%). In comparison, the most rapid growth in robotic-assisted procedures was in colorectal surgery, which increased from 0.3% in 2008 to 8.5% in 2013, in thoracic surgery, which increased from 0.4% to 9.4%, and in general surgery, which increased from 0.7% to 5.0%. But despite the increase in robotic-assisted surgery, there is not much evidence of better outcomes such as lower mortality, shorter length of stay, or lower costs. “In contrast to the disruptive changes to open surgery brought about by laparoscopic technology, the addition of robotic-assisted technology were often found to be equivalent in outcome to its conventional laparoscopic counterparts,” the investigators wrote.

While robotic-assisted surgery is gradually increasing, conventional laparoscopic procedures are declining, the data showed. The case volume of all traditional laparoscopic surgeries decreased by 39.4% between 2009 and 2013 while robotic-assisted laparoscopic procedures increased by 250% over a 6-year period, although the total number of robotic-assisted surgeries is still comparatively small. The study found that the total number of traditional laparoscopic procedures decreased from 956,304 to 737,615 from 2009 to 2013. From mid-2008 to mid-2013, robotic-assisted laparoscopic procedures increased from 17,720 to 33,530.

Patient characteristics such as age, sex, income level, type of insurance, presence of comorbidity, and type of hospital were all significant predictors of whether robotic-assisted surgery would be utilized during a laparoscopic procedure, study findings suggest. Additionally, 5 of the top 10 most common robotic-assisted procedures are performed by urologists.

The investigators noted that there were limitations on the study due to the lack of data on operative indication, disease severity, and postoperative complications in the HCUP-NIS database. In addition, “surgeons are known to preferentially select ‘safer’ patients during the initial adoption of new technology; this may lead to an overestimation of robotic procedure’s clinical benefit in our simple outcome measure.”

The investigators concluded that “although robotic-assisted technology has seen progressive increase in prevalence, its adoption is conspicuously uneven across specialties and procedures. ... The next step in this body of work is to identify specific perceived technical advantages by surgeons working in certain anatomic areas in order to optimize target procedures for the uptake of robotic technology in the future.”

The investigators reported no conflicts of interest.

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