Point-Counterpoint: Are there significant advantages for robotic vs. laparoscopic surgery for abdominal procedures?

Another recent study looked at outcomes in a group of 68 patients who had either hand-assisted or robot-assisted nephrectomy. Length of stay was significantly shorter for the laparoscopy group. In the robot-assisted group, extended operating room time and the robot’s cost tacked $1,165 onto the bottom line (J. Endourol. 2012 Nov. 7 [e-pub ahead of print]).

A recent randomized study provides even stronger evidence. It compared surgical outcomes between laparoscopic and robotic surgery for right-sided colonic cancer in 70 patients who were randomized to the procedures. The group that underwent the robotic surgery had longer surgery times, and the cost was about $2,000 more than that of the laparoscopic procedure (Br. J. Surg. 2012;99:1219-26).

Given the current state of affairs, both in terms of pricing and clinical data, surgical robots don’t make a lot of sense for abdominal procedures. There is a clear ergonomic advantage with the robot, and the three-dimensional imaging allows you to do some very fine maneuvers in small places. But almost any operation that can be done by a skilled laparoscopic surgeon can be done with identical fidelity in less time, with equivalent outcomes, and for a lot less money.

Dr. Soper is Surgeon-in-Chief at Northwestern Memorial Hospital, and the Loyal and Edith Davis Professor and Chairman of Surgery at Northwestern University Feinberg School of Medicine, Chicago.