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MICHAEL WOODHEAD ROBOTIC surgery is increasingly being used for indications beyond prostate cancer but offers no advantages over conventional surgery despite its higher cost, two new studies show.
A randomised trial of robotic surgery for resection of rectal cancer in 471 UK patients found no significant differences in the main outcomes or in rates of complications when compared with laparoscopic surgery.
Published in the Journal of the American Medical Association, the study also showed that operating times were 40 minutes longer with robotic surgery, and costs were $ 1483 more than conventional surgery.
A similar lack of benefit was seen for robotic surgery when used for radical nephrectomy, a second study from the US showed.
The review of 5180 robotic
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Operating times are 40 minutes longer with robotic surgery.
surgery procedures at 416 hospitals found no difference in operative outcomes or postoperative complications compared with conventional laparoscopic surgery.
Robotic surgery had longer operating times and cost about $ 3500 more than conventional surgery.
The authors said robotic surgery had been rapidly adopted by surgeons and accounted for one in four radical nephrectomy procedures, despite a lack of evidence for additional benefit.
They said financial imperatives were driving its use, as surgeons had to perform at
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least 100-150 procedures a year to pay for the ongoing costs of a robotic system.
An accompanying commentary said robotic surgery might only offer better outcomes when it replaced open procedures.
“ In contrast, for procedures in which a minimally invasive laparoscopic procedure is already in use, there is no meaningful incremental benefit,” the commentary said.
Adoption of robotic surgery was driven by intense marketing to surgeons, as well as competition among hospitals wanting to offer the latest technology, it added.
“ Without clear demonstration of improved outcomes with robotic-assisted procedures, the complicated issue of the cost will become increasingly important,” the commentary concluded. JAMA 2017; online.
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