Robotic Surgery May Not Improve Outcomes

While minimally invasive robotic surgery can result in less blood loss, shorter hospital stays, and fewer complications, there is no evidence that it improves cure rates.

In addition, because the procedure is in high demand and requires special training, it can be unprofitable for hospitals, according to a new review by ECRI (Plymouth Meeting, PA, USA), a nonprofit health services research agency. ECRI reviewed 625 cases in two studies that compared traditional open surgery, laparoscopic surgery, and robotic surgery for the removal of a cancerous prostate.

The cancer cure rate was found to be nearly identical for all three procedures. Hospital stay was significantly shorter, however, with robotic-assisted prostatectomy compared to open surgery: 25.9 hours vs 52.8 hours in one study. Another study showed a significant difference in catheterization time: seven days for robotic-assisted patients, 7.9 days for laparoscopy patients, and 15.8 days for open surgery. Open surgery had a significantly higher overall complications rate of 15%, vs 10% for laparoscopy and 5% for robotic-assisted surgery. There was no evidence to indicate that any surgical method was better than another with regard to side effects such as urinary incontinence and sexual impotency.

Open surgery was clearly the least expensive procedure, at U.S.$487 less per case than laparoscopy and $1,726 less than robotic surgery. "Hospitals have to consider whether they can use the system for more than one type of procedure to make it worth the capital equipment investment,” noted Diane Robertson, director of health technology assessment services for ECRI. "If you have to choose between someone who hasn't performed many robotic surgeries and a person who has performed many open procedures--take the open procedure,” she advised.




Related Links:
ECRI