Surgeons removing patients’ kidneys in keyhole surgeries are better off working without robot assistance because using tech can result in longer operating times and increased costs.
That’s the conclusion put forward by researchers at the Stanford University School of Medicine who found that whether the operation was performed by human-only teams or with robot assistance had little effect on patient outcomes and lengths of hospital stay, but robot assistants contributed to longer operating times and increased costs, compared to traditional keyhole (laparoscopic) surgery.
“Although the laparoscopic procedure has been standard of care for a radical nephrectomy for many years, we saw an increase in the use of robotic-assisted approaches, and by 2015 these had surpassed the number of conventional laparoscopic procedures,” said Benjamin Chung, MD, associate professor of urology.
“We found that, although there was no statistical difference in outcome or length of hospital stay, the robotic-assisted surgeries cost more and had a higher probability of prolonged operative time.”
Although, surgeries that are less technically challenging, such as the removal of a whole kidney, may not benefit as significantly from a robot’s help, the researchers note that robots can help when tackling procedures that require increased dexterity.
Procedures such as the removal of the prostate or the removal of just a portion of the kidney, require a high degree of delicate manoeuvring and extensive internal suturing that render the robot’s assistance invaluable.
In cases where robot assistance was used unnecessarily, the researchers concluded there may be an expectation on the part of the hospital or the surgeons themselves to justify the large initial investment in purchasing the robot by using it for many types of procedures.
Patients themselves may also view robot-assisted surgery as more technologically advanced.
“There is a certain incentive to use very expensive equipment,” said Chung. “But it is also important to be cognisant as to how our health care dollars are being spent. Although robotic surgery has some advantages, are those advantages relevant enough in this type of case to justify an increase in cost?”
To gather their data the researchers analysed the approach of 416 hospitals across the US from 2003 to 2015.
They found that while in 2003 only 1.5% of patients needing laparoscopic surgery had it done via robot-assisted surgery, this had increased to 27% by 2015.
On average, the total hospital cost (including the cost of supplies, room and board, pharmaceuticals and operating room time) for the robot-assisted procedure exceeded that of the traditional laparoscopic procedures by about $2,700 per patient.
The researchers speculated that the increased cost may be due to longer times spent in the operating room as well as the increased cost of disposable instruments upon which surgical robots rely.