Outcomes for Robotic vs. Laparoscopic Surgery

Since the introduction of robot-assisted surgery, the technique has been lauded for improving on laparoscopic methods, which have been the cutting-edge approach for many years, in various respects [1]. According to its proponents, robotic surgery offers enhanced ergonomics, visualization, and dexterity, while lessening surgeon fatigue and the occurrence of tremors compared to laparoscopic or open surgery [2]. In part because of this laundry list of apparent advantages, practitioners have made greater use of robotic surgery over the past few decades [2]. Interestingly, however, research has increasingly called into question whether robotic surgery truly improves patient outcomes compared to laparoscopic surgery, which is typically less costly.

Before delving into the literature comparing outcomes of robotic and laparoscopic surgery, it is important to note a few recurring methodological points of concern. For one, researchers have noted a lack of control in the literature for surgeon expertise, which is notable given the considerable learning curve associated with using robotic techniques [3]. Moreover, meta-analyses are hindered by the fact that different studies study different forms of patient outcomes; therefore, it is difficult to attain a comprehensive measurement across surgery types of the advantages and disadvantages of robot-assisted surgery [3].

Nevertheless, in some contexts, there is evidence that robotic surgery promotes better patient outcomes than laparoscopic surgery. For instance, in colorectal operations, Tam et al. report that robotic techniques are associated with shorter hospital stays and lower rates of conversion to open surgery [4]. This latter result has been corroborated by other studies as well [4]. Another example concerns prostatectomies. One study reported that patients who received robot-assisted prostatectomies had lower pain scores and better quality of recovery in the short term [2]. Six weeks after surgery, however, laparoscopic and robotic surgery patients had similar measures on both counts [2]. More generally, estimated blood loss appears to be less, across various surgery types, when practitioners employ robot-assisted techniques [3].

However, there are other measures and contexts in which robotic surgery produces similar, or worse, outcomes compared to laparoscopic surgery. According to Muaddi and colleagues, this is the case for hysterectomy, robotic rectal surgery, cholecystectomy, or roux-en-y gastric bypass [2]. Moreover, patients undergoing minimally invasive operations to manage their cervical cancer appear to have lower overall survival rates and higher disease recurrence when they are treated using robotic methods [2]. Additionally, operating times for robot-assisted urologic and gynecologic surgeries do not appear to be lower than those for traditional surgeries of the same type, while operating times for elective colonic cancer right-side resections tend to be longer for robotic surgeries [5, 6].

Various factors can explain this divergence. Some of the benefits of robot-assisted surgery can be attributed to the improved range of motion it facilitates [1]. Moreover, robotic surgeries are associated with reduced invasiveness, which could enable faster recovery [3]. Conversely, the learning curve attributed to robotic surgery may also explain why the technique can produce worse outcomes than laparoscopic surgery [1]. This appears to be the case for gastrectomy. Robotic surgeries performed by experienced surgeons were followed by hospital stays about as long as those following laparoscopic surgeries, while patients whose robotic surgeries were performed by inexperienced surgeons stayed longer in the hospital [1].

All in all, there is no overarching conclusion to be drawn regarding whether robotic surgery is preferable to laparoscopic surgery. That determination will likely depend on the type of surgery being performed, the surgeon’s level of skill, and the outcome indicators being assessed. Therefore, it is best practice to take all of these factors into account before electing to perform a robot-assisted surgery.

References

[1] B. H. Kang et al., “Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery,” Journal of Gastric Surgery, vol. 12, no. 3, pp. 156-63, September 2012. [Online]. Available: https://doi.org/10.5230/jgc.2012.12.3.156.

[2] H. Muaddi et al., “Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews,” Annals of Surgery, vol. 273, no. 3, pp. 467-73, March 2021. [Online]. Available: https://doi.org/10.1097/SLA.0000000000003915.

[3] H. F. Roh, S. H. Nam, and J. M. Kim, “Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-review,” PLOS One, vol. 13, no. 1, pp. 1-12, January 2018. [Online]. Available: https://doi.org/10.1371/journal.pone.0191628.

[4] M. S. Tam et al., “A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery,” Surgical Endoscopy, vol. 30, pp. 455-63, April 2015. [Online]. Available: https://doi.org/10.1007/s00464-015-4218-6.

[5] N. Bakalar, “Are Robotic Surgeries Really Better?,” The New York Times, Updated August 16, 2021. [Online]. Available: https://www.nytimes.com/2021/08/16/well/live/robotic-surgery-benefits.html.

[6] P. Cuk et al., “Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis,” Surgical Endoscopy, vol. 36, pp. 32-46, November 2022. [Online]. Available: https://doi.org/10.1007/s00464-021-08782-7.