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Stanford University School of Medicine

Robot-assisted surgery may not always be best, according to large Stanford study

Robotic surgery, or robotic-assisted surgery, has become increasingly prevalent during the past decade. But a new comprehensive study of more than 400 hospitals and about 24,000 patients suggests robot-assisted surgery may not always be better in terms of procedure cost and operating room time.

Patients in the study underwent a procedure called a radical nephrectomy, in which one of their entire kidneys is removed as a treatment for kidney cancer, sometime between 2003 and 2015. Stanford urologist Benjamin Chung, MD, and former Stanford visiting scholar In Gab Jeong, MD, PhD, found, that at least for this procedure, using the robot increased the costs of the procedure by about $2,700 when compared to a conventional laparoscopic procedure to remove the organ. They published their results today in the Journal of the American Medical Association. 

As I described in our release:

Surgical robots are helpful because they offer more dexterity than traditional laparoscopic instrumentation and use a three-dimensional, high-resolution camera to visualize and magnify the operating field. Some procedures, such as the removal of the prostate or the removal of just a portion of the kidney, require a high degree of delicate maneuvering and extensive internal suturing that render the robot’s assistance invaluable. But Chung and his colleagues wondered whether less technically challenging surgeries, such as the removal of a whole kidney, may not benefit as significantly from a robot’s help.

Chung and Jeong found that robot-assisted surgery, which made up only about 1.5 percent of radical nephrectomies in 2003, had surpassed the number of conventional laparoscopic surgeries by 2015. They also saw patients had similar outcomes regardless of which of two procedures was used.

The discrepancy in cost is likely due to the fact that surgical times were slightly longer when the robot was used, and the disposable instruments used during robot-assisted surgery. From our release:

Chung noted that the study covers a time period when many physicians were just learning to use the robots for this type of procedure; as time passes, it’s possible the operating time will decrease and that the cost differences between the two procedures will narrow. But for now, the study suggests that robot-assisted surgery isn’t always the right choice.

As Chung told me, “There is a certain incentive to use very expensive equipment. But it is also important to be cognizant 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?"

Previously: Catherine Mohr on the economic logic of robotic surgery, Dr. Robot? Not anytime soon and  Stanford surgeon uses robot to increase precision, reduce complications of head and neck procedures
Photo by Master Video/Shutterstock

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