Surge in robotic surgery in 2010s outpaces the evidence for its effects on patients and costs, researchers warn.
Robots designed to help surgeons perform minimally invasive operations have become a fixture in operating rooms across the country in the past decade. A new study in 73 hospitals across Michigan shows what this has meant for some of the most common operations.
Its authors call for more oversight of this type of surgery from policymakers, out of concern that adoption of robotic general surgery is outpacing the evidence supporting it from a safety or cost standpoint.
The study shows that three-quarters of the hospitals in the study offered robot-assisted surgery in 2018, and that the percentage of surgeons operating at those hospitals who did at least some of their operations with the help of a robotic system rose from 10% to more than 30%.
The percentage of general surgery operations at those hospitals that involved a robot rose eightfold in that same time, from 1.8% of all such operations to 15.%.
Among the 23 hospitals that acquired their first surgical robot during the study period, the researchers found that the robots may be supplanting conventional laparoscopic surgery techniques rather than reducing open surgery further.
At these hospitals, laparoscopic procedures rose rapidly and open procedures dropped rapidly in the four years before the robots arrived. But both nearly plateaued after the robot was put into use.
The study is published in JAMA Network Open by a team from the Department of Surgery at Michigan Medicine using data from the Michigan Surgical Quality Collaborative. The same team published data in JAMA Surgery last fall showing that colon operations involving a robot were only slightly safer than open operations, and about as safe as laparoscopic operations. Earlier that year, in the wake of an FDA warning about the use of robots in breast cancer surgery, they published a commentary in JAMA calling for more evidence to be gathered on safety and cost, and for regulators to slow the growth of robotic surgery until such evidence came in.
"Trends in the Adoption of Robotic Surgery for Common Surgical Procedures," JAMA Network Open. DOI: 10.1001/jamanetworkopen.2019.18911
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