32 Years Later: Has Robotic Surgery Fulfilled its Promise?

Viewpoints from Steven Wexner, MD

The first robotic surgical system was introduced in 1985 and the first iteration of the current platform became available for colorectal surgery in 2001.

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A study asks: “Is it worthwhile?”

To evaluate any potential advantages of the robotic platform as compared with traditional open and non-robotic minimally invasive surgical techniques, Tan and coworkers from the Imperial College in London performed a systematic review and meta-analysis.

The authors were able to identify 99 relevant articles in which the data on 14,448 patients were included. The authors assessed many types of resection including proctectomy, colectomy, thyroidectomy, prostatectomy, cystectomy, nephrectomy, vasovasotomy, vasoepididymostomy, coronary artery bypass graft, anterior mediastinal mass resection, endometrial cancer staging, hysterectomy, total hip arthroplasty, unicompartmental knee arthroplasty, total knee arthroplasty and spinal pedicle screw insertion.

A variety of robotic platforms and trial designs were included. The authors compared the robotic platforms with both open and non-robotic minimally invasive surgery and included both prospective and prospective randomized controlled trials. They were able to identify a reduction in blood loss and transfusion with the robotic platform and noted the robotic platform afforded a decreased length of hospitalization and decreased overall complication rate than as compared to open surgery.

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The common denominator — and an eye toward the future

Unfortunately, the authors found that these advantages were not shown within the prospective randomized controlled trials.

The common denominator that they found throughout these 99 articles (covering a wide array of surgical procedures) was a significantly increased length of surgery.

I am impressed by the honesty of the authors, including my good friend and respected colleague, Lord Ara Darzi of Denham. His group at the Imperial College in London have been staunch proponents of robotics and have for many years organized and hosted the superbly high quality annual Hamlyn Symposium in London. They are at the cutting edge of robotics well beyond the current surgical platforms.

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Hopefully, with collaboration amongst surgeons, engineers and other stakeholders, future iterations of robotic systems will consistently show clinically significant benefits.