Robotic surgeries: 10 issues you need to know

It seems that the futuristic space age populated by robots is here, ushered in irrevocably by surgery-performing robots. With the FDA’s 2000 approval of Intuitive Surgical’s da Vinci Surgical System, the use of these systems has flourished, both for oncologic and non-oncologic use.

Robot-assisted procedures are exactly what they sound like — surgeries assisted by robots, not performed by robots. Robotic surgery provides “seven degrees of freedom” to surgeons, mimicking each gesture and facilitating easier learning. Robotic instrumentation also reportedly quells hand tremors, unlike laparoscopic instrumentation.

Despite these conveniences, skilled surgeons are needed to learn and master these technologies to obtain optimal results. HemOnc Today offers 10 “fast facts” about robotic surgery.

1. Robotic surgery can be costly.

Although robotic surgery may reduce costs by shortening hospital stays for patients, investing in the robotic system carries a significant upfront cost. Equipment can range from $1 million to $2.3 million per robot. Moreover, because data regarding long-term outcomes with robotic procedures is scarce, it is not clear whether this technology will lead to additional expenses. Read more

2. A substantial learning curve may exist for surgeons using robotic systems.

Although the concept of robotics implies replacing a human with a machine, there are many skills required to use these systems effectively. According to a 2011 study, surgeons may need to perform more than 1,500 robotic laparoscopic radical prostatectomy procedures to attain “expert” status. Read more

3. Robotic surgery has yielded positive outcomes in removing voice box tumors.

A 2012 preliminary prospective study reported that transoral robotic surgery (TORS) demonstrated efficacy and safety in patients with laryngopharyngeal carcinomas. Patients with these carcinomas might opt for minimally invasive procedures such as TORS to avoid possibly damaging toxicities related to standard radiotherapy and chemotherapy. Read more

4. Robot-assisted radical cystectomy for bladder cancer reduced deaths and complications.

According to a 2012 retrospective cohort study, fewer deaths and overall complications were seen in bladder cancer patients who underwent robot-assisted radical cystectomy surgery vs. those who had surgery without robotic assistance. The study also found that robot-assisted procedures were more expensive and did not reduce the lengths of hospital stay. Read more

5. Patients may have more regrets about robot-assisted radical prostatectomy than with other types of prostatectomy.

A 2008 study conducted at Duke University Medical Center found that in men who underwent radical prostatectomy surgery, the choice to have robot-assisted prostatectomy was associated with more regrets, while the decision to have retropubic prostatectomy was linked to a greater rate of satisfaction. Read more

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6. Robot-assisted radical prostatectomy appears to be linked to greater continence and potency.

The feelings of regret reported in the 2008 Duke University Medical Center study may be somewhat mitigated by the findings of a 2012 Italian study. In it, researchers found that robot-assisted radical prostatectomy yielded greater rates of continence and potency than laparoscopic radical prostatectomy. Additionally, erection recovery was 80% among previously potent patients who were treated with nerve-sparing techniques. Read more

7. Hospitals that purchase robotic surgery systems appear to perform more radical prostatectomy surgeries.

According to a 2011 study, hospitals that invested in a robotic surgery system performed approximately 30 more radical prostatectomy procedures per year than they had done before attaining this technology. Read more

8. Robotic-assisted colorectal cancer resection outcomes are similar to those with laparoscopic surgery.

In a study presented at 2013 Digestive Disease Week, researchers found that robotic-assisted colorectal cancer resection yielded outcomes comparable to those seen with laparoscopic procedures; additionally, the robotic surgeries led to fewer conversions to open surgery. Read more

9. Patients with head and neck cancers appear to have a better quality of life after robotic surgery.

Compared with conventional therapy, chemotherapy or radiation, patients who undergo robotic surgery to treat head and neck tumors appear to have a better quality of life, according to researchers at the University of Pennsylvania. Read more

10. Robotic-assisted hysterectomy was FDA-approved for use in 2005.

Although a minimally invasive robotic hysterectomy appeals to many patients, physicians caution that long term data — including data on long term survival differences vs. laparoscopic or open hysterectomies — is not yet available on robotic hysterectomies. Read more