Robotic abdominal surgery has no advantage over open laparoscopic surgeries: meta-analysis


Dive brief:

  • A new meta-analysis comparing robot-assisted pelvic abdominal surgery to laparoscopy, open surgery, or both, finds that robotic platforms are expensive and lead to a longer operating time than laparoscopy, but with no obvious difference compared to open surgery in terms of the quality of evidence and results.
  • The analysis published in the Annals of Internal Medicine, which includes 50 studies with 4,898 patients, watchandomized controlled trials from early April 2021 concluding that “there is currently no clear benefit with existing robotic platforms”. The researchers noted, hHowever, that “wWith refinement, competition and cost reduction, future versions have the potential to improve clinical outcomes without the existing drawbacks. ”
  • Open abdominal surgery is performed through large incisions, while laparoscopy involves minimally invasive surgery with a few small incisions. Robotic platforms such as Intuitive Surgical’s da Vinci System was designed to facilitate surgery using a minimally invasive approach. However, in a potential blow to Intuitive and others, the meta-analysis finds no distinct benefit for bots. The company did not return a request for comment at the time of posting.

Dive overview:

the The systematic review of all randomized controlled trials of abdominopelvic surgery is a sobering assessment IIntuitive surgery da Vinci system, which was approved by the FDA over 20 years ago and is used in gynecological, gastrointestinal and urological procedures.

While the meta-analysis found “no obvious difference” in operative time of robots compared to open surgery, one drawback found with robotic platforms is longer operative time compared to laparoscopic surgery.

Intuitive Surgical’s own safety information recognizes that the risks of using its da Vinci System are longer operative times and the need for additional or larger incision sites. The company admits that “a longer operative time, a longer duration of anesthesia” could potentially lead to an increase in complications.

The meta-analysis reports that “of the 39 studies that reported the incidence of [surgical] complications, 4 (10%) showed fewer complications with robot-assisted surgery.

With robots offering no real advantage over conventional or laparoscopic surgery when it comes to mainly gynecological, gastrointestinal and urological interventions, meta-analysis seems to suggest corporate influence as the reason why this expensive technology is widely used to perform these surgeries.

“The use of robot-assisted surgery has increased dramatically since its inception in the 1980s, and almost all surgical subspecialties have adopted it,” note the study authors, noting that among the published literature on the surgery robotics “Two-thirds of the articles were by authors who received speaker fees, consulting fees, or honoraria.”

Intuitive’s da Vinci website lists applications for robot-assisted abdominal procedures, including: bariatric surgery, gallbladder surgery, inguinal hernia repair, ventral hernia repair, breast surgery acid reflux, stomach surgery, pancreatic surgery, as well as small intestine and spleen surgeries.

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