Are Robotic Surgeries Really Better?

Robotic Surgeries
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Surgical procedures performed with the aid of a robot are sometimes marketed as the “best” form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest.

Robotic surgery is performed by surgeons, not robots. But instead of conventional hand-held tools used in laparoscopic surgery, which involves tiny incisions, and open surgery, in which the surgeon enters the body through a large incision, the doctor uses a machine. The surgeon controls the machine’s tools remotely by using joysticks and foot controls while viewing the surgical site through a high-definition monitor that provides a three-dimensional image of the procedure.

Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference.

For example, in 39 studies that reported the incidence of complications requiring further surgical interventions, up to 9 percent of conventional laparoscopies led to such problems, but so did as much as 8 percent of robotic operations. In studies of gastrointestinal surgery, life-threatening complications ranged from 0 to 2 percent for robot-assisted surgery, from 0 to 3 percent for laparoscopy, and from 1 to 4 percent for open surgeries.

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For various reasons, sometimes robot-assisted or laparoscopic surgeries do not work, and the surgeon must switch to doing an open operation. Overall, this happened up to 8 percent of the time in robotic operations and as much as 12 percent in laparoscopies. In urologic and gynecologic surgeries, there was almost no difference between robot-assisted operations and laparoscopies in the number of operations that had to be switched to open procedures.

Long-term outcomes of at least two years were reported in eight of the reviewed studies, and they found that mortality rates were similar in all three techniques. In up to 3 percent of robotic surgeries and 5 percent of open surgeries, the patient died. There were no deaths in laparoscopic procedures.

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