With the surgical robot, similar outcomes at a higher cost

December 18, 2013

In a study of national data on colon surgery, Johns Hopkins researchers found that while patients who undergo either minimally invasive laparoscopic surgery or the high-tech robotic approach have similar outcomes, robotic surgery is significantly more expensive.

The findings provide a counterpoint to the aggressive advertising used by some hospitals to tout benefits of the pricey new gadget, even before research has been done to learn whether is actually better for patients.

"The true test of something new in medicine should be: Is it better? Is it safer? Does it save money? If not, then we probably shouldn't be using it," says Nita Ahuja, M.D., an associate professor of surgery and oncology at the Johns Hopkins University School of Medicine and leader of the study published online on Dec. 18 in JAMA Surgery. "What we have found is that the robot is no better than laparoscopy and it costs more. It has no benefit."

Using the U.S. Nationwide Inpatient Sample database, Ahuja and her team analyzed data from 244,129 colectomies (surgery to remove part or all of the colon) between October 2008 and December 2010 performed at hospitals across the country. They found similar complication rates, mortality rates and length of hospital stays between and robotic surgery, but found that a robotic surgery cost an average of nearly $3,000 more.

Robotic surgery is costlier because there are pricey disposable parts that need to be purchased for each surgery.

The study was also the first of its size to look at all colon removal surgeries, including open surgery, which was done over the study period in 51.7 percent of patients. Laparoscopy was done in 47.6 percent of cases, while .7 percent of patients had robotic surgery.

Open surgery involves a larger incision that allows surgeons to work inside the body cavity with their hands. About 20 years ago, the less invasive laparoscopy appeared. With laparoscopy, surgeons typically make several small incisions and insert cameras and other instruments into those holes to perform their work. Laparoscopy, in many types of surgery, is associated with shorter hospital stays and faster recovery times.

Ahuja's study confirmed that for colon surgery, when compared to , laparoscopic surgery is associated with a lower mortality rate, a lower complication rate, shorter hospital stays and lower costs.

Robotic surgery is performed by a surgeon who controls instruments inside the body via computer, often from a room adjacent to the patient. Surgeons lose some of the tactile feel they use to make certain judgments, but many say they gain a larger range of motion, as robotic arms and "hands" can do things that human arms and hands cannot. It is also easier to learn robotic surgery, says Ahuja, a colorectal surgeon.

The researchers say there may be some bias in who is chosen for which type of surgery; healthier and younger patients may be getting laparoscopic and robotic , skewing the results somewhat. A randomized, controlled clinical trial comparing approaches head to head would be the best way to determine which one is truly the best, Ahuja says.

Meanwhile, Ahuja says, the surgical robot is gaining popularity in , even though there is no evidence it is better and despite the new evidence showing that it is more expensive.

If the robot proved better despite the costs, she would favor it. But that's not what the data show—so far, at least.

"Just because something sounds like it's good doesn't mean it is," she says. "We need to keep studying it before it becomes the standard of care without the supporting evidence."

Explore further: Johns Hopkins surgeons among the first in the country to perform a robotic single-site hysterectomy

Related Stories

Johns Hopkins surgeons among the first in the country to perform a robotic single-site hysterectomy

May 30, 2013
Two Johns Hopkins gynecologic surgeons are among the first in the nation to perform a robotic hysterectomy using a single, small incision.

Physician bonuses help drive increases in surgery with minimal patient benefit

July 22, 2013
Financial incentives for Ontario surgeons are likely a key factor driving greater use of laparoscopic colon cancer surgery, says a study led by a McMaster University surgeon.

Robot-assisted kidney cancer surgery offers many benefits, but at a cost

May 7, 2013
Robot-assisted surgery to remove kidney cancers has seen a rapid increase in use, and has both replaced and proven safer than laparoscopic procedures for the same purpose, according to a study by the Vattikuti Urology Institute ...

Approach to hysterectomy varies despite advances

April 1, 2013
(Medical Xpress)—By age 65, one-third of women in the United States will have a hysterectomy, an operation to remove the uterus. Most women will undergo a traditional abdominal hysterectomy, despite advances in minimally ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.