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Robotic-assisted surgery is not always preferable to laparoscopic

Robotic-assisted surgery does not improve some outcomes in kidney removal and rectal cancer procedures

Ingrid Torjesen

Wednesday, 25 October 2017

Two studies published in JAMA have found that robotic-assisted procedures do not improve some outcomes for kidney removal or rectal cancer versus laparoscopic procedures.

In one study,* researchers examined the use of robotic-assisted radical nephrectomy (kidney removal) in the United States and compared the in-hospital outcomes and costs for this procedure and laparoscopic radical nephrectomy. The study included patients who had undergone one of these procedures for a renal mass at 416 US hospitals between January 2003 and September 2015.

Among 23,753 patients included in the study, 18,573 underwent laparoscopic radical nephrectomy and 5,180 underwent robotic-assisted radical nephrectomy. Use of robotic-assisted surgery increased from 1.5% (39 of 2,676 radical nephrectomy procedures in 2003) to 27% (862 of 3,194 radical nephrectomy procedures) in 2015. Compared with laparoscopic radical nephrectomy, robotic-assisted radical nephrectomy was not associated with an increased risk of any or major postoperative complications but was associated with prolonged operating time and higher hospital costs.

In another study,** researchers at the University of Leeds compared robotic-assisted versus conventional laparoscopic surgery for risk of conversion (change due to unforeseen complications that arise during surgery) to open laparotomy (surgical incision through the abdominal wall) among patients undergoing resection (surgical removal) for rectal cancer.

For the study, conducted at 29 sites in 10 countries, patients with rectal cancer were randomised to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection. The overall rate of conversion to open laparotomy was 10.1% and the researchers found that there were no statistically significant differences in the rates of conversion to open laparotomy for robotic-assisted laparoscopic surgery compared with conventional laparoscopic surgery (8.1% vs 12.2%, respectively), and there were no statistically significant differences in complication rates or quality of life at six months.

"These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection," the authors write.

* In Gab Jeong, Yash S Khandwala, Jae Heon Kim, et al. Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015. JAMA. 2017;318(16):1561-1568. doi:10.1001/jama.2017.14586

** David Jayne, Alessio Pigazzi, Helen Marshall, et al. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer. The ROLARR Randomized Clinical Trial. JAMA. 2017;318(16):1569-1580. doi:10.1001/jama.2017.7219

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