Robot-assisted surgery associated with longer operating times, higher cost

This study is right that for the same operation manual laparoscopic is currently more efficient than robotic surgery. The issue here is that robotic surgery does not seek to displace manual laparoscopic surgery- it seeks to displace open surgery. Example from the article:<p>&gt;65 percent of patients with kidney tumors that necessitated the removal of the entire organ underwent an open surgical procedure. About 34 percent had their kidney removed using a laparoscopic procedure, and only the remaining 1.5 percent of cases<p>That 1.5 percent is growing by reducing the 65 percent open, not the 34 percent laparoscopic. Surgical robots are able to complete cases where laparoscopic is not an option due to the complexity. Additionally, they are able to increase the pool of operable patients. Many patients that are not candidates for open surgery and have a case that is too complex for laparoscopic are able to be successfully operated on roboticly.<p>Disclaimer: I work in this field, and believe that it is going in the right direction, but do acknowledge that the technology does currently lead to increased cost and time.

The robots extend the working career of laproscopic surgeons. The training is long, and their career with traditional laproscopic surgury is limited by the onset of microtremors, which we all get eventually. The robots contain adjustable tremor filters, which add 8-10 years to the career of an experienced surgeon. That is a huge benefit.

This falls exactly under the same type of news as:<p>1905: new &quot;automobile&quot; is slower than a good old horse!<p>Mature technologies or practices will always have an edge when new alternatives come, but mature techs dont improve much while the new ones can only go up. Robots will become faster, be more autonomous, etc and should drive down costs down the road. Just like digital photography started by being much worse than film back in the 90s, while beating its performance in most metrics in 2010s.

Judging from the comments, it seems that many people are confused about this.<p>From what I see in practice: the reasons stated in the OR to choose the robot amount in most part to increasing the surgeon&#x27;s comfort. The additional degrees of freedom in instrument motion, and the stereoscopic vision are very much appreciated. In addition, believe me when I say that hype is a major drive. Robots are often presented as &quot;the most advanced technology&quot;, and this resonates with the patient expecting a high level of care and feeling important. It is true that the robot is sometimes chosen for difficult cases, but it is a question of reassurance and comfort for the surgeon more than anything else. Operations being (much) longer is not without consequence on patient outcome, and no operation done with a robot could not be done without.<p>Secondly, current robots are absolutely not geared at automation. The surgeon is in control at all times, and the machine does not perform any preprogrammed move. Even worse, to my knowledge there is no robot providing haptic feedback on the market, so that you have to rely on vision for many things which would normally be done using the sense of touch (tightening sutures, for example).<p>From the point of view of the anesthesiologist, the whole robot story is actually a bit sad and seems to add very little for a huge investment in both money and logistics.

There are so many factors here that it is difficult to assess the article. The key for me, which doesn&#x27;t seem to be discussed, is asking why did the doctors opt for a slower procedure?<p>If they have a financial incentive to keep the patient in the operating theater for longer, that is a problem and needs to be addressed. If they are slowly learning a new technique (as the article seems to be hinting) that is normal but interesting. If they are using a more precise technique to bring complicated cases up to the average outcome, that is praiseworthy and should be lauded.<p>This article is interesting regardless, but there isn&#x27;t enough in it to draw a conclusion.

It reduces fatigue, I can see why doctors are opting to use the robots. It extends how much the Doc can do and do it well. I&#x27;d be interested in seeing the data and how robots impact the day in day out ability to perform surgeries. It may not be case specific efficient, but on a whole are the doctors doing better work and more of it?

A few (potentially useful) additional points:<p>a) The ability to address more difficult cases is increased with robot-assisted surgery<p>b) Ergonomics of the situation should be considered as well for someone who can go from standing, leaning, or otherwise &quot;on their feet&quot; all the time to being able to sit and having an armrest.<p>c) While autonomous robots for complex procedures like this are likely many decades away for a variety of reasons, it&#x27;s not unlikely that we&#x27;ll see assistive technology for repetitive tasks in the future. In that sense, we are really at the early stages of the surgical robotics field! (In fact, depending on what who you talk to, the field is as young as 30 years old)<p>d) I partially disagree with the notion that a procedure done with the robot could be done without it<p>e) Some competitors are emerging onto the scene, such as Senhance by TransEnterix or Verb Surgical&#x27;s product, which will progress this technology even further (if not out of the pure competitiveness of it all).<p>For those interested in reading more, I would suggest the following articles:<p>[0] Vitiello V, Lee SL, Cundy TP, Yang GZ. Emerging robotic platforms for minimally invasive surgery. IEEE reviews in biomedical engineering. 2013;6:111-26.<p>[1] Lee SL, Lerotic M, Vitiello V, Giannarou S, Kwok KW, Visentini-Scarzanella M, Yang GZ. From medical images to minimally invasive intervention: Computer assistance for robotic surgery. Computerized Medical Imaging and Graphics. 2010 Jan 31;34(1):33-45.<p>[2] Marcus H, Nandi D, Darzi A, Yang GZ. Surgical robotics through a keyhole: From today&#x27;s translational barriers to tomorrow&#x27;s “disappearing” robots. IEEE Transactions on Biomedical Engineering. 2013 Mar;60(3):674-81.<p>Disclaimer 1: Have done a few years of research with a surgical robot, so am biased towards advocating it&#x27;s use.<p>Disclaimer 2: I am not from the institutions of the articles I mention.

Also worth noting that complications and major complications were apparently lower (20% lower with major complications) with the robots but the study did not get to the hurdle of statistical significance.<p>N.B. for people who have no clue about statistics: failure to achieve statistical significance does not show no effect. In reality this study suggests that there was a useful effect, but did not conclusively prove it.<p>This confusion happens so often in medical papers it is almost a meme. A meme that has killed a lot of people (see e.g. the Vioxx fiasco).

Personally, my main take away from this article was that in 2015 50% of the patients that had a kidney removed (which would roughly be the other 24k patients the study didn&#x27;t comment on) had their kidneys removed via an old school open incision procedure. Why is that still happening at all? Laparoscopic procedures are significantly safer for the patient, cheaper and faster than old school methods, and they have a quicker recovery time, but just two years ago literally half of the kidney removals performed in these 416 hospitals were using a completely outdated method.

Hmm, there&#x27;s no mention of error rates &#x2F; mistakes.<p>24,000 operations without error is quite possible.<p>If the robot reduced the chance of catastrophe by 5x (to pluck a figure from thin air) it may well pay for itself even at an extra $3k per patient.<p>Would you trade $5k for a 5x reduction in never waking up ?

Can someone with experience shed some light on the future of this industry? I think surgical robots are really cool, but I don&#x27;t know the capabilities or limitations of the technology. This article only talks about laporoscopic surgery for removing kidneys, but surely there are many other types of surgeries - some of which robots excel at and many for which it fails entirely?<p>Basically, I&#x27;d love for someone knowledgeable to tell me more about the long term timeline for this technology. How quickly will it grow, and will it ultimately replace entire types of surgery and transform how we treat people or continue to be an alternative with no obvious superiority?

I am interested in whether doctors were able to take cases that they normally don&#x27;t take.<p>I do not expect error rates to go down because doctors are already incentivized to avoid difficult cases.

It should be noted that robot-assisted surgery is hugely helpful for partial kidney removal versus the whole thing, as the article states. So the headline on its own doesn&#x27;t cover the whole picture here and may even be misleading.

Figures I&#x27;ve seen show that things are worse for a while and then the robots are better, after a significant learning curve.<p>The story acknowledges that this study was done early on so it will have been affected by the learning curve.

Not a surgeon or robot-user, but just by way of example, conventional wisdom in the medical world is that the best niche for robotically-assisted surgery is radical prostatectomy for prostate cancer. Conventional wisdom is that the robot permits better preservation of pelvic nerves, leading to lower rates of postoperative incontinence. If true, this is well worth a longer, more expensive procedure.

If this requires highly trained doctors then of course it will cost more but it should require less skill overtime until its an automated consultation where you gently fall asleep, then wake up feeling rested and refreshed with some minor soreness but not a scar can be found and you go on with your day.

Ok. But over the long term isn&#x27;t the hope of the robotic method to make the treatment available to more people, perhaps at hospitals that normally wouldn&#x27;t offer such things.<p>Certainly, as the method is being vetted and perfected that too needs to be factored into the evaluation?

In most industries robots make something cheaper. I am confident that the US health system will find a way to become even more expensive with the help of robots.

How about outcomes? At the end of the day that should be the benchmark we should use.

Anesthesiologist friend confirms this.<p>Robots are nowhere near making a huge impact on outcomes yet.

Which one would be willing to accept if it would be able to save lives.