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Robotic Surgery: Safe But Costly

Fri, 05/10/2013 - 11:51am
Charlene Laino

Laparoscopy for treatment of pelvic lesions was equally safe whether performed conventionally or with robotic assistance, but cost favors conventional minimally-invasive surgery.

Overall, there was a 7 percent major postoperative complication rate among patients who received conventional video-assisted laparoscopy and a 10 percent rate among patients who underwent minimally invasive robotic surgery, a nonsignificant difference (P=0.42, RR=0.96, 95% CI 0.58 to 1.57), Farr Nezhat, MD, of St. Luke's-Roosevelt Hospital Center in New York City, and colleagues reported at the annual American Congress of Obstetricians and Gynecologists annual meeting.

There were only two intensive care unit admissions, one in each group, and both in patients with advanced disease, the researchers reported in their poster presentation.

There were no grade 4 or grade 5 complications and no perioperative or intraoperative deaths, according to the analysis of 77 surgeries for treatment of ovarian, fallopian tube, and primary peritoneal cancers.

Study author Mario Vega, MD, also of St. Luke's-Roosevelt, told MedPage Today that the equivalent complication rates do not mean the surgeries should be used interchangeably. Instead, robotic surgery should be reserved for more complicated surgeries, he said.

"Laparoscopy is cheaper, faster, takes less time," he said. "The bottom line is that if you have a good laparoscopy system, you don't need [robotic assistance]," Vega said.

"If a surgeon is not comfortable with laparoscopy, it is useful. But otherwise, it should be reserved for more complicated surgeries," Vega said.

Those include treatment of cancer and severe endometriosis, serious abdominal surgeries and fibroid resections, he said. Surgeons may also prefer robotic surgery for the treatment of obese patients, "as it can be uncomfortable moving a lot of layers of fat around," he said.

That finding echoes an analysis of robotic surgery for hysterectomy, which found robotic surgeries done at 400 hospitals were generally safe but costly.

The Da Vinci robotic surgery system received FDA approval in April 2005. Use has soared in recent years, but robotic surgical systems are not available at all hospitals.

Nezhat and colleagues analyzed data from 20 surgeries for early-stage disease and 57 for advanced and/or recurrent disease.

Of the 20 surgeries performed for early disease, eight were done conventionally, 10 were performed robotically and two were laparoscopy converted to laparotomy.

Among the 57 cases of advanced or recurrent disease, 38 were performed conventionally, 11 robotically, and eight were conversions to laparotomy.

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