For colon surgery, robots cost more but aren’t worth it

"Just because something sounds like it's good doesn't mean it is," says surgeon Nita Ahuja. She concluded that more expensive robot-assisted colon surgeries turn out no better than laparoscopic procedures. (Credit: ignis/Wikimedia Commons)

Robot-assisted colon operations are significantly more expensive than minimally invasive laparoscopic surgery with no better results, researchers say.

The findings provide a counterpoint to the aggressive advertising used by some hospitals to tout the benefits of using surgical robots.

“The true test of something new in medicine should be: Is it better? Is it safer? Does it save money?” says Nita Ahuja, associate professor of surgery and oncology at the Johns Hopkins University School of Medicine “If not, then we probably shouldn’t be using it.”

“What we have found is that the robot is no better than laparoscopy and it costs more. It has no benefit,” says Ahuja, leader of a study published by JAMA Surgery.

Costs $3,000 more

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

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One reason: Robotic surgery involves expensive disposable parts that must be purchased for each surgery.

The study was also the first of its size to look at all forms of colon removal surgery, including open surgery, which was done in 51.7 percent of the cases studied. Laparoscopy was done in 47.6 percent of cases, while 0.7 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 procedures, laparoscopic surgery is associated with a lower mortality rate, a lower complication rate, shorter hospital stays, and lower costs than open surgery.

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.

More evidence needed

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 surgery, 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 best, Ahuja says.

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

“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.”

The Johns Hopkins Center for Surgical Trials and Outcomes Research supported the research.

Source: Johns Hopkins University