The Truth about Robotics in Gynecologic Surgery
There has been a lot of news about robotic surgery lately. Most of the news is generated by the makers of these sophisticated robots and by hospitals and practices who use the robots to perform surgery. The Women’s Surgery Center recognizes the benefits of robotic surgery in some types of surgery such as urologic and cardiothoracic procedures. When considering minimally invasive laparoscopic gynecologic procedures, the Women’s Surgery Center is committed to educating women about all surgical alternatives for gynecologic conditions. We believe that the most informed patient can make the best decisions. The information provided below has been determined through medical studies that have been presented at national medical meetings in 2008 and 20091.
What is robotic surgery?
Surgery with a robot is more accurately called robot-assisted surgery. The surgery itself is standard laparoscopic surgery; however, the tools are part of the robot, rather than a surgeon’s own hands. In order to perform robot-assisted surgery, the surgeon stands at video game-like controls several feet away from the patient. Ultimately, the robot is another tool that enables a surgeon to perform laparoscopic surgery. The robot does not perform the surgery itself, and it is only as good as the surgeon operating it.
Why use a robot at all?
Robotic arms have very precise movements and can allow a surgeon to perform laparoscopic surgery when they otherwise may not have been able to and would have advised their patient to have open surgery. Experts in the field of laparoscopic gynecologic surgery have stated that the robot may be helpful for those surgeons learning laparoscopy, but is not helpful to advanced laparoscopic surgeons for even the most difficult benign surgeries. Advanced Laparoscopic Surgery is used by these surgeons to perform almost any GYN surgery without robotic assistance.
Is robot-assisted surgery better than advanced laparoscopic surgery?
No. Any successful laparoscopic surgery including robotic surgery is better than open surgical procedures. Robotic surgery; however, is not better than Advanced Laparoscopic Surgery and has several shortcomings.
What are the problems with robot-assisted surgeries?
Incision size, operating room time, recovery time in the hospital, and cost are all higher with robotic surgery as compared to Advanced Laparoscopic Surgery.
Incision Size
Robotic assisted surgeries typically require 5 incisions, three 8 mm incisions and two 12 mm (1/2 inch) incisions. Advanced laparoscopic procedures require either two 5 mm incisions for most surgeries, up to four 5 mm incisions for almost all remaining surgeries.
Total incision length – the length of all the incisions combined – equals 10 mm for most ALS procedures, versus 48 mm for robotic procedures, almost 5 times the incision length for robotics.
Smaller incisions means less pain after advanced laparoscopic surgeries. Half inch incisions significantly increase pain after surgery, and other complications such as herniation and bleeding. Robotic assisted surgeries have larger incisions with increased pain and recovery when compared to Advanced Laparoscopic Surgery. Advanced laparoscopic surgeries performed by the Women’s Surgery Center use incisions that are one-fifth the size of robot-assisted surgeries.
Operating Room Time
Operating Room (OR) time, which is time the patient is under anesthesia, is significantly higher with robot-assisted surgeries than with ALS. Doctors from The Women’s Surgery Center compared data from the two largest robotic studies to date and their data from Advanced Laparoscopic Surgery for laparoscopic hysterectomy. The Women’s Surgery Center study showed an average OR time that was twice as long with robotic surgery as compared to Advanced Laparoscopic Surgery. Robot-assisted surgeries lasted nearly 2 times as long as surgeries performed by the Women’s Surgery Center.
Cost
Increased OR time also means increased cost. Robot-assisted surgeries cost, in OR time alone, nearly 2 times as much as ALS procedures. This was for operating room time only. Each robot costs from $1.5 to $2 million, with an annual maintenance cost of $150,000 or more. Robotic surgery is far more expensive that Advanced Laparoscopic Surgery, and will ultimately increase medical costs significantly to hospitals and patients for GYN surgery.
Recovery Time and Hospital Stay
Comparison of Women’s Surgery Center to robotic procedures clearly demonstrates a faster recovery time and shorter hospital stay for hysterectomy. The average hospital stay for patients who had a hysterectomy with the Women’s Surgery Center was 0.3 days; most patients left the hospital within 6 hours of the procedure. Robotic assisted hysterectomy required a stay of 1.35 days, nearly 4 times longer than Women’s Surgery Center patients.
The bottom line on robotics compared to Advanced Laparoscopic Surgery
In summary, robotic assisted surgery for gynecologic procedures is used by surgeons who are not well versed in Advanced Laparoscopic Surgery, and require the robot to assist with the procedure. Robotic surgery is certainly better than open surgery, but is inferior when compared to a well trained laparoscopic surgeon using advanced laparoscopic techniques. As compared to Advanced Laparoscopic Surgery with a highly qualified surgeon, the robot:
• Increases the incision size,
• Increases the length of hospital stay,
• Increases pain associated with the procedure,
• Increases the recovery time, and
• Greatly increases operative time and cost.
Patients considering robotic surgery should always obtain a consultation with an Advanced Laparoscopic Surgeon regarding the option of Advanced Laparoscopic Surgery. The Women’s Surgery Center is recognized for our excellence in advanced laparoscopic surgery. At the Women’s Surgery Center nearly all women are candidates for laparoscopic surgery, whether they’ve had prior surgeries, have very large fibroids or ovarian masses, if they are overweight, or even if they have possible gynecologic cancer. If you’ve been told that you don’t qualify for or can’t have laparoscopic surgery, we urge you to seek a second opinion from a qualified advanced laparoscopic surgeon at the Women’s Surgery Center.
* Women’s Surgery Center studies were presented at annual meetings of the American College of Obstetrics and Gynecology, the Society of Laparoscopic Surgeons, and the American Association of Gynecologic Laparoscopy.