Robot-assisted surgery compared with open surgery and laparoscopic surgery.

Abstract

Robotic surgery for prostatectomy, hysterectomy, nephrectomy, and cardiac surgery are four procedures of interest to Canadian jurisdictions, based on clinical importance and the current and predicted use of robotic surgery. Surgical robots were developed to facilitate minimally invasive surgery (laparoscopy) and to assist surgeons performing surgical procedures that would otherwise not be possible with traditional open or laparoscopic techniques. Eleven Canadian hospitals have robotic systems.1 The most widely marketed and studied surgical robot is the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA),2 which is the only system available in Canada. The da Vinci Surgical System is a tele-manipulation system in which the operating surgeon directs three or four surgical arms from a computer video console using master handles, while seated close to the patient. Since 2000, this surgical system has been approved by the US Food and Drug Administration for urologic, general laparoscopic, gynecologic laparoscopic, general non-cardiovascular thoracoscopic, and thoracoscopically assisted cardiotomy surgical procedures in adults and children.2 The first-generation da Vinci Surgical System (the da Vinci Standard) was approved by Health Canada in March 2001. The second-generation da Vinci S Surgical System was approved in 2006, and the third-generation da Vinci Si was approved in January 2010.3,4 Robot-assisted surgery with the da Vinci System may offer benefits to patients through the use of minimally invasive techniques, which may result in reduced blood loss, reduced blood transfusion, fewer complications, reduced postoperative pain, shorter hospital stays, and reduced recovery times. Surgeons may also benefit through improved ergonomics (for example, three-dimensional visualization and freedom, and intuitiveness of movement-enabled eye-hand coordination that may be lost in laparoscopic surgery), potentially resulting in better surgical performance. Robot-assisted surgery is, however, associated with high capital and operating costs. Objective The objective of the report was to evaluate the clinical and cost-effectiveness of robot-assisted surgery compared with open and laparoscopic procedures.