A P R I L 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 1 3
Ask some experts about the benefits of robotic
surgery and they might question the justifica-
tion of investing in an expensive technology
that doesn't significantly improve clinical out-
comes, especially during this era of healthcare
reform. It might be time to ignore that tired
argument, says Chris Schabowsky, PhD, pro-
gram manager at ECRI Institute, an independent
healthcare research firm in Plymouth Meeting,
Pa. He points to ECRI's recent assessment of 60
systematic review articles published in 2015 on
the use of the da Vinci system during urologic,
gynecologic, general and ENT procedures.
ECRI researchers looked at short-term outcomes, including rates of intraoperative blood transfusions, post-
op pain, adverse events, operative time, length of stay and clean margins in oncology surgery, as well as long-
term outcomes, such as reoperation rates and overall survival of oncology patients.
The evidence shows robotics prostatectomy can reduce intraoperative blood loss, operative time and length of
stay, compared with conventional laparoscopic surgery. It also shows that the precision of robotic surgery lets
surgeons perform more partial nephrectomies than radical nephrectomies. "There's well-documented evidence
that partial nephrectomy maintains some function of the kidney that's resected," says Dr. Schabowsky. "That's a
clear-cut advantage of robotics."
Robotic general surgery is booming. In 2012, 40,000 cases were performed. That number jumped to
100,000 in 2014. However, Dr. Schabowsky says there's not enough clinical evidence to assess the technolo-
gy's impact on cholecystectomy and colorectal surgery outcomes. Surgeons who perform laparoscopic gall-
bladder resections might understandably wonder how the use of a robot that quadruples the time and triples
the expense of the case makes good clinical and financial sense. Says Dr. Schabowsky, "That procedure in
particular remains controversial." — Daniel Cook
EVOLVING EVIDENCE
Do Robots Improve Clinical Outcomes?
• INNOVATIVE FINDINGS New clinical trials suggest robotic sur-
gery may be a safer, more effective option.
Florida
Hospital
